Osteoporosis- spring_2025

Osteoporosis Overview

Definition

Osteoporosis is a skeletal disorder characterized by compromised bone strength, which increases the risk of fractures. It involves a progressive loss of bone density over time, primarily due to an imbalance between bone resorption and bone formation.

Importance

Healthy bones are critical for maintaining mobility and overall well-being. Osteoporosis can severely impact the quality of life due to the risk of fractures, which can lead to disability and decreased independence, particularly in the elderly population.

Presentation by Dr. Sandra Joiner

Topics Covered:

• Why Bone Health Matters: Emphasis on the role of bones in physical health, movement, and preventing chronic illnesses related to immobility.

• What is Osteoporosis?: Discusses the pathophysiology of Osteoporosis, highlighting how decreased bone density affects structural integrity.

• How to Prevent Bone Loss: Lifestyle interventions including diet, exercise, and avoiding harmful substances.

• How Osteoporosis is Diagnosed: Overview of diagnostic criteria, including medical history assessment, physical examination, and imaging technologies.

• Treatments to Prevent Fractures: Comprehensive treatment strategies focus on pharmacological and non-pharmacological approaches.

• How to Prevent Falls: Importance of balance exercises, safety modifications at home, and regular vision checks.

Statistics on Osteoporosis

• Awareness: Approximately 70% of people aged 65 and older are undiagnosed and have never been screened for Osteoporosis, resulting in an urgent need for increased awareness and screening programs.

• Seriousness: Osteoporosis is recognized as a major public health challenge, affecting millions and contributing to high healthcare costs and morbidity.

• Comparison of Health Problems: Annually, the incidence of fractures due to Osteoporosis surpasses that of breast cancer, heart attacks, and strokes, making it a significant concern for public health (source: CDC and National Osteoporosis Foundation, 2015).

Bone Structure and Changes

• Peak Bone Mass: Describes the timeframe for bone mass accumulation, which peaks in early adulthood and begins a gradual decline, especially accelerated during menopause.

• Lifecycle of Bone Density: Rapid bone mass gain during childhood and adolescence followed by a peak and subsequent decline.

• Graph: This graph illustrates the changes in bone density from age 10 to 90, emphasizing the progressive loss of bone density with aging.

Bone Health Decline

• Osteoporosis Process: Mineral density loss renders bones brittle and increases fracture susceptibility.

• Bone Remodeling: A physiological process where old bone is replaced by new bone, occurring approximately every 7-10 years.

  • Bone Cells:

    • Osteoblasts: Cells responsible for new bone formation.

    • Osteoclasts: Cells that resorb old or damaged bone.

Osteoporotic Bone Structure

• Changes: The loss of trabecular (cancellous) bone significantly weakens the overall bone structure.

• Fracture Risk: Increased fragility correlates with rapid remodeling processes.

• Micrographs Comparison: Visual representation contrasting normal bone with osteoporotic bone under microscopic examination.

Bone Remodeling Signals

Factors Involved:

• RANKL (Receptor Activator for Nuclear Factor Ligand): A key factor in regulating bone remodeling.

• Interleukins 1 and 6: Cytokines that play roles in inflammation and bone metabolism.

• Tumor Necrosis Factor Alpha: A cytokine involved in systemic inflammation that can influence bone resorption.

• Estrogen and OPG (Osteoprotegerin): Important for maintaining the balance between bone formation and resorption.

• Growth Factors: Various proteins that stimulate cell proliferation, differentiation, and bone healing.

Risk Factors for Osteoporosis

Unchangeable Factors:

• Gender: Women are at a higher risk, particularly post-menopause due to estrogen loss.

• Age: Increased age corresponds with higher risk due to natural bone density loss over time.

• Family History: Genetic predisposition to lower bone density or previous fractures can influence risk.

• Previous Fractures: A history of fractures is a strong predictor of future fracture risk.

Changeable Factors:

• Diet: Adequate intake of calcium and vitamin D is vital for bone health throughout life.

• Physical Activity: Regular weight-bearing and muscle-strengthening exercises contribute to higher bone density.

• Lifestyle Choices: Risk behaviors such as smoking and excessive alcohol consumption negatively affect bone health.

Bone Density Testing

DXA Scan:

• Eligibility: Recommended for women over 65, men over 70, and younger individuals with a family history or other risk factors.

• Process: A straightforward, non-invasive test that typically takes about 15 minutes to perform.

• Understanding DXA Results:

  • T-scores:

    • < -2.5: Indicates Osteoporosis.

    • -1.0: No significantly increased risk of fractures despite lower density.

Calcium and Vitamin D

Dietary Sources of Calcium:

• Dairy: Low-fat yogurt, milk, cheese (150-400 mg).

• Protein: Sardines, tofu, and almonds (75-400 mg).

• Vegetables: Kale and broccoli (20-260 mg).

Vitamin D Requirements:

• RDA: Varies between 600-2,000 IU/day based on age and health status.

• Sources: Fatty fish, fortified dairy products, and cereals provide essential vitamin D.

Physical Activity for Bone Health

Strength-Building Exercises:

• Activities: Engage in exercises that provide mechanical loading to bones, enhancing density.

• Recommended Activities: Include high-impact activities such as jumping, resistance training, and brisk walking to promote bone health.

  • Safety in Activity: It's essential to maintain proper body alignment and avoid high-risk positions to minimize the chance of fractures during exercise.

Treatment Options for Osteoporosis

Pharmacological Therapies:

• Bisphosphonates: Frontline medications for reducing the risk of vertebral and hip fractures. Examples include Alendronate and Risedronate.

• SERMs (Selective Estrogen Receptor Modulators): Raloxifene is indicated specifically for postmenopausal Osteoporosis, but it carries certain risks such as venous thromboembolism.

• Parathyroid Hormone (PTH) Analog: Teriparatide is used in patients with high fracture risk.

• Calcitonin & Monoclonal Antibodies: Such as Denosumab for patients with specific indications.

• Important Considerations: Patients must be monitored for potential side effects, particularly gastrointestinal issues with bisphosphonates. Treatment plans should be regularly reviewed and adjusted based on patient feedback and clinical response.

Conclusion

Health Maintenance:

• Individuals are encouraged to stay proactive about their bone health by participating in regular screenings and adopting healthy lifestyle practices. Effective management approaches and timely interventions are crucial if a diagnosis of Osteoporosis is made, and patients should seek professional guidance to develop a tailored treatment plan for bone health maintenance.