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.