The human body grows, develops and is maintained through the physical stress placed upon it. The ease through which work and daily tasks are accomplished decrease the availability of opportunities for a physically active lifestyle. Osteoporosis (OP) is considered to be one of the major chronic diseases that affect older people who led mainly a sedentary lifestyle in their younger years. “Osteoporosis causes bones to become weak and brittle — so brittle that a fall or even mild stresses like bending over or coughing can cause a fracture. Osteoporosis-related fractures most commonly occur in the hip, wrist or spine” (Mayo Clinic, 2014). Bone density weakens due to the loss of bone minerals as the body ages. Without the stress of physical activity, bone density decreases at a greater rate.
Osteoporosis affects both men and women, however it is more prevalent in the female population. People expose themselves to this disease through dietary choices and physical inactivity. This disease has the potential to decrease the affected individual’s quality of life (QoL) to perform activities of daily living, while increasing their respective mortality due to injury from fractures sustained from a fall. As with the global growth of disease related to physical inactivity, osteoporosis is also on the rise. Early intervention has the potential to prevent the occurrence of this disease. Providing awareness is essential to fighting the spread of this disease.
Signs and Symptoms
Osteoporosis generally goes unnoticed until the person suffering from the disease sustains a fracture. It is often referred to as the silent disease. Back pain, loss of height and curved upper back occur as a result of vertebral fractures. There is normally no pain associated to the hollowing of the bones. The process of development is gradual, which offers hope to those who want to improve their health status.
Causes
Fixed Risk Factors Modifiable Risk Factors
Age Alcohol
Female gender Smoking
Family history of osteoporosis Low body mass index
Previous fracture Poor nutrition
Ethnicity Vitamin D deficiency
Menopause/hysterectomy Eating disorders
Long term glucocorticoid therapy Insufficient exercise
Rheumatoid arthritis Low dietary calcium intake
Primary/secondary hypogonadism in men Frequent falls
Figure 1. Fixed and modifiable risk factors associated with osteoporosis adapted from Who’s at Risk? by International Osteoporosis Foundation, 2015.
Pathophysiology
The body has the ability mend injuries sustained from everyday activities. Osteoporosis increases the likelihood of fractures throughout the body. When the afflicted individual’s body is healing, deformities from the multiple fractures develop. The deformities hinder activities of daily living. “As OP is commonly seen in elderly individuals, comorbidities make it even harder to cope with those fractures. Adachi et al. also reported similar results to those of our study, which indicate that fracture history is correlated with worse QoL. They also evaluated the QoL outcomes with multiple fracture types” (Kuru, et al., 2014).
Diagnosis
Osteoporosis is difficult to detect because there are no overt signs and symptoms. When a patient arrives to the medical treatment facility for a fracture sustained from a low energy trauma. Patient history and physical examination could help give the provider clues to the root cause of the patient’s visit. “Osteoporosis is asymptomatic until a fracture occurs. An important part of diagnosing osteoporosis begins with understanding the risk factors that predispose to fracture (Table 1). Dual-energy x-ray absorptiometry (DXA) remains the gold standard for assessing bone density” (Nanes & Kallen, 2014).
Management
An osteoporosis diagnosis does not have to be a death sentence. Understanding the modifiable risk factors associated with osteoporosis presents with an opportunity for people suffering from the disease to lead a healthy way of life. Management of osteoporosis should be handled based on the specific population. For example, Liberman and Cheung (2015) discuss treatment for the geriatric population should include a non-pharmacological approach. “Inactivity and immobility promotes reduced bone mass, and even moderate (or more vigorous) walking programs help reduce the risk of hip fractures.(22) Those who are at high-risk of falls may benefit from a home occupational therapy safety assessment. Smoking cessation and moderation of alcohol intake are also recommended” (Liberman & Cheung, 2015). Geriatric patients are likely to have more than one medication prescription. The addition of another medication could lead to non-compliance by the patient resulting in little to no treatment of osteoporosis.
Epidemiology
In North America, it is estimated that 44 million people suffer from or at risk of the disease (Holroyd, Cooper, & Dennison, 2008). Prevalence of fractures from osteoporosis affects the radius/ulna in the arm, femur/hip, and vertebrae more than any other bones throughout the body. “Epidemiological studies from North America have estimated the remaining lifetime risk of common fragility fractures to be 17.5% for hip fracture, 15.6% for clinically diagnosed vertebral fracture, and 16% for distal forearm fracture among white women aged 50 years” (Holroyd, Cooper, & Dennison, 2008). By following the risk factors linked to osteoporosis, the medical professional can identify the people who fall into the fixed risk factors and associate with the modifiable risk factors have the highest probability for developing the disease.
Etymology
Osteoporosis received its name from French pathologis Jean Georges Chretien Frederic Martin Lobstein in the 1830s. “The components of the word ‘osteoporosis’ literally mean ‘porous bones’ – ‘osteo’ is for bones, and ‘porosis’ means porous – helpfully describing this condition that results in reduced bone density and increased fragility of the bones” (MacGill, 2015).
History of Disease
According to Stride, Patel, and Kingston (2013), there is evidence of osteoporosis in the remains ancient Egyptian females. John Hunter, an English surgeon, was the first to discover the resorption of old bone during new bone growth in the 1700s. Later in the 1830s, Jean Georges Chretien Frederic Martin Lobstein observed bones that were marred by holes that were larger than normal. Around the 1940s, Fuller Albright of Massachusetts General Hospital is credited for defining postmenopausal osteoporosis and used estrogen to treat women with the condition. It was during the 1960s when devices with a high degree of accuracy were developed to detect bone loss. “In 1984, the National Institutes of Health publicized this disease, citing it as a significant threat to health and emphasizing that bone loss could be reduced by estrogen therapy, calcium, good nutrition and exercise” (Science Beta, 2007).
References
Holroyd, C., Cooper, C., & Dennison, E. (2008). Epidemiology of osteoporosis. Best Practice &
Research Clinical Endocrinology & Metabolism , 22 (5), 671-685.
International Osteoporosis Foundation. (2015). Who’s at Risk? Retrieved March 19, 2016, from
International Osteoporosis Foundation: www.iofbonehealth.org
Kuru, P., Akyuz, G., Cersit, H. P., Celenlioglu, A. E., Cumhur, A., Biricik, S., et al. (2014).
Fracture history in osteoporosis: Risk factors and its effect on quality of life. Balkan
Medical Journal , 31, 295-301.
Liberman, D., & Cheung, A. (2015). A practical approach to osteoporosis management in the
geriatric population. Canadian Geriatrics Journal , 18 (1), 29-34.
MacGill, M. (2015, November 3). What is osteoporosis? What causes osteoporosis? Retrieved
March 20, 2016, from Medical News Today: www.medicalnewstoday.com
Mayo Clinic. (2014, December 13). Osteoporosis. Retrieved March 19, 2016, from Mayo Clinic:
www.mayoclinic.org
Nanes, M. S., & Kallen, C. B. (2014). Osteoporosis. Seminars in Nuclear Medicine , 44 (6), 439-
450.
Science Beta. (2007, June 11). History of osteoporosis. Retrieved March 20, 2016, from Science
Beta: www.sciencebeta.com