osteoporosis seminar

Osteoporosis means "porous bones," causes bones to become weak and brittle – so brittle that even mild stresses like bending over, lifting a vacuum cleaner or coughing can cause a fracture.

In most cases, bones weaken when low levels of calcium, phosphorus and other minerals in the bones and results as low bone density.

A common result of osteoporosis is fractures of the spine, hip or wrist.

Although it's often thought of as a women's disease, osteoporosis also affects many men.

SYMPTOMS Back pain, which can be severe if fractured or

collapsed vertebra Loss of height over time, with an

accompanying stooped posture Fracture of the vertebrae, wrists, hips or other

bones

Normal bone has the appearance of a honeycomb matrix (left). Under a microscope, osteoporotic

bone (right) looks more porous.

CAUSES The strength of the bones depends on their

size and density; bone density depends in part on the amount of calcium, phosphorus and other minerals bones contain.

When the bones contain fewer minerals than normal, they're less strong and eventually lose their internal supporting structure.

The process of bone remodeling

Scientists have yet to learn all the reasons why this occurs, but the process involves how bone is made. Bone is continuously changing — new bone is made and old bone is broken down — a process called remodeling, or bone turnover.

A full cycle of bone remodeling takes about 2-3 months.

In young – the body makes new bone faster than it breaks down old bone, and the bone mass increases.

Reaches the peak bone mass in mid-30s. After that, bone remodeling continues, but

loses slightly more than gain. At menopause, when estrogen levels drop,

bone loss increases dramatically. Many factors contribute to bone loss, the

leading cause in women is decreased estrogen production during menopause.

Risk of developing osteoporosis depends on how much bone mass attained between ages 25 and 35 (peak bone mass) and how rapidly loses it later. The higher peak bone mass, the more bones "in the bank" and less likely to develop osteoporosis as ages.

Not getting enough vitamin D and calcium in the diet may lead to a lower peak bone mass and accelerated bone loss later.

What keeps bones healthy

Regular exercise Adequate amounts of calcium Adequate amounts of vitamin D, which is very

essential for absorbing calcium

RISK FACTORS Sex – Fractures from osteoporosis are about

twice more in women than in men. Risk in women at menopause (45 yrs) that accelerates bone loss. Risk in men is greater than age 75.

Age. The older, the higher risk of osteoporosis. Bones become weaker as ages.

Race. Greatest risk – white or of Southeast Asian descent. Black and Hispanic men and women have a lower, but still significant, risk.

Family history. Osteoporosis runs in families. Parent or sibling with osteoporosis puts at greater risk, especially if having a family history of fractures.

Frame size. Men and women who are exceptionally thin or have small body frames tend to have higher risk because they may have less bone mass to draw from as they age.

Lifetime exposure to estrogen. The greater a woman's lifetime exposure to estrogen, the lower her risk of osteoporosis.

Eating disorders. Women and men with anorexia nervosa or bulimia are at higher risk of lower bone density in their lower backs and hips.

Corticosteroid medications. Long-term use like prednisone, cortisone, prednisolone and dexamethasone, is damaging to bone. Common treatments for chronic conditions – asthma, rheumatoid arthritis and psoriasis.

Thyroid hormone. Too much thyroid hormone can cause bone loss.

Other medications. Long-term use of the blood-thinning medication heparin, the cancer treatment drug methotrexate, some anti-seizure medications, diuretics and aluminum-containing antacids also can cause bone loss.

Breast cancer. Postmenopausal women who have had breast cancer are at increased risk of osteoporosis, especially if they were treated with chemotherapy or aromatase inhibitors such as anastrozole and letrozole, which suppress estrogen.

Low calcium intake. A lifelong lack of calcium plays a major role in the development of osteoporosis.

Medical conditions and procedures that decrease calcium absorption. Stomach surgery (gastrectomy) can affect the body's ability to absorb calcium.

Sedentary lifestyle. Bone health begins in childhood. Children who are physically active and consume adequate amounts of calcium-containing foods have the greatest bone density. Exercise throughout life is important, but can increase bone density at any age.

Excess soda consumption. The link between osteoporosis and caffeinated sodas isn't clear, but caffeine may interfere with calcium absorption and its diuretic effect may increase mineral loss. In addition, the phosphoric acid in soda may contribute to bone loss by changing the acid balance in the blood.

Chronic alcoholism. For men, alcoholism is one of the leading risk factors for osteoporosis. Excess consumption of alcohol reduces bone formation and interferes with the body's ability to absorb calcium.

Depression. People who experience serious depression have increased rates of bone loss.

TESTS AND DIAGNOSIS Osteopenia refers to mild bone loss that isn't

severe enough to be called osteoporosis, but that increases the risk of osteoporosis.

The best screening test is dual energy X-ray absorptiometry (DEXA) – measures the density of bones in the spine, hip and wrist and it's used to accurately follow changes in these bones over time.

Ultrasound Quantitative CT scanning

Dual energy X-ray absorptiometry

Test should ….

Older than age 65, regardless of risk factors. Postmenopausal and have at least one risk

factor for osteoporosis, including having fractured a bone.

Having vertebral abnormality. Use medications, such as prednisone, that can

cause osteoporosis. Type 1 diabetes, liver disease, kidney disease,

thyroid disease or a family history of osteoporosis.

Experienced early menopause.

COMPLICATIONS Fractures are the most frequent and serious

complication of osteoporosis. Often occurs in spine or hips – bones that

directly support your weight. Hip fractures and wrist fractures from falls are

common. Compression fractures can cause severe pain

and require a long recovery. If many such fractures, can lose several inches of height as the posture becomes stooped.

TREATMENTS AND DRUGS Hormone therapy (HT) Prescription medications – Bisphosphonates,

Raloxifene (Evista) / selective estrogen receptor modulators (SERMs), Calcitonin, Teriparatide (Forteo), Tamoxifen.

Emerging therapies – New physical therapy program combines the use of a device called a spinal weighted kypho-orthosis (WKO), a harness with a light weight attached and specific back extension exercises. The WKO is worn daily for 30 minutes in the morning and afternoon.

ESTROGEN AND BONE PROTECTIONEstrogen is essential for healthy bone, and that when the production of estrogen is reduced, as occurs normally in postmenopausal women and pathogenically after exposure to radiation or chemotherapeutic drugs, bones become brittle and break easily. However, the mechanisms involved aren't clearly understood.

The new study observed that one way estradiol helps to maintain bone density is by stopping the activation of an enzyme known as caspase-3. Also called the executioner caspase, caspase-3 is the central player in initiating the process of apoptosis, or programmed cell death of osteoblasts, the bone cells that aid in the growth and development of new bone and teeth.

PREVENTION Do exercise such as walking, running,

skipping rope, jogging regularly. Add soy in diet – plant estrogens found in soy

helps to maintain bone density and reduce the risk of fractures.

Avoid smoking, it can reduce the levels of estrogen and increase bones Loss.

Avoid excessive alcohol. Avoid caffeine, which is very harmful. Consider hormone therapy.

LIFESTYLE AND HOME REMEDIES Maintain good posture – Good posture which

involves keeping the head held high, chin in, shoulders back, upper back flat and lower spine arched – helps to avoid stress on the spine. When sit or drive, place a rolled towel in the small of the back. Don't lean over while reading or doing handwork. When lifting, bend at the knees, not the waist, and lift with the legs, keeping the upper back straight.

Prevent falls. Manage pain. Don't ignore chronic pain.

ESTIMATED DAILY CALCIUM INTAKES

RECOMMENDED DAILY INTAKE OF VITAMIN D

Milk equivalents containing 300 mg of calcium per serving