Bones have different stages of development, including resorption and deposit. A very common disease of bones that affects these stages is osteoporosis. Osteoporosis is a metabolic bone disease that can you to make too little bone, lose too much bone, or both. The different stages of bone breakdown and development have different cells that go with the stage. Osteoclasts break down the bone matrix by secreting lysosomal enzymes and protons that digest it. The demineralized matrix is then phagocytized-transported across the cell and first released into the interstitial fluid, then into the bloodstream. Osteoclasts are activated by parathyroid hormone and immune T cell proteins. Osteoblasts deposit new bone matrix creating the osteoid seam, which is a band of unmineralized bone matrix that marks the new bone matrix area. Osteoporosis can affect both of these functions. Too much thyroid hormone can cause excess bone loss, just as low calcium intake contributes to less bone production. Some medications meant to help fight or prevent seizures, gastric reflux, cancer, and transplant rejections have also been associated with osteoporosis. Osteoporosis is considered subclinical until it is complicated by fractures. In certain patients, being treated with effective antifracture medication can prevent fractures and improves clinical outcomes. Primary care providers and specialists are critical in screening for and diagnosing osteoporosis. Many improvements have been made in diagnosing and treating osteoporosis, yet there is still a lack of screening for at-risk patients, and a lack of fracture prevention education. There are many ways to treat osteoporosis, both pharmaceutical and nonpharmaceutical. Nonpharmaceutical approaches include counseling on osteoporosis risks for individual patients, weight-bearing exercises, incorporating a sufficient daily calcium intake, maintain serum vitamin D sufficiency, addressing risk factors that can be changed that are associated with falls, such as sedative medications, hypotension, vision or movement issues, and out-of-date prescription lenses, if applicable. Counseling against smoking and excessive alcohol intake is another nonpharmaceutical approach, as is balance training, muscle-strengthening, and avoiding having multiple pharmacies. Pharmaceutical approaches include bisphosphates such as alendronate, which prevents bone breakdown by limiting osteoclast activity, estrogen-related therapy, which helps raise estrogen levels in females, and parathyroid hormone analogs, which is a synthetic version of parathyroid hormone. Primary osteoporosis includes idiopathic osteoporosis that occurs in children and young adults with unknown reasons, and involutional osteoporosis, which is more related to aging. Involutional osteoporosis is divided into two types. Type l or postmenopausal osteoporosis occurs in women between 51 and 75 years old, and is recognized by rapid bone loss. Type ll or senile osteoporosis happens in people over 75 years old, and is defined with loss of trabecular and cortical bone as a result of aging. Secondary osteoporosis is less than 5% of all osteoporosis cases, and is caused by disease or certain medications. Osteoporosis is considered a global health problem because it has a morbidity rate, due to osteoporotic fracture in the elderly population. A difficulty diagnosing osteoporosis is that it doesn’t always follow the same presentation patterns as previously seen. There is a general list of symptoms, but it manifests differently in each person. People who have uncomplicated osteoporosis may remain symptom free until they obtain a fracture. This is part of what makes osteoporosis screening so important, and why osteoporosis is such a huge problem globally.
LeBoff, M. S., Greenspan, S. L., Insogna, K. L., Lewiecki, E. M., Saag, K. G., Singer, A. J., Siris, E. S. (2022) The clinician’s guide to prevention and treatment of osteoporosis. Osteoporosis International, 33(10), 2049-2102.
Aibar-Almazán, A., Voltes-Martìnez, A., Castellote-Caballero, Y., Afanador-Restrepo, D. F., Caercelén-Fraile, M. C., López-Ruiz, E. (2022) Current Status of the Diagnosis and Management of Osteoporosis. International Journal of Molecular Sciences 23(16), 9465.
Mayo Foundation for Medical Education and Research. (2021) Osteoporosis. Mayo Clinic.,being%20broken%20down%20and%20replaced

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  1. In this essay Arianna goes over the underlying mechanisms involved in osteoporosis, the types of osteoporosis, and the multiple forms of treatment for them. She begins by explaining that osteoporosis can be caused by insufficient bone growth, accelerated breakdown, or both. Growth is caused by osteoblast activity which deposit minerals onto the matrix, and breakdown is a result of osteoclasts secreting enzymes, and supplying the removed minerals to the bloodstream as commanded by parathyroid hormone. As a result too little calcium or too much parathyroid hormone can cause bone loss. Some medications for the treatment of other conditions can contribute to osteoporosis. There are three types of osteoporosis: Primary and involutional. Under the umbrella of primary is idiopathic osteoporosis, which occurs in childhood and early adulthood. Under involutional is postmenopausal and senile. Postmenopausal is a result of decreased estrogen levels (51-75 year old women), which stimulate osteoblasts, and senile, which is a result of old age (75+ years). There are two types of treatment options: pharmaceutical and non-pharmaceutical. Pharmaceutical options include biphosphates, which limit osteoclast activity, estrogen therapy, and parathyroid hormone analogs. Non-pharmaceutical options include weight bearing therapy, sufficient calcium and vitamin D intake, balance training, muscle strengthening, and the assessment of risk factors of medications with subsequent education. Counseling for excessive smoking and alcohol consumption is also there for those its applicable to. A message that Ariana pushed was that symptoms manifest themselves uniquely between individuals and can be hard to spot, which is why education and frequent testing is so important.


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