Each year in the United States, osteoporosis accounts for an estimated 300,000 hip fractures, 700,000 vertebral fractures, 250,000 wrist fractures and 300,000 fractures at other sites. The annual direct expenditure for care of patients with osteoporotic fractures in the United States was $18 billion in 2002. This expenditure has been predicted to double by 2025.
An estimated 30 million American women and 14 million American men have osteoporosis or osteopenia (low bone mass). This fragility of bone places these individuals at risk for the pain and disability associated with fracture.
According to The International Osteoporosis Foundation, in women over 45 years of age, osteoporosis accounts for more days spent in hospital than any other diseases, including diabetes, myocardial infarction and breast cancer. It is also estimated that half of American women over age 50 will have an osteoporosis related fracture in their lifetime.
Osteoporosis is an under diagnosed and under treated disease with a clinical manifestation of bone fracture. The complications of osteoporotic fracture incur high treatment costs both for the individual and society. Increasing public awareness regarding the maintenance of bone health will lessen the occurrence of osteoporosis and incidence of debilitating fractures that erode quality of life.
Prevention is a Primary Goal Regarding Osteoporosis.
Calcium retention combined with calcium supplementation, anti-resorptive therapy, exercise and a nutrient rich diet work in synergy to prevent, delay and manage osteoporosis.
The educational material presented provides advanced insight regarding bone formation and self repair. This knowledge helps instill an appreciation of these biological processes and allows for a deeper understanding of the therapeutic options to maintain bone health.
The Bone (factory) Physiology
Bone is not passive, it is a highly adaptable vibrant tissue with a blood supply that receives oxygen and nutrients and a nervous system that relays messages for growth and repair. Throughout the lifespan, bone is constantly being renewed and undergoes a continuous cycle of bone resorption (withdrawl) and bone formation (deposit). Bone is continually renewed to repair micro cracks caused by normal wear and tear.
Bone remodeling replaces old bone with new bone tissue. Bone remodeling is coordinated by osteoclast and osteoblast cells that function as remodeling units.
Osteoclasts are bone resorption cells that digest bone. Osteoclasts resorb bone by attaching to the bone surface and lowering the surrounding pH to an acidic level of around 4.5. The bone mineral is then broken down by enzymes and the collagen is degraded.
Osteoblasts are bone-forming cells that secrete collagen and mineral to create new bone. In healthy adults, the whole skeleton is continuously being regenerated every 10 years through renewal of bone.
If there is more bone resorption than formation, the result will be fragile thinned bone. Prior to menopause estrogen regulated the balance between the amount of bone that was withdrawn and the amount of bone that was rebuilt. However, for many, but not all women, diminished estrogen production resulting from menopause offsets this balance.
For a significant amount of postmenopausal women reduced estrogen production results in excess activity of osteoclasts and diminished osteoblast function, resulting in porous fragile bone. The bones become weak as cortical bone becomes thinner and the spaces in the spongy trabecular bone become larger. Compression or crush fractures occur upon impact due to the shattering of such effected bone.
Cortical and Trabecular Bone
The two major types of bone are cortical and trabecular. Estrogen receptors are found on both cortical and trabecular bone. Cortical bone makes up the hard outer layer of bone and accounts for about eighty percent of the total bone mass of an adult skeleton. This outer bone has a smooth, white, solid appearance due to minimal gaps and spaces.
Trabecular bone accounts for the remaining twenty percent of total bone mass, but has nearly ten times the surface area of cortical bone. Trabecular bone is the spongy interior within cortical bone. Trabecular bone has the appearance of a porous sponge and is comprised of vertical and horizontal free formed interlaced columns.
Trabecular bone turns over six to seven times faster than cortical bone. It is the predominant type of bone in the spine, hip and wrist (distal radius) and is metabolically more active than cortical bone, and experiences more changes that are osteoporotic. The imbalance of bone remodeling due to postmenopausal diminished estrogen causes the trabecular columns to hollow out.
Anti-resorptive medications maintain bone density
. . . but do not stimulate new bone.
Anti-resorptive therapy is indicated for the prevention and treatment of postmenopausal osteoporosis.
Bisphosphonates, Selective Estrogen Receptor Modulators and Estrogen Replacement are prescription anti-resorptive medications that have been FDA approved for the treatment of osteoporosis.
Bone remodeling replaces old bone with new bone tissue. Anti-resorptive therapy helps maintain bone density by decreasing bone remodeling. The aim of anti-resorptive therapy is to ensure adequate bone remodeling, repair of micro damaged bone, and to increase bone strength.
Advanced educational overviews regarding Bisphosphonates, Selective Estrogen Receptor Modulators and Estrogen Replacement in regard to osteoporosis prevention and management are listed on the site map page of this website.
The site map page also connects to educational presentations regarding nutrition and exercise for osteoporosis prevention and management.
Keep in Mind . . .
In order for bones to renew and repair it is important to provide a balanced supply of minerals such as calcium, magnesium, boron, phosphorus, potassium, vitamins and certain hormones.
For example, Vitamin D is necessary for the optimal absorption of calcium. Vitamin C stimulates procollagen, enhances collagen synthesis and stimulates alkaline phosphatase an enzyme that is essential for bone mineralization as well as the production of matrix proteins. One calcium (600 mg) supplement with vitamin D and one vitamin C (500 mg) work in synergy to maintain bone integrity. Vitamin K and B12 help synthesize bone proteins. Vitamin A helps to stimulate bone building osteoblast cells. Soy isoflavones (50 mg) daily also nurtures bone and arteries.
A more detailed explanation regarding the nutritional factors effecting bone health is presented the Calcium and Bone overview.
In Summary
The postmenopausal years are likely to represent one third or more of a woman’s lifespan. However, becoming older no longer necessitates becoming weak and frail. Maintaining a healthy bone structure will contribute to a better quality of life during these years of maturity.
The prevention and treatment of osteoporosis involves the proactive management of calcium metabolism and intervening with the bone remodeling cycle. This education presentation overviewed the nutritional, pharmacological, and nutraceutical therapeutic components that when implemented will help maintain bone health.
Individualizing such osteoprotective therapies with the guidance of a health practitioner will prevent bone loss and painful, debilitating fractures. Additionally, utilizing enhanced nutrition and exercise for the management of bone health also contributes to cardiovascular wellness.
I hope the information I have presented regarding osteoporosis prevention and management will inspire you to be proactive regarding bone health.