CLINICAL CONDITION
– OSTEOPOROSIS –
ANATOMY AND PHYSIOLOGY I
(ANP 405)
LECTURER: DR.ROZANNA MOHD SAID
NAME STUDENT ID CODE PROGRAM
ANGELBETH JOANNY OPENG
2016251304 HS 2441A
NURALIYAH SARAH SOFIA BINTI MOHD ALI 2016653566 HS 2571A
Introduction
Bones are living tissue and consist of their own blood vessels and are made of living cells which help them grow and repairing process. The bone skeleton is a remarkable organ that serves both a structural function which are providing mobility, support and protection for the body. It is not a static organ but is constantly changing to better carry out its function. Some individuals may have strong bones and others will have weak bones, largely because of differences in their genes. Old bones break down and new bone is formed on a continuous basis. In fact the tissue of skeleton replaced many times during life. Commonly osteoporosis been diagnosed in later life but the most important time to focus on building healthy bones is during the first three decades of life. It is often considered a silent disease as there are no clear outward symptoms caused by the loss of bone density. Generalized osteoporosis is the most common form of the disease which affecting most of the skeleton.
There are two types well known of osteoporosis which are primary and secondary osteoporosis. Most common type is the primary as it is a disease of elderly because of cumulative impact of bone loss and deterioration of bone structure referred as age related and associated with the postmenopausal decline in estrogen levels or lack of essential calcium and vitamin D needed. Men usually go through only slow, continuous phase and that is why women lose more bone than do men. Secondary osteoporosis is caused by the condition such as hormonal imbalances, diseases or medications given.
SECTION 1
Definition clinical condition
What is Osteoporosis? Clinically, Osteoporosis can be defined as an absolute decrease in the amount of bone(David, 1996) where this decrease happens gradually and painless according to their research. It can also be define as a condition where bone becomes ‘thin’ that occurs when the calcium that keeps them strong has seeped out ( Isadore, 1991) and a type of disease that characterized by decreasing in bone mass and density-determine by peak bone mass and amount of bone loss (Steven, 2011). Overall, it can be conclude that Osteoporosis is a condition where an individual bone reduces in density, increase in fragility and experience calcium loss. It is a type of disease related to the bones disorder that eventually can lead to many health problem and serious complication.
Epidemiology
Osteoporosis are mostly discovered among population aged over 30 years and above ( Hanafi, 2002). However, it is not possible for anyone to get this chronic disease. There are some population that have high risk to develop Osteoporosis that include individual with low hormone levels (Hanafi, 2002), individual with unbalanced diet and eating disorder(Dhani,2011), long-term consuming of some types of medication such as corticosteroid that may interfere with the bone building process and also those patients with some chronic disease (David, 1996) such as lupus and chronic liver disease.
Many studies and research conducted shows that Osteoporosis keep increasing throughout the years. In some country such as United States, Europe and Japan, almost 75 million of people develop this disease. To illustrate, in 2002, research conducted by National Osteoporosis Foundation found that there were 8 million osteoporotic women and a 2 billion osteoporotic men only in US (Johnell, 2009). Graph 1 below shows the comparison between the number of man and women with osteoporosis disease in perspective with their age from the research conducted in the year of 2007-2010.
Graph 1
As the number of patient with this disease increase, eventually it can increase the risk of fracture to happen. Fracture is a situation when an individual broke their bones accidently. It can started from a small and thin crack to a complete break. This complication occurs as the structure of the individual bones is not strong enough(weakened) due to some reasons. Fracture can occur both in women and man. However, in many cases, mostly the osteoporotic fractures occurs in elderly women. This can be related to the reducing of the density of bones in women after the menopause (Johnell, 2009). Graph 2 shows the significance of age and genders that lead to fractures.
Graph 2
There were many reasons and causes that lead to the development of an individual body. Undeniable, some of these causes may seems to be seen just as a minor causes that contribute to this disease. However, it is good for each individual to make some precaution in order to prevent any dangerous complication and side effects to happen.
Signs & symptoms
Among all types of chronic disease, Osteoporosis is one of the disease that should be concerned the most as it rarely give any signs nor symptoms in the early stage. However, the sign and symptoms becomes obvious once it reach the higher level.
The sign and symptoms that can be seen related to this disease is when fractures occur as the bones become brittle and fragile making it broke easily especially on lumbar vertebrae, distal radius and femoral neck (Carlson,1991). This symptoms is due to the condition of bones that do not receives enough calcium and other nutrient causing it to weakened.
Another symptoms are when the vertebra structure of an individual changes-stooped posture (Hanafi, 2002). This condition is contributed by several factors such as decreasing in bone mass that eventually causing the back-bone(vertebra) to lost its strength to support the individual body and failed to maintain the normal structure and posture of human body which lead to back pain that caused by a collapsed vertebra that limiting their movements.
Impact to society
It is important for an individual to worry about Osteoporosis? The answer is yes. This is because, this disease can give obvious impact not only for the individual itself, but also to the society. The obvious impact that can be seen to individual with this disease is it will limited their work. As a person with Osteoporosis may experience body pain that eventually will limiting their movement. This will effect them in terms of either their works and daily activity. It may also affect the individual in terms of their feeling and emotion also the ability to make something efficiently, slowly cause a long-term disability or even mortality.
In context of society, this disease can give impact in many aspect. When the number of Osteoporosis patient inclined, it may reduce the number of active and healthy person causing the number of man power to decline. Another impact is the increasing in hospitalizations and at the same time increased the cost and expenditure for Osteoporotic, especially in dealing with fracture cases.
SECTION 2
Structure involve in and changes in normal structures that lead to Clinical condition
The type of tissues bone structures involved such are cortical bone which is hard outside layer of all bones in the body and makes up most of the skull and ribs. It is strong, dense and tough. Also the trabecular bone that is known as spongy texture inner layer bone and the network of trabeculae is lighter and less dense. In a normal thigh bone, the cortical bone along the outside of the shaft of the bone. With osteoporosis, it lead to reduction of bone density and structure in spongy bone as well as thinning of cortical bone. When bones have thinned to the point that osteoporosis is diagnosed, the physical structure and soundness of bones has changed like the cortical bones become thinner and spongy bones becomes less dense with bigger spaces forming between the bone structure of struts also become thinner. Trabecular bone is more active and is broken down and regenerated more quickly than cortical bone. Cells within the bones including osteoblasts which is involve in forming new bone and osteoclasts which break down bone, it is when bone is resorbed calcium and other minerals are removed from bone tissue and released into the circulation. The osteoblasts and osteoclasts activity needed to maintain healthy bone tissue.
The aspects measured of bone quality changes leading in osteoporosis are cortical porosity, under-mineralized matrix, cement line accumulation, trabecular perforation and fatigue accumulation. The cortical porosity has been important as it measure of prevalence and holes within bony cortex. Regarding to cement line accumulation stated that secondary ‘Haversion’ bone has poorer tensile strength and material properties than primary lamellar bone. The reduced tensile strength may reflect the long term accumulation of cement lines which can be seen residual of previous bone remodeling events. Under light microscope can be observed the cement lines appear as thin ribbon of loosely woven collagen fiber than distinguished from surrounding lamellar bone, (S.Saha and R.Vincentelli, 1985, c.35, p.13). For the microstructure level changes is actually influence directly about the reduction of mechanical properties of the trabecular bone. The loss of hormonal support not only the bones affected but other structural elements of the body such as the joints, muscles, body shape, skin and hair. Besides the children suffer from ‘Rickets’ will seem abnormal in fact as the growing bone become soft or rubbery and easily deformed. The new bone formed at the epiphyseal growth plate fails to ossify, bowed legs and deformities of the skull, ribcage and pelvis are common.
The thinness factor also considered as high chances of a person to develop osteoporosis and the way to define thinness is measures the body mass index (BMI). People with a BMI of 21 or less have a higher rate of bone loss than those who are heavier, and obese people have lower rates of bone loss than those who are ideal weight. ‘Bone Mineral Density’ (BMD) is an early diagnosis of osteoporosis which is its measures before the occurrence of fractures. These measure bone density at various skeletal sites therefore enable a prediction of risk of later fracture. In one side that low bone mineral density which without fracture predicts higher mortality, further supporting the concept that comorbidity and frailty often accompany osteoporosis, (W.S Browner 1991, p. 825). The relationship between BMD and fracture risk in children with chronic disease not been as clearly established as in adults. This is because the large variation in bone size in children of the same age as well as the rapid growth of bone length during early childhood and puberty affects the measured bone density.
Broken wrist is the first sign that considered a person have osteoporosis that is occurred often in woman after menopause and following a fall as people commonly put out an arm in an attempt to break their fall. Healthy bones should be able to withstand a simple fall so a broken bone in these circumstances, without any other disease is an indication be underlying osteoporosis. The hip fracture typically occurs as the result of a fall. The fractures can be medial, lateral and inter-trochanteric. Like any fracture, a broken hip is very pain and has an immediate impact on day to day living. The impact causes a combination of bending and axial compression in the proximal femur. Bending leads to axial compressive stresses superiorly and tensile stresses inferiorly. The maximum stress in a cross section under bending is determined by the section modulus. The characteristics such are femoral neck length, femoral neck width and upper neck region could be the significance prognostic.
Spinal fracture is due to osteoporosis of bones in the spine which is vertebrae usually occur in the lumbar which lower part or thoracic that middle of the spine. Bones becomes compressed because of reduce strength. It also referred to as ‘crush’, ‘collapsed’ or ‘wedge’ fractures that depending on which vertebrae affected (NOS, p.17). The non-weight bearing trabeculae are resorbed first and therefore the vertebral bodies typically show a rarefaction of the horizontal trabeculae accompanied by relative accentuation of the verticalization which is vertical striation and presence of reinforcement lines back pain is the frequent symptom of spinal fracture. The rib cage moves downward when spine loses structural support. Spinal bones do not return to its original shape even healed which result in height loss and spinal curvature. If fractures of spine healed in flattened or wedge shape, this cause spine to tip forward resulting in an outward curve at back and height loss. Figure 1 shows the types of some fracture that commonly happen among osteoporotic patient.
Figure 1
The condition changes such are degenerative inflammatory of the joints. It is subchondral scleroses with osteophytes or even more extensive ossification are typical for spondylarthrosis and spondylitises. The other condition detected is osteomalacia. It is “stout” trabeculae and “looser’s zones” at painful weight bearing parts of the extremities are characteristic. Malignant bone lesions also is a sign osteoporosis detected by clinical method. The nails and teeth can be measured or evaluated to indicate that the people having osteoporosis such as the hardness of nails where assessing the degree of nail brittleness and Raman spectroscopy is used to determine disulfide bond content in nails (Springer,2007).The reduction of bone density and its strength leading to osteoporosis determined by quantitative ultrasound that is measure the speed of sound in the bones. Patients that suffer from osteoporosis have problem with teeth which loosen due to widening of the alveoli.
The iliac crest bone is the curved superior border of the ilium, the largest of the three bones that merge to form the coxa or hip bone. It is located on the superior and lateral edge of the ilium very close to the surface of the skin in the hip region. The osteoporosis of the part commonly identified to older woman. Cortical width, trabecular volume, trabecular bone surface density and trabecular number were all reduced whereas the trabecular separation and star volume were increased. These structural changes in cancellous bone indicate that extensive perforations of trabecular plates have occurred or that whole trabecular elements have been removed.
Figure 2: Comparison between Normal and Osteoporotic bone
Figure 3: Division of hip fracture
Conclusion
To conclude, Osteoporosis is a disease that most people can easily develop as it related to the bones. Thus, it is important to take this matter seriously as it may cause a great impact when an individual start to develop it such as illness, long-term disability and mortality. Despite the effect of this disease, one should started their action in order to prevent and avoid from this illness as there is a saying ‘An apple a day keeps the doctor away’. Some of the ways to prevent the development of this disease is by taking a balance and proper diet by ensuring all types of nutrients including calcium is consume consistently, being an active person by doing exercise at least 2 to 3 times per week, reduce the intake of substance or medications that can disturb the system in the body such as steroid and avoid tobacco as well as excessive alcohol consumption.
References
Book:
Calson Wade (1991). Symptoms Ailments and their Natural Remedies. (1st edition). New York
David Green (1996). Medical Management of Long-Term Disability. (2nd edition). Chicago
Frederic H.Martini (2015). Visual Anatomy and Physiology.(2nd edition),Pearson Education Limited
Hanafi Ismail (2000). Kenali gejala penyakit dan rawatanya.( 2nd edition). Putrajaya
Isadore Rosenfeld (1991). The Best Treatment. (1st edition). New York, New York
Muhammad Dhani (2011). 57 Penyakit Berbahaya & Rawatanya. (1st edition). Batu caves; Selangor
Philip (2001). Osteoporosis, outcomes osteoporotic fractures, chapter 34.
Steven R. F., Herb Z., Alex M., (2011). Medical Aspects of Disability. (4th edition). New York
EBook/ Website:
Johnell O., Kanis J. , An Estimate of the Worldwide Prevalence and Disability Associated with
Osteoporotic Fractures , 2009. www.sciencedirect.com. Retrieved 25th October 2016
Isador H.Lieberman. ,Anatomy of Osteoporosis,2016.
www.spineuniverse.com/conditions/osteoporosis/anatomy-osteoporosis.
Retrieved 5th October 2016
Science Direct, Richard Eastell (2013, October). Bone disorder osteoporosis, article retrieved from:
www.sciencedirect.com.ezaccess.library.uitm.edu.my/science/article/pii/S1357303913002193