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. Comments are closed.
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