An Overview of Bone Disease: Osteoporosis

Osteoporosis, or porous bone is a common bone disorder. It is characterized by low bone mass and structural deterioration of bone tissue as a result of bone resorption exceeding bone formation. The deterioration of bone tissue and low bone mass leads to fragile bones and increase risk for spontaneous fractures to occur (Hubert & VanMeter, 2018). The estimated prevalence is approximately 10 million in the United States, with many more individuals at an increased risk due to having low bone mass. Although women have a higher risk, a significant number of men have been diagnosed with osteoporosis. The condition is a leading factor in an estimated 1.5 million fractures annually. There are often no signs or symptoms and osteoporosis goes undiagnosed until a fracture has occurred. The U.S Preventive Services Task Force recommends routine screenings for all women age 65 years or older and postmenopausal women under 65 years of age with predisposing factors associated with increased risk of fractures such as parental history of fractures, smoking, excessive alcohol intake, and low body weight.

Etiology and Risk Factors

Bone mass typically reaches its peak in young adulthood then begins to gradually decline throughout the lifetime. The decline in bone mass and strength increases risk for spinal fractures in low trauma accidents. The rate of decline in bone mass includes many contributing factors. The most significant factor contributing to bone mass decline is deficiency in gonadal steroids. Other contributing factors include lifestyle and environmental factors such as poor diet or malabsorption disorders, leading to deficiencies in vitamin D, calcium and protein, smoking, high caffeine intake and a sedentary lifestyle.

Hormonal factors such as hyperparathyroidism may also increase bone loss. Osteoporosis is a disease that is age-related. Although a significant number of men are diagnosed, women have a higher risk of developing osteoporosis due to menopausal transitions. Additional nonmodifiable factors such as culture and genetic predisposition impact formation of osteoporosis including Asian and Caucasian individuals due to typically small and light bone structures.

Pathophysiological Processes

In both men and women, a large decrease in bone mass density begins as early as in the third decade of life. Loss of bone mass continues through the lifetime primary effecting trabecular bone in the spine. In women, bone loss at the spine increases during the transition into menopause. Women also lose cortical bone during menopausal transition. By comparison, due to men not undergoing menopause, the loss of trabecular bone is comparatively less than the bone loss in women. The loss of trabecular and cortical bone mass result in alterations in skeletal geometry and ultimately results in effects on skeletal strength (Drake et al., 2015). The progressive bone loss and skeletal alterations predisposes aging adults to an increased risk of fractures. Similarly, incidences of vertebral fractures in women begin to increase during the menopausal period.

Clinical Manifestations and Complications

The beginning stages of osteoporosis are often asymptomatic. Once a fracture occurs, healing and recovery happens at a slow rate. A common sign of this condition is back pain (Hubert & VanMeter, 2018). Osteoporosis related fractures may cause chronic and acute pain, disability, an impaired quality of life and mortality. Loss of height may occur in individuals who have multiple fractures. Spontaneous fractures such as fractures that occur without any fall or physical trauma and may occur while performing daily chores.

The probability of future fractures occurring increases after every additional fracture (Sözen et al., 2017). The complications of osteoporosis include development of abnormal curvatures in the spine such as kyphosis and scoliosis. Diagnostics Screening and diagnosis for osteoporosis is assessed by bone mineral density (BMD) measurement which provides an estimate of bone strength. Dual-energy X-ray absorption (DXA) is most commonly used to measure BMD. The U.S Preventive Services Task Force recommends routine screenings for all women age 65 years or older and postmenopausal women under 65 years of age with predisposing factors associated with increased risk of fractures such as parental history of fractures, smoking, excessive alcohol intake, and low body weight. Osteoporosis often goes undiagnosed until a fracture has occurred. Screening for osteoporosis may facilitate treatment before the occurrence of a fracture.

Conclusion

Osteoporosis is a bone disorder characterized by low bone mass and structural deterioration of bone tissue as a result of bone resorption exceeding bone formation (NIH, 2018). An estimated 10 million individuals are diagnosed with osteoporosis in the United States. There are often no signs or symptoms and the disease goes undiagnosed until a fracture has occurred. Those living with the deteriorating bone disease are at an increased risk for fracture as a result of fragile bones.

References

• Drake, M. T., Clarke, B. L., & Lewiecki, E. M. (2015). The pathophysiology and treatment of osteoporosis. Clinical Therapeutics, 37(8), 1837-1850.doi: http://dx.doi.org.chamberlainuniversity.idm.oclc.org/10.1016/j.clinthera.2015.06.006
• Hubert, R. J. & VanMeter, K. C. (2018). Gould’s pathophysiology for the health professions (6th ed.). St. Louis, MO: Elsevier. Jakob, F., Seefried, L., & Schwab, M. (2014). [Age and osteoporosis. Effects of aging on osteoporosis, the diagnostics and therapy]. Der Internist, 55(7), 755-761. doi:10.1007/s00108-014-3468-z
• Kling, J. M., Clarke, B. L., & Sandhu, N. P. (2014). Osteoporosis prevention, screening, and treatment: a review. Journal of women's health (2002), 23(7), 563-72.
• National Institutes of Health. (2018). Osteoporosis and related bone disease (NIH Publication. No. 18-AR-8004). Retrieved from https://www.bones.nih.gov/sites/bones/files/pdfs/ osteopoverview-508.pdf
• Sözen, T., Özışık, L., & Başaran, N. Ç. (2017). An overview and management of osteoporosis. European Journal Of Rheumatology, 4(1), 46-56. doi:10.5152/eurjrheum.2016.048
• U.S. Preventive Services Task Force (USPSTF). (2018). Osteoporosis to Prevent Fractures: Screening.https://www.uspreventiveservicestaskforce.org/Page/Document/ UpdateSummaryFinal/osteoporosis-screening1