Osteoporosis and its Management - Assignment Example

Running Head: OSTEOPOROSIS Number: Year: of Faculty Member: of Supervisor: INTRODUCTION Everyone has gone through a medical condition that in many ways results to impairment of bodily functions. In human body, diseases are broadly referred to as any conditions causing extreme pain, dysfunction, social problems, and death, or similar problems for those who are in close association with the person. Diseases can be caused by external factors such as invading microorganisms or internal dysfunctions. In a broader sense, disease includes injuries, disabilities, disorders, infections, on top of the isolated signs and symptoms. It is important to note that understanding a specific medical condition entails understanding the specific signs and symptoms as well as the pathogenesis of the diseases that drives the sufferer to a health care facility. The presenting signs and symptoms of a patient are utilized by the health care providers as a challenge to gather clusters of information to perform diagnostic tests, form a specific diagnosis, and conduct a management plan. Otherwise, ignoring the signs and symptoms often results to advance form of diseases that could have been prevented if addressed properly during the early stage. I have chosen the topic, osteoporosis, for the reason that my mother was recently diagnosed with osteoporosis after a long time of ignoring the signs and symptoms of the so – called preventable disease. After disregarding the disease for a period of time, I learned to develop the advocacy of knowing further what osteoporosis is all about. DEFINITION OF OSTEOPOROSIS Osteoporosis, a common skeletal disorder in the elderly, is defined as progressive loss of bone density in conjunction with increased loss of bone tissues, brittleness of bones, weakening of bone structure that makes the elderly prone to serious fractures (Schwartz et al, 1994; Cooper, 2003; Kozier et al., 2004; Shiel, 2009; Human Kinetics, 2009). Figure 1: The Structure of L3 vertebrae in a 31 year old (top) woman and in a 70 year old woman. Note that the plate – like structures are converted to thin rods (Poole and Compston, 2006). CHARACTERISTICS OF OSTEOPOROSIS Osteoporosis is characterized by abnormal porous bone with compressible sponge - like structure and low bone mass in addition to deterioration of structures of the tissue leading to bone fragility that increases its susceptibility to fractures (International Osteoporosis Foundation, 2002; Shiel, 2009; Human Kinetics, 2009). According to Shiel (2009), the risk of acquiring fractured bone especially in the hip, spine, and wrist is increased with osteoporosis. International Osteoporosis Foundation (2002) added that osteoporosis remains to be under diagnosed and under treated despite of its increasing global awareness. MECHANISM OF INJURY Osteoporosis is referred to as decreased mass of a normal mineralized bone (Rosai, 1989). It develops when an individual is unable to repair and maintain the bone tissue mass acquired throughout growth and maturation (Rosai, 1989). Schwartz et al. (1994) noted that at the age of 30, both men and women subsequently lose bone throughout life because the skeletal bone mass reaches its peak by then. Because of estrogen loss at menopause, women achieves a lower starting peak bone mass and experience a hormonal acceleration of bone loss. For this reason, symptomatic osteoporosis with fracture is much more widespread in women (Rosai, 1989; Schwartz et al. 1994). EPIDEMIOLOGY OF OSTEOPOROSIS According to the International Osteoporosis Foundation (2002), more than 200 million of the population worldwide is affected with osteoporosis, and 80 percent of which are women. International Osteoporosis Foundation (2002) further noted that osteoporosis becomes a major health treat among 44 million Americans, and costs an excess of $17 billion annual budget in the US healthcare system compared to the $6 million budget for breast cancer. On the lighter side, International Osteoporosis Foundation (2002) reported that osteoporosis is a preventable and treatable condition that results in considerable savings to health care system. In the United States, almost 10 million people were diagnosed with osteoporosis, and eighty percent of these populations are women who are older than 50 years old (eMedicine Health, 2009). Moreover, 18 million of Americans are at risk of developing osteoporosis because of low bone mass (eMedicine Health, 2009). According to the World Health Organization (WHO), the prevalence of osteoporosis in the US among white women aged 50 – 59 years is estimated to be 14%, in women aged 60 – 69 years is about 22%, in those aged 70 – 79 years of age is 39%, and in women who are 80 years old and above, is 70% (eMedicine Health, 2009). Figure 2: Annual Incidence of Osteoporosis (Source: International Osteoporosis Foundation (2002), The following are the risk factors identified in osteoporosis (International Osteoporosis Foundation, 2002; Xu et al., 2005). These are: (1) Female with too small structure or frame (2) Advanced age with family history of osteoporosis (3) Postmenopausal status (4) Absence of menstruation (5) Anorexia nervosa (6) Low calcium diet (7) Low levels of testosterone in men (8) Inactive lifestyle and smoking (9) Excessive alcohol use (10) Caucasian or Asian PATHOPHYSIOLOGY OF OSTEOPOROSIS Robbins et al. (1995) noted that the causes of osteoporosis are not known; however, many reasons most likely contribute to the slow loss of bone mass. Robbins et al (1995) added that genetic factors are proposed to be the determinant of the size of bone mass acquired during young adulthood. Subsequently, slowing of osteoblastic function and increased osteoclastic activity related with aging, is induced by endocrine influences such as decreased estrogen levels and increased IL – 1 level that results to negative balance in bone turnover (Robbins et al., 1995; Schwartz et al., 1994; Isselbacher et al., 1995). Poole and Compston (2006) further explained that osteoporosis is an age - related loss of bone during the fourth and fifth decade of life, and occurs due to increased breakdown of bone by a cell that functions in the breakdown and resorption of bone tissue known as osteoclasts as well as decreased formation of bones by osteoblasts. Poole and Compston added that estrogen and Vitamin D insufficiency in addition to secondary hyperparathyroidism greatly contributes to the formation of osteoporosis in the elderly. Poole and Compston cited reduced physical activity and decreased insulin – like growth factors production as other possible factors that may contribute to osteoporosis. Positive family history for osteoporosis especially in the maternal side increases the risk of an individual to have osteoporosis later in life (Poole and Compston, 2006). Having a higher peak bone mass is significantly determined by genetics as well as by environmental influence (Robbins et al., 1995; Schwartz et al., 1994; Isselbacher et al., 1995). Low body mass is related to increase risk of acquiring fracture and individuals with petite structures are more likely to develop osteoporosis later in life (Robbins et al., 1995; Schwartz et al., 1994; Isselbacher et al., 1995). Robbins et al. (1995) reported that the aforementioned factors predispose an individual to fractures in the femoral neck, wrists, and vertebrae. Osteoporosis remains difficult to diagnose because of the following reasons: (1) Osteoporosis remains asymptomatic not until skeletal fragility is in its advanced stage. (2) There is no other easy means of determining the severity of bone loss. Although absorptiometry and quantitative CT is reliable in determining bone loss, bone loss of less than 30 to 40 percent remains unreliable in the radiographs. (3) Osteoporosis belongs to one group of osteopenic disorders and is therefore difficult to diagnose. THE PATHOPHYSIOLOGY OF THE CHARACTERISTIC SIGNS AND SYMPTOMS Poole and Compston (2006) noted that osteoporosis is evident clinically as a fracture. An individual aged more than 45 with low trauma fracture should be suspected of having osteoporosis (Poole and Compston, 2006). Poole and Compston added that osteoporosis may present as: (1) Back ache (2) Loss in height (3) Spinal deformity (4) Radiological osteopenia. On the other hand, in two thirds of patients, vertebral fractures secondary to osteoporosis may be asymptomatic. Robbins et al. (1995) noted that osteoporosis can cause bone pain because of the following: (1) Microfractures (2) Loss in height (3) Vertebral column stability As the density of bone decreases, people are not just vulnerable to fractures but the spine also starts to compress. Consequently, as one gets older, people may have a tendency to shrink or develop curvature in the spine (Robbins et al., 1995; Schwartz et al, 1994; Kozier et al., 2004). Schwartz et al. (1994) noted that the characteristic signs and symptoms of osteoporosis depend on its origin. Schwartz et al. (2004) stated that the estrogen receptors shown in osteoblasts responds anabolically to estrogen, thereby explaining the accelerated bone loss in postmenopausal women. According to Schwartz et al (1994), osteoporosis can be classified as primary or secondary. In primary osteoporosis, osteoporosis can be subclassified into idiopathic or involutional. Furthermore, Schwartz et al noted that involutional osteoporosis can be subdivided into: (1) Type I (postmenopausal osteoporosis) Type I osteoporosis generally occurs in women who are 50 – 75 years old. It is primarily characterized by loss of primary trabecular bone (Schwartz et al. 1994; Robbins et al., 1995). (2) Type II (senile) Schwartz et al. (1994) added that type II osteoporosis is found in patients who are more than 70 years of age and has a 2:1 female preponderance with proportional loss of trabecular and cortical bones. Type II osteoporosis is also thought to have resulted from depressed renal 1 – alphahydroxylase activity associated with increasing age that leads to inadequate levels of active vitamin D in addition to decreased absorption of interstitial calcium. As a result, these patients will have a mild secondary parathyroidism that contributes greatly to chronic loss of bone (Schwartz et al., 1994; Kozier et al., 2004; Robbins et al., 1995). (3) Type III (increased parathyroid hormone). Schwartz et al. (1994) noted that type III osteoporosis bears similarity with type I except that the level of serum parathyroid hormones is elevated. Schwartz et al. (1994) stated that secondary osteoporosis can be ruled out from the history, physical examination, and laboratory studies. Schwartz et al. (1994) also noted that as the first indication of the disorder, osteoporotic patients often presents with fracture following a minor injury or trauma. Oftentimes, patients may present with frequent backache with progressive kyphosis and loss of height. Fractures are commonly located at the distal radius, hip, and vertebrae. Moreover, patients with acute fracture normally presents with severe pain in the back (Schwartz et al., 1994; Kozier et al., 2004; Robbins et al., 1995). REFERENCES Cooper, C. (2003) ‘What is Osteoporosis?’ Postgraduate Medical Journal, 79(2003), 133 – 138 EMedicineHealth (2009) Osteoporosis. Retrieved 09 March 2009 from http://www.emedicinehealth.com/osteoporosis/article_em.htm Human Kinetics (2009). Benefits of Strength Training. Retrieved 04 March 2009 from http://www.humankinetics.com/products/showexcerpt.cfm?excerpt_id=3884 International Osteoporosis Foundation (2002). Osteoporosis, Characteristics, Risks Factors Prevention and Detection. Retrieved 09 March 2009 from http://www.compumed.net/distributors/PDF/Characteristics_risk.pdf Isselbacher, K.J., Brunwald, E., Wilson, J.D., Martin, J.B., Fauci, A.S., and Kasper, D.L. (1995). Harrison’s Principles of Internal Medicine. New York: McGraw – Hill, Inc. Kozier, B., Erb, G., Berman, A., and Synder, S. (2004) Fundamentals of Nursing, 7th Edition. New Jersey: Pearson Education, Inc. Poole, K. and Compston, J. (2006) ‘Osteoporosis and its Management’, British Medical Journal, 333(2006), 1251-1256  Robbins, S. L., Cotran, R.S. and Kumar, V. (1995). Pathologic Basic of Diseases, 2nd Edition. Philadelphia: W.B. Saunders Company. Rosai, J. (1989). Ackerman’s Surgical Pathology. Toronto: The C.V. Mosby Company. Siegrist, M. (2006) ‘Role of physical activity in the prevention of osteoporosis’, Med Monatsschr Pharm; 31(7):259-64. Retrieved 09 March 2009 from PubMed Database Schwartz, S.I., Shires, G.T., and Spencer, F.C. (Eds.). (1994). Principles of Surgery, 6th Edition. New York: McGraw – Hill, Inc. Shiel, W. (2009). Osteoporosis. Retrieved 05 March 2009 from http://www.medicinenet.com/osteoporosis/article.htm Xu, J., Bartoces, M., Neale, A., Dailey, R., Northrup, J., and Schwartz, K. (2005). Natural History of Menopause Symptoms in Primary Care Patients: A MetroNet Study. 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