Osteoporosis

6th group
Description
Osteoporosis is classified as a metabolic bone disorder. Osteoporosis occurs
when the creation of new bone doesn’t keep up with the removal of old
bone.Osteoporosis causes bones to become weak and brittle — so brittle that
a fall or even mild stresses such as bending over or coughing can cause
a fracture. (Marianne, 2017)
CLASSIFICATION
Osteoporosis may be classified into two types:

• Primary osteoporosis. Primary osteoporosis occurs in women

after menopause and in men later in life, but it is not merely a consequence of
aging but of failure to develop optimal peak bone mass during childhood,
adolescence, and young adulthood.

• Secondary osteoporosis. Secondary osteoporosis is the result of medications or

other conditions and diseases that affect bone metabolism.
Pathophysiology
Normal bone remodeling in adults will increase bone mass until around the age of 35 years. Genetic,
nutritional, lifestyle (smoking, drinking coffee), and physical activity affect peak bone mass. Loss due to age
begins as soon as the peak of bone mass is reached. The disappearance of estrogen at menopause results in
accelerated bone reasorbtion and continues throughout the postmenopausal years.
Nutritional factors influence the growth of osteoporosis. Vitamin D is important for calcium absorption and
for normal bone mineralization. Diets containing calcium and vitamin D must be sufficient to maintain bone
remodeling and bodily functions. Inadequate intake of calcium and vitamin D over the years results in a
reduction in bone mass and the growth of osteoporosis.
Causes
The causes of osteoporosis and their effects on bone include:
• Genetics
• Age
• Nutrition
• Physical exercise
• Lifestyle choices
• Medications
Clinical Manifestations
Common signs and symptoms found in patients with osteoporosis include:
• Fractures. The first clinical manifestation of osteoporosis may be fractures,
which occur most commonly as compression fractures.
• Kyphosis. The gradual collapse of a vertebra is asymptomatic, and is called
progressive kyphosis or “dowager’s hump” associated with loss of height.
• Decreased calcitonin. Calcitonin, which inhibits bone resorption and promotes
bone formation, is decreased.
• Decreased estrogen. Estrogen, which inhibits bone breakdown, decreases with
aging.
• Increased parathyroid hormone. Parathyroid hormone increases with aging,
increasing bone turnover and resorption.
Prevention
To prevent primary and secondary osteoporosis, measures such as the following must be
implemented:

• Identification. Early identification of at-risk teenagers and young adults could prevent
osteoporosis.

• Diet. A diet with increased calcium intake strengthens the bones and avoids fractures.

• Activities. Participation in regular weight-bearing exercises results in excellent bone

maintenance.

• Lifestyle. Modifications in lifestyle such as reduced use of caffeine, cigarettes,

carbonated softdrinks, and alcohol could improve osteogenesis for bone remodeling.
Assessment and Diagnostic Findings
Osteoporosis may be undetectable on routine x-rays until there has been 25% to 40%
demineralization, resulting in radiolucency of the bones.

• Dual-energy X-ray Absorptiometry (DXA). Osteoporosis is diagnosed by DXA,

which provides information about BMD at the spine and hip.

• BMD testing. BMD testing is useful in identifying osteopenic and osteoporotic bone
and in assessing response to therapy.

• Laboratory studies. Laboratory studies such as serum calcium, serum phosphate,

serum alkaline phosphatase, urine calcium excretion, hematocrit, erythrocyte
sedimentation rate, and x-ray studies are used to exclude other possible disorders that
contribute to bone loss.
Pharmacologic Therapy
The first-line medications and other medications used to treat and prevent osteoporosis include:
• Calcium supplements with vitamin D. To ensure adequate calcium intake, a calcium supplement
with vitamin D may be prescribed and taken with meals or with a beverage high in vitamin C to
promote absorption, but these supplements should not be taken at the same day as biphosphonates.
• Biphosphonates. Biphosphonates that include daily or weekly oral preparations of alendronate or
risedronate, monthly oral preparations of ibandronate, or yearly intravenous infusions
of zoledronic acid increase bone mass and decrease bone loss by inhibiting osteoclast function.
• Calcitonin. Calcitonin directly inhibits osteoclasts thereby reducing bone loss ans increasing bone
mineral density, and is administered by nasal spray or
by subcutaneous or intramuscular injection.
• Selective estrogen receptor modulators (SERMs). SERMs such as raloxifene, reduce the risk of
osteporosis by preserving bone mineral density without estrogenic effects on the uterus.
• Teriparatide. Teriparatide is a subcutaneously administered anabolic agent that is administered
once daily, and as a recombinant PTH, it stimulates osteoblasts to build bone matrix and facilitates
overall calcium absorption.
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