10/25/2022 Wear a yellow ribbon this October!![]() Have you ever seen a yellow ribbon worn in October? If not, it's your chance to spread some awareness for spina bifida in October! Today is World Spina Bifida day, and October is spina bifida awareness month! What is Spina Bifida? Spina Bifida is a defect in the neural tube in which the baby's neural tube fails to develop in the first 28 days of the pregnancy, often before the mother even knows she is pregnant. According to the Centers for Disease Control and Prevention, in the United States, approximately 1,427 babies are born with spina bifida yearly. Women of Hispanic heritage have the highest rate of pregnancies with spina bifida compared to non-Hispanic white and non-Hispanic black women. In spina bifida, a portion of the spinal cord protrudes out from an opening in the spine, resulting in severe nerve damage. In babies, spina bifida is characterized by a fluid-filled sac on the back called a meningocele. The area along the spine, where the neural tube fails to develop into the backbone, results in an unprotected spinal cord impacting its development. An underdeveloped spinal cord can cause damage to the nervous system. The severity of birth defects depends on the location and size of the opening on the spine. What are the types of Spina Bifida? There are three types of spina bifida: myelomeningocele, meningocele, and spina bifida occulta. Myelomeningocele is the most severe spina bifida, with significant damage to parts of the spinal cord and nerves. Individuals with myelomeningocele have moderate to severe symptoms that limit their ability to move body parts below the level of the myelomeningoceleand loss of bladder and bowel control. Babies born with the second type, meningocele, do not show symptoms. Occasionally, nerve damage around the spine occurs, leading to loss of movement, bladder, and bowel control. In this case, during pregnancy, there is abnormal spine formation with a gap in the bones of the spine. Spina Bifida Occulta is also known as "hidden" spina bifida as it doesn't involve the sac of fluid out of the baby's back and, therefore not noticeable to the eye. The condition causes a small gap in the spine that is not often discovered until late childhood or adulthood and doesn't cause any disabilities. It is usually only found when an x-ray or ultrasound is performed for other reasons How is Spina Bifida Diagnosed? Spina Bifida can be diagnosed during pregnancy and after pregnancy. Most modern cases get diagnosed during pregnancy through a triple screening process. The Alpha-fetoprotein test is a blood test that measures the level of alpha-fetoprotein, or AFP, in a pregnant woman's blood. High alpha-fetoprotein levels indicate the baby may have spina bifida. An ultrasound imaging test generates pictures of the baby in the mother's womb, and spina bifida is often visible in these images. Amniocentesis – A sample of amniotic fluid from around the baby is taken from the womb and tested for AFP levels. Similar to the blood test, high AFP levels suggest the baby has spina bifida. ![]() Celebrating amazing people with spina bifida this month! Tanni Grey-Thompson is one of Great Britain's greatest-ever paralympic athletes, amassing 16 Olympic medals across five paralympic games in wheelchair racing events. She was born with spina bifida and has been paralyzed below the waist since she was seven. Since her retirement at 37, she has gone on to campaign for the rights of individuals with disabilities, support charities, and help advance British sports in her role as the chairwoman of Welsh Sports. Tanni Grey-Thompson is a stellar example of not letting the challenges of a disability stop her from achieving massive success throughout her life. She received the Damehood, or DBE, from the English Monarchy for her services to disabled sports and is also an independent member of the house of lords. Her story and stories from other spina bifida patients should be celebrated this month to inspire others and remind everyone that the only limitations are the ones we set for ourselves. 10/20/2022 Spooky Scary Skeletons!![]() Halloween is approaching, and I bet you have seen skeletons as decorations. Did they scare you or make you feel uneasy? Did they make you think of your makeup and what your skeleton does for you? Did you know some spooky, scary skeletal diseases can affect you or your loved ones? Osteoporosis is a chronic metabolic bone disease that leads to low bone mass, bone tissue breakdown, and disruption of bone microarchitecture. It ultimately leads to decreased bone strength and a higher risk of fracturing a bone. Osteoporosis is a significant health problem, with more than 200 million people worldwide experiencing hip fractures. To enhance bone health awareness, the National Osteoporosis Society of the United Kingdom, renamed Bone Health and Osteoporosis Foundation, recognized October 20th as World Osteoporosis day! ![]() Who is at risk for this disease? Osteoporosis is one of the most common bone diseases, and it is seen mainly in the elderly population. While this disease can affect all genders and races, it is more common in Caucasians and women. The elderly are more likely to experience this disease due to menopause in women and aging in the elderly, causing a decrease in resorption and formation rates of the bone. Bone cells are continuously lost and replaced by resorption and rebuilding. This process is called bone remodeling. When the bone remodeling process is imbalanced, leading to a decline in new bone formation, the bones become weak, a primary contributor to osteoporosis. Many risk factors are associated with osteoporosis, making a seemingly healthy person more likely to contract osteoporosis. Some common risk factors include low calcium or vitamin D intake, smoking, obesity, excessive drinking of alcohol, hyperthyroidism, imbalance in sex hormones, family history, aging, ethnicity, cushing’s disease, and anorexia nervosa. More about bone remodeling! Osteoporosis is caused due to a decline or imbalance of bone remodeling. In short, bone remodeling replaces old bone with new bone. However, the process is much more complex. The bone remodeling cycle in adults involves four phases; activation, resorption, reversal, and formation, and occurs within a basic multicellular unit comprised of osteoclasts, osteoblasts, and capillaries. It is essential to note the difference between osteoclast and osteoblast. The osteoclast is a bone cell that will break down the bone, while the osteoblast is a bone cell that will rebuild the bone. The remodeling process takes anywhere from 120- 200 days, depending on the type of bone. In the activation phase, osteoclasts precursor cells are recruited to the bone surface from the circulation, marking the resorption site. During the resorption phase, the osteoclasts adhere to the surface of the bone to degrade the bone matrix by the enzymes cathepsin K and matrix metalloproteinases. The resorption terminates with the apoptosis of osteoclasts on the bone surface. The exact mechanism of reversal is not well understood. In the reversal phase, new bone formation initiates. During the formation phase, osteoblasts secrete type 1 collagen-rich osteoid matrix. The newly formed bones are mineralized by depositing hydroxyapatite crystals amidst collagen fibrils. Treatment and management of Osteoporosis There are different treatments for osteoporosis depending on the severity of the disease. Individuals with osteoporosis can be either low, moderate, or high risk. Low-risk patients have a mild form of the disease and will be given a daily intake of 1200mg of calcium and vitamin D 800 IU, along with lifestyle advice to help manage the disease. Moderate-risk patients have a higher chance of fractures and take calcium and vitamin D along with therapy that best fits the patient. High-risk patients have already experienced a hip fracture or other kind of fracture. Along with calcium and vitamin D supplements, non-pharmacological treatments such as eating sufficient protein, exercising to strengthen muscles and improve balance, cessation of smoking, decreasing alcohol intake, and learning fall prevention strategies are used to manage high-risk patients Studies have shown that different medications and therapies can help prevent various fractures. Bisphosphonates are drugs often used in patients with osteoporosis because this family of drugs slows bone loss. This drug can reduce vertebral, nonvertebral, and hip fractures. Denosumab and Teriparatide can also reduce certain kinds of fractures. Estrogen also plays a vital role in women’s health; it aids in many body functions. Most importantly, it promotes the function of osteoblast, the bone cell that supports the rebuilding of bone. During menopause, estrogen levels will decrease, resulting in reduced osteoblast function, ultimately leading to fragile bones. To counteract the loss of estrogen, these patients undergo hormone replacement therapy with estrogen and progestin. A study showed a 30% to 50% decrease in fractures in women treated with estrogen. Life with Osteoporosis The quality of a patient’s life is a primary concern for doctors when treating patients with a chronic disease like osteoporosis. Hip fractures are one of the most detrimental experiences of this disease, with hip fractures being the most common. Only 25% of patients return to everyday life after experiencing a hip fracture. Patients lose their ability to walk, causing them to lose their independence. Unfortunately, the inability to walk worsens the disease and results in a higher chance of experiencing more fractures. Despite these challenges, many treatment and prevention strategies are available to improve the quality of life for these patients. |
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