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According to the National Osteoporosis Foundation, bone is living, growing tissue that changes throughout the different stages of life (National Osteoporosis Foundation 2017). There are 300 soft bones at birth but during childhood and adolescence, bone tissue is slowly replaced by hard bone as bone mature (Iofbonehealth.org 2017). Throughout the stages of life, old bone or soft bone is removed (resorption) and new bone or hard bone is added to the skeleton (formation) (National Institute of Arthritis and Musculoskeletal and Skin Diseases 2016). According to the National Institute of Arthritis and Musculoskeletal and Skin Diseases, resorption (the process of breaking down bone) can supply needed calcium and phosphorus when there is a deficiency in the diet. When dietary calcium and phosphorus are sufficient, the formation phase of remodeling can take up these minerals and replenish the skeleton bank. Remodeling repairs the damage to the skeleton that can result from repeated stress such as muscle and bone stress caused by collegiate sports.
Remodeling replaces small cracks or deformities in areas of cell damage, prevents the accumulation of too much old bone by removing or replacing old bone, and is also responsible for the skeleton as the bank for calcium and phosphorus. While remodeling consists of removing and replacing bone at the same site (osteoclast), modeling allows for the formation of new bone at one site and the removal of old bone from another site within the same bone (osteoblast) (National Institute of Arthritis and Musculoskeletal and Skin Diseases 2016). Although remodeling predominates the early childhood and early adolescent years, modeling occurs primarily in response to weakening of the bone which occurs primarily in the later years. The structure of normal healthy bones consists of well-connected plates or broad bands that provide great strength. However, in individuals with osteoporosis or dysfunctional bones, the bands are disrupted and often become thin, weakened rods.
As a result, the rods may not be connected to another piece of bone thus they no longer contribute to bone strength. Childhood and adolescence is the prime time for the formation of bone. Bones grow and yield in larger, heavier, and denser bones. Bone formation surpasses bone resorption until peak bone mass (maximum bone density and strength) is reached usually occurring during adulthood (mid 20s). Bone resorption slowly begins to exceed bone formation as a result. Fortunately, osteoporosis will only develop when bone resorption occurs too quickly or when bone replacement occurs too slowly (National Institute of Arthritis and Musculoskeletal and Skin Diseases 2016). Osteoporosis is defined as “porous bone” meaning structural deterioration of bone tissue, leading to bone fragility and an increased risk of fractures of the hip, spine, and wrist (National Institute of Arthritis and Musculoskeletal and Skin Diseases 2016). Healthy bone looks like a honeycomb when viewed under a microscope. However, when osteoporosis occurs, the holes and spaces present in a honeycomb are much larger than in healthy bone (National Osteoporosis Foundation 2017). Weak and fragile bones are a result of the loss in bone mass density and contain an abnormal tissue structure. Furthermore, as bones lose bone mass density, they become weak and fragile and are more likely to break. With that being said, osteoporosis is a result of the loss of bone that occurs when the body makes too little bone and the bones become weak. This disease can be so severe that bones may break from a simple fall, sneezing, or even by bumping into a table or chair (National Osteoporosis Foundation 2017).
According to the International Osteoporosis Foundation, osteoporosis resulting from low bone mass is a major public health concern for approximately 44 million U.S. women and men that are in the later stages of life aged 50 and older (Iofbonehealth.org 2017). Osteoporosis or low bone mass represents 55 percent of the 44 million adults aged 50 and older at risk for this disease. The hip, spine or wrist is the most common bones broken as a result of osteoporosis. (National Institute of Arthritis and Musculoskeletal and Skin Diseases 2016). Osteoporosis can even cause a reduction in height as well as permanent pain. Height loss or stooped height occurs when osteoporosis affects the bones of the spine. Additionally, 20 percent of seniors that develop osteoporosis and fall and break a hip, die from complications or surgery to repair the broken bone within one year of the incident (National Institute of Arthritis and Musculoskeletal and Skin Diseases 2016).
According to the National Institute of Arthritis and Musculoskeletal and Skin Diseases, age, ethnicity, family history, and gender are all risk factors of osteoporosis (National Institute of Arthritis and Musculoskeletal and Skin Diseases 2016). Age is a risk factor because the chances of getting osteoporosis increases as age increases. Ethnicity poses a risk because statistics show that Caucasian and Asian women are more likely to get osteoporosis as opposed to African American and Hispanic women who have a lower chance of getting the disease (National Institute of Arthritis and Musculoskeletal and Skin Diseases 2016). Family history may be a risk because those that have a family history of osteoporosis are at a higher risk of developing the disease. Gender also plays a role in the development of osteoporosis because women have a greater chance of developing osteoporosis due to having smaller bones than men (National Institute of Arthritis and Musculoskeletal and Skin Diseases 2016).
Additionally, diet is the most important lifestyle factor that contributes to the development of osteoporosis. Approximately 99% of calcium found in the body is found in bone, where it serves as a key structural role in bone. Getting too little calcium and vitamin D can increase a person’s chances of getting osteoporosis (Iofbonehealth.org 2017). According to a study conducted by Flynn, inadequate dietary calcium in the early stages of life impairs bone development. Dietary requirements for calcium are determined by the needs for bone development and maintenance which vary throughout the stages of life. The need for dietary calcium is greater during the periods of rapid growth which is at its peak in childhood and adolescence, during pregnancy and lactation, and in older aged adults (Flynn 2003).
According to a more recent study on the role of vitamin D, the body needs vitamin D in order to absorb calcium. Without enough vitamin D, the human body is unable to form enough of the hormone calcitriol, active vitamin D, which leads to insufficient calcium absorption from the diet (Hill and Aspray 2017). Higher Vitamin D levels are associated with a greater bone mass density in both young and old populations. Vitamin D is significant to the health of bones because it is needed to absorb calcium and to promote bone growth. Too little vitamin D results in soft or fragile bones which leads to various bone diseases such as osteoporosis. Therefore, an adequate intake of calcium and vitamin D is needed to prevent soft or fragile bones which are referred to as rickets in children and osteomalacia in adults, the softening of bones that typically occur through a deficiency of vitamin D or calcium and contribute to the loss of bone mass leading to osteoporosis (Hill and Aspray 2017).
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