Twenty years ago osteoporosis was a word used mainly by researchers and
physicians. Over the past few years, there has been an explosion of information
about this condition that can cause severe pain and crippling. No cure is known
yet, but ways to lessen your potential for osteoporosis have been identified.
Today, one in three Americans are 50 or older. The baby boom generation will
begin to enter their retirement shortly after the turn of the century that is
rapidly approaching. Thanks in part to medical advances and the emphasis on
exercise and healthy diets, vast numbers of these baby boomers can expect to
reach their eighties, nineties, and beyond. Yet, if present day trends unhealthy
eating and lack of exercise continues, osteoporosis threatens to be one of the
biggest public health dangers of modern times. Osteoporosis, literally meaning
“porous bone”, is a disease of the skeleton in which the amount of calcium
present slowly decreases to the point where the bones become extremely brittle
and subject to fractures. The skeleton serves two functions. It provides
structural support for organs and muscles and also serves as a depository for
the body’s calcium and other minerals, manly phosphorous and magnesium. The
bone holds 99% of the body’s calcium. The other 1-% of remaining calcium is
freed to circulate in the blood and is essential for crucial functions in the
body such as blood clotting, muscle, contractions and nerve functions. Bones
have two main sections. The outer section of the bone is the cortical bone. It
is composed of a hard shell that serves to protect the other section of the
bone, called the trabecular bone. This part of the bone is an inner lacy,
structural matrix of calcium that helps support the bone structure. Bone tissue
is constantly being broken down and reformed to help the body cope with everyday
stress and for maintaining a properly functioning body. The breakdown of the
bones is called resorption and is performed by cells known as osteoclasts that
did holes into the bone allowing calcium to be released into the body. Then,
cells produced by the bone called osteoblasts help rebuild the bone. The
osteoblasts first fill in these holes left by the osteoclasts with collagen and
then by laying down crystals of calcium and phosphorous. A complex mix of
hormones and chemical factors controls this osteoclast-osteoblast balance. The
trabecular and cortical parts of the bone both give off calcium to the body when
it is needed, but as aging progresses the amount slowly declines. The rebuilding
of bones makes them denser until about the age of 35 and peak period of bone
mass building is somewhere between the ages of 25 to 35. After the age of 35,
the body becomes slower and slower in replenishing bone as time goes on.
Osteoporosis develops when bone resorption occurs too quickly or if formation
occurs too slowly. Because weakened bones, an increased susceptibility to
fractures of the hip characterize osteoporosis, spine, and wrist are prevalent.
Doctors have identified two types of osteoporosis that correlate with specific
types of fractures. Type I osteoporosis, often referred to, as post enopausal
osteoporosis, is most associated with wrist and spine fractures. Type II
osteoporosis, also called senile osteoporosis, is generally attributed to
reduced calcium by old age and causes mainly hip fractures. There are more than
300,000 hip fractures, 300,000 wrist fractures, and over 700,000 spinal
fractures in the US each year (Peck and Avioli 19). Osteoporosis causes more
than 1.5 million fractures each year and the cost to the healthcare system for
these fractures is over 13.8 billion dollars per year, greater than the cost for
congestive heart failure and asthma. Of the individuals who fractured a hip,
one-half will be permanently disabled, 20% will require long-term nursing care,
and 20% of hip fracture victims die within a year, usually from complications
caused by surgery. Hip fractures are responsible for about 65,000 deaths per
year in the United States. Hence, osteoporosis represents a major public health
problem. There is no single cause of osteoporosis, and it seems that there are
many factors that contribute to the disease. Some people are more prone to
develop osteoporosis than others are. Factors that increase the likelihood of
developing osteoporosis can be separated into controllable and uncontrollable
factors. Uncontrollable factors include age, sex, body frame, and race. The
longer a person lives, the greater their chance is in developing osteoporosis.
Osteoporosis is associated with age because bone mass begins to decline after it
peaks at about the age of 35. The more years that passes the more loss of bone
increases. Roughly estimating, people lose 10% of bone mass per year (24). As
people grow older they also become less physically active, and this assist in
bone loss. Also, other changes occur with age that can affect out ability to
absorb calcium. The skin and kidney do not make Vitamin D with the same
efficiency as they do in youth. This affects the ability to absorb calcium from
the diet or from supplements. A decline in stomach acid after the age of 60 may
also affect the ability of the body to absorb calcium. Another risk factor for
osteoporosis is sex. Women are four times as likely to develop osteoporosis than
men are. One reason is that woman generally have thinner, lighter bones then men
do. Also, the rapid loss of estrogen women experience after menopause can be
contributed to osteoporosis. Estrogen protects the body against bone loss. Women
with regular menstrual periods are exposed to healthy levels of estrogen from
puberty to menopause. Around the time of menopause though, the levels of
estrogen sharply declines. Early menopause or surgically induced menopause, such
as a hysterectomy, can increase a woman’s likelihood of developing
osteoporosis because the protective effect of estrogen is lost. Another
contribution of sex to osteoporosis is t women live longer then men do, which
gives them more time to develop weaker bones. Race is also a risk factor of
osteoporosis. Caucasians and Asians have a higher risk of osteoporosis than
African-Americans and Hispanics do. African-Americans in the US ave heavier and
larger bones than Caucasians, although the reason for this is unknown. (33).
Controllable risk factors for osteoporosis includes lack of calcium, lack of
physical activity, cigarette smoking, and alcohol and caffeine intake. Lack of
calcium is one of the great cause of osteoporisisCalcium is needed to build
strong bones during childhood and early adult hood, and to prevent losses
thereafter. Studies have linked an inadequate amount of calcium intakes appear
to be associated with low bone mass, rapid bone loss, and high fracture rates (Germano
99). Today, many people consume less than half of the amount of calcium
recommended to build and maintain healthy bones. Calcium needs change during
ones lifetime. The body’s demand for calcium is greater during childhood and
adolescence when the skeleton is growing rapidly. Pregnant and lactating woman
also need increased calcium, as do postmenoptusal woman and older men and women.
Good sources of calcium include low fat dairy products such as milk, cheese, and
yogurt, dark green leafy vegetables like broccoli, collard greens, and spinach
and other foods fortified with calcium like orange juice, cereals and bread.
Lack of physical activity is another controllable factor. Bone is a living
tissue that responds like muscles to exercise. Individuals who are inactive,
immobilized, or bedridden for a long time are at higher risk. Weight bearing
exercises such as walking, running, tennis, and other exercises that cause
muscle to work against the force of gravity play an important role in preventing
bone loss. Therefore, resumption of physical activity is an important factor in
building bone and preventing bone loss. Other risk factors are smoking, alcohol,
and caffeine. A high intake of caffeine-containing foods, such as coffee, is
thought to increase the amount of calcium eliminated in the urine (Bonnick 59).
For individuals who have osteoporosis, a comprehensive treatment program
includes a focus on nutrition, exercise, and safety issues to prevent falls that
may result in fractures. In addition, medications may be prescribed to slow or
stop bone loss, or increase bone density. Currently the U.S. Food and Drug
Administration for the treatment of postmenopausal osteoporosis approve
estrogen, calcitonin, and alendronate. Estrogen, reloxifene and alendronate are
approved for the prevention of the disease. While osteoporosis can be prevented
and treated, there is, as of now, no cure. Prevention is the only way to avoid
this disease and its debilitating consequences. Yet millions of Americans are
not actively protecting themselves against osteoporosis. Over the past decade,
important information has slowly been uncovered about the causes of osteoporosis
and the ways to prevent it. One of the most significant findings is that
osteoporosis in not an inevitable part of growing older. One of the great myths
associated with this disease is that as people age, they are all susceptible to
suffering fractures or to becoming stooped over. This major misconception that
causes individuals to overlook their risk and to avoid taking the necessary
steps to prevent and treat osteoporosis.