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Osteoporosis

Osteoporosis

Definition

The word osteoporosis literally means "porous bones." It occurs when bones lose an excessive amount of their protein and mineral content, particularly calcium. Over time, bone mass, and therefore bone strength, is decreased. As a result, bones become fragile and break easily. Even a sneeze or a sudden movement may be enough to break a bone in someone with severe osteoporosis.

Description

Osteoporosis is a serious public health problem. Some 44 million people in the United States are at risk for this potentially debilitating disease, which is responsible for 1.5 million fractures (broken bones) annually. These fractures, which are often the first sign of the disease, can affect any bone, but the most common locations are the hip, spine, and wrist. Breaks in the hip and spine are of special concern because they almost always require hospitalization and major surgery, and may lead to other serious consequences, including permanent disability and even death.

To understand osteoporosis, it is helpful to understand the basics of bone formation. Bone is living tissue that is constantly being renewed in a two-stage process (resorption and formation) that occurs throughout life. In the resorption stage, old bone is broken down and removed by cells called osteoclasts. In the formation stage, cells called osteoblasts build new bone to replace the old. During childhood and early adulthood, more bone is produced than removed, reaching its maximum mass and strength by the mid-30s. After that, bone is lost at a faster pace than it is formed, so the amount of bone in the skeleton begins to slowly decline. Most cases of osteoporosis occur as an acceleration of this normal aging process, which is referred to as primary osteoporosis. The condition also can be caused by other disease processes or prolonged use of certain medications that result in bone loss. If so, this is called secondary osteoporosis.

Osteoporosis occurs most often in older people and in women after menopause. It affects nearly half of men and women over the age of 75. Women are about five times more likely than men to develop the disease. They have smaller, thinner bones than men to begin with, and they lose bone mass more rapidly after menopause (usually around age 50), when they stop producing a bone-protecting hormone called estrogen. In the five to seven years following menopause, women can lose about 20% of their bone mass. By age 65 or 70, though, men and women lose bone mass at the same rate. As an increasing number of men reach an older age, there is more awareness that osteoporosis is an important health issue for them as well. In fact, a 2003 report noted that one in every eight men over age 50 will suffer a hip fracture as a result of osteoporosis.

Causes and symptoms

A number of factors increase the risk of developing osteoporosis. They include:

  • Age. Osteoporosis is more likely as people grow older and their bones lose tissue.
  • Gender. Women are smaller and start out with less bone. They also lose bone tissue more rapidly as they age. While women commonly lose 30-50% of their bone mass over their lifetimes, men lose only 20-33%.
  • Race. Caucasian and Asian women are most at risk for the disease, but African American and Hispanic women can get it too.
  • Figure type. Women with small bones and those who are thin are more liable to have osteoporosis.
  • Early menopause. Women who stop menstruating early because of heredity, surgery or lots of physical exercise may lose large amounts of bone tissue early in life. Conditions such as anorexia and bulimia also may lead to early menopause and osteoporosis.
  • Lifestyle. People who smoke or drink too much, or do not get enough exercise have an increased chance of osteoporosis.
  • Diet. Those who do not get enough calcium or protein may be more likely to have osteoporosis. That is why people who constantly diet are more prone to the disease.
  • Genetics. Research in Europe reported in 2003 that variations of a gene on chromosome 20 might make some postmenopausal women more likely to have osteoporosis. Studies were continuing on how to identify the gene and use information from the research to prevent osteoporosis in carriers.

Osteoporosis is often called the "silent" disease, because bone loss occurs without symptoms. People often do not know they have the disease until a bone breaks, frequently in a minor fall that would not normally cause a fracture. A common occurrence is compression fractures of the spine. These can happen even after a seemingly normal activity, such as bending or twisting to pick up a light object. The fractures can cause severe back pain, but sometimes go unnoticedeither way, the vertebrae collapse down on themselves, and the person actually loses height. The hunchback appearance of many elderly women, sometimes called "dowager's" hump or "widow's" hump, is due to this effect of osteoporosis on the vertebrae.

Diagnosis

Certain types of doctors may have more training and experience than others in diagnosing and treating people with osteoporosis. These include a geriatrician, who specializes in treating the aged; an endocrinologist, who specializes in treating diseases of the body's endocrine system (glands and hormones); and an orthopedic surgeon, who treats fractures such as those caused by osteoporosis.

Before making a diagnosis of osteoporosis, the doctor usually takes a complete medical history, conducts a physical exam, and orders x rays, as well as blood and urine tests, to rule out other diseases that cause loss of bone mass. The doctor also may recommend a bone density test. This is the only way to know for certain if osteoporosis is present. It also can show how far the disease has progressed.

Several diagnostic tools are available to measure bone density. The ordinary x ray is one, though it is the least accurate for early detection of osteoporosis, because it does not reveal bone loss until the disease is advanced and most of the damage has already been done. Two other tools that are more likely to catch osteoporosis at an early stage are computed tomography scans (CT scans) and machines called densitometers, which are designed specifically to measure bone density.

The CT scan, which takes a large number of x rays of the same spot from different angles, is an accurate test, but uses higher levels of radiation than other methods. The most accurate and advanced of the densitometers uses a technique called DEXA (dual energy x-ray absorptiometry). With the DEXA scan, a double x-ray beam takes pictures of the spine, hip, or entire body. It takes about 20 minutes to do, is painless, and exposes the patient to only a small amount of radiationabout one-fiftieth that of a chest x ray.

Doctors do not routinely recommend the test, partly because access to densitometers is still not widely available. People should talk to their doctors about their risk factors for osteoporosis and if, and when, they should get the test. Ideally, women should have bone density measured at menopause, and periodically afterward, depending on the condition of their bones. Men should be tested around age 65. Men and women with additional risk factors, such as those who take certain medications, may need to be tested earlier.

Treatment

There are a number of good treatments for primary osteoporosis, most of them medications. Two medications, alendronate and calcitonin (in nose spray form), have been approved by the Food and Drug Administration (FDA). They provide people who have osteoporosis with a variety of choices for treatment. For people with secondary osteoporosis, treatment may focus on curing the underlying disease.

Drugs

For many women who have gone through menopause, the treatment of choice for osteoporosis has been hormone replacement therapy (HRT), also called estrogen replacement therapy. Many women choose HRT when they undergo menopause to alleviate symptoms such as hot flashes, but hormones increase a woman's supply of estrogen, which helps build new bone, while preventing further bone loss. A 2002 report from a large clinical trial called the Women's Health Initiative helped verify HRT's positive effects in preventing osteoporosis in postmenopausal women.

However, the WHI also revealed several risks with taking combined HRT (estrogen and progesterone). In fact, the trial was stopped early because the incidence of invasive breast cancer in women on HRT passed a threshold that was considered too risky for the benefits they were receiving. The study also found that the women on combined hormone therapy were at increased risk for coronary heart disease and stroke. Whether or not a woman takes hormones and for how long is a decision she should make carefully with her doctor. Women should talk to their doctors about personal risks for osteoporosis, as well as their risks for heart disease and breast cancer.

Since estrogen may no longer be recommended for prevention of osteoporosis, selective use of alendronate and calcitonin are possible alternatives. Alendronate and calcitonin both stop bone loss, help build bone, and decrease fracture risk by as much as 50%. Alendronate (sold under the name Fosamax) is the first nonhormonal medication for osteoporosis ever approved by the FDA. It attaches itself to bone that has been targeted by bone-eating osteoclasts, protecting the bone from these cells. Osteoclasts help the body break down old bone tissue.

Calcitonin is a hormone that has been used as an injection for many years. A new version is on the market as a nasal spray. It too slows down bone-eating osteoclasts.

Side effects of these drugs are minimal, but calcitonin builds bone by only 1.5% a year, which may not be enough for some women to recover the bone they lose. Fosamax has proven safe in large, multi-year studies, but not much is known about the effects of its long-term use. Several medications under study include other bisphosphonates that slow bone breakdown (like alendronate), sodium fluoride, vitamin D metabolites, and selective estrogen receptor modulators. Some of these treatments are already being used in other countries, but have not yet been approved by the FDA for use in the United States.

In early 2003, a report announced that the FDA had recently approved the first drug that could form bone in osteoporosis patients. The drug is a form of the human parathyroid hormone called teriparatide. It shows promise for those patients at highest risk for fracture from the disease. There are some patients who cannot use the drug, so all considering the new treatment must check with their physician and may need to undergo bone densitometry scans or other testing.

Surgery

Unfortunately, much of the treatment for osteoporosis is for fractures that result from advanced stages of the disease. For complicated fractures, such as broken hips, hospitalization and a surgical procedure are required. In hip replacement surgery, the broken hip is removed and replaced with a new hip made of plastic, or metal and plastic. Though the surgery itself is usually successful, complications of the hip fracture can be serious. Those individuals have a 5-20% greater risk of dying within the first year following the injury than do others in their age group. A large percentage of those who survive are unable to return to their previous level of activity, and many move self-care to a supervised living situation or nursing home. That is why getting early treatment and taking steps to reduce bone loss are vital.

Alternative treatment

Alternative treatments for osteoporosis focus on maintaining or building strong bones. A healthy diet low in fats and animal products and containing whole grains, fresh fruits and vegetables, and calcium-rich foods (such as dairy products, dark-green leafy vegetables, sardines, salmon, and almonds), along with nutritional supplements (such as calcium, magnesium, and vitamin D), and weight-bearing exercises are important components of both conventional prevention and treatment strategies and alternative approaches to the disease. In addition, alternative practitioners recommend a variety of botanical medicines or herbal supplements. Herbal supplements designed to help slow bone loss emphasize the use of calcium-containing plants, such as horsetail (Equisetum arvense ), oat straw (Avena sativa ), alfalfa (Medicago sativa ), licorice (Glycyrrhiza galbra ), marsh mallow (Althaea officinalis ), and yellow dock (Rumex crispus ). Homeopathic remedies focus on treatments believed to help the body absorb calcium. These remedies are likely to include such substances as Calcarea carbonica (calcium carbonate) or silica. In traditional Chinese medicine, practitioners recommend herbs thought to slow or prevent bone loss, including dong quai (Angelica sinensis ) and Asian ginseng (Panax ginseng ). Natural hormone therapy, using plant estrogens (from soybeans) or progesterone (from wild yams), may be recommended for women who cannot or choose not to take synthetic hormones.

Prognosis

There is no cure for osteoporosis, but it can be controlled. Most people who have osteoporosis fare well once they receive treatment. The medicines available now build bone, protect against bone loss, and halt the progress of this disease.

Prevention

Building strong bones, especially before the age of 35, and maintaining a healthy lifestyle are the best ways to prevent osteoporosis. To build as much bone mass as early as possible in life, and to help slow the rate of bone loss later in life, doctors advise:

Getting calcium from foods

Experts recommend 1,500 milligrams (mg) of calcium per day for adolescents, pregnant or breastfeeding women, older adults (over 65), and postmenopausal women not using hormone replacement therapy. All others should get 1,000 mg per day. Foods are the best source for this important mineral. Milk, cheese, and yogurt have the highest amounts. Other foods that are high in calcium are green leafy vegetables, tofu, shellfish, Brazil nuts, sardines, and almonds.

Taking calcium supplements

Many people, especially those who do not like or can not eat dairy foods, do not get enough calcium in their diets and may need calcium supplements. Supplements vary in the amount of calcium they contain. Those with calcium carbonate have the most amount of useful calcium. Supplements should be taken with meals and accompanied by six to eight glasses of water a day.

Getting vitamin D

Vitamin D helps the body absorb calcium. People can get vitamin D from sunshine with a quick (15-20 minute) walk each day or from foods such as liver, fish oil, and vitamin-D fortified milk. During the winter months it may be necessary to take supplements. Four hundred mg daily is usually the recommended amount.

Avoiding smoking and alcohol

Smoking reduces bone mass, as does heavy drinking. Avoiding smoking and limiting alcoholic drinks to no more than two per day reduces risks. An alcoholic drink is one-and-a-half ounces of hard liquor, 12 ounces of beer, or five ounces of wine.

Exercise

Exercising regularly builds and strengthens bones. Weight-bearing exerciseswhere bones and muscles work against gravityare best. These include aerobics, dancing, jogging, stair climbing, tennis, walking, and lifting weights. People who have osteoporosis may want to attempt gentle exercise, such as walking, rather than jogging or fast-paced aerobics, which increase the chance of falling. Exercising three to four times per week for 20-30 minutes each time helps.

Resources

PERIODICALS

Doering, Paul L. "Treatment of Menopause Post-WHI: What Now?" Drug Topics April 21, 2003: 85.

Elliott, William T. "HRT, Estrogen, and Postmenopausal Women: Year-old WHI Study Continues to Raise Questions." Critical Care Alert July 2003: 1.

LoBuono, Charlotte. "New Osteoporosis Drug is First to Form Bone." Drug Topics January 6, 2003: 24.

"More Men at Osteoporosis Risk than Commonly Believed." Tufts University Health and Nutrition Letter August 2003: 8.

Nelson, Heidi D. "Postmenopausal Osteoporosis and Estrogen." American Family Physician August 15, 2003: 606.

"Osteoporosis Gene Identified." Diagnostics and Imaging Week March 13, 2003 4.

"Three Out of Four Women Currently Taking Prescriptions for Osteoporosis Are Not Receiving Full Treatment, According to Recent Data from a National Physician Audit." Drug Cost Management Report January 2003: 11.

KEY TERMS

Alendronate A nonhormonal drug used to treat osteoporosis in postmenopausal women.

Anticonvulsants Drugs used to control seizures, such as in epilepsy.

Biphosphonates Compounds (like alendronate) that slow bone loss and increase bone density.

Calcitonin A hormonal drug used to treat postmenopausal osteoporosis

Estrogen A female hormone that also keeps bones strong. After menopause, a woman may take hormonal drugs with estrogen to prevent bone loss.

Glucocorticoids Any of a group of hormones (like cortisone) that influence many body functions and are widely used in medicine, such as for treatment of rheumatoid arthritis inflammation.

Hormone replacement therapy (HRT) Also called estrogen replacement therapy, this controversial treatment is used to relieve the discomforts of menopause. Estrogen and another female hormone, progesterone, are usually taken together to replace the estrogen no longer made by the body.

Menopause The ending of a woman's menstrual cycle, when production of bone-protecting estrogen decreases.

Osteoblasts Cells in the body that build new bone tissue.

Osteoclasts Cells that break down and remove old bone tissue.

Selective estrogen receptor modulator A hormonal preparation that offers the beneficial effects of hormone replacement therapy without the increased risk of breast and uterine cancer associated with HRT.

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Boughton, Barbara; Odle, Teresa. "Osteoporosis." Gale Encyclopedia of Medicine, 3rd ed.. 2006. Encyclopedia.com. 30 Sep. 2016 <http://www.encyclopedia.com>.

Boughton, Barbara; Odle, Teresa. "Osteoporosis." Gale Encyclopedia of Medicine, 3rd ed.. 2006. Encyclopedia.com. (September 30, 2016). http://www.encyclopedia.com/doc/1G2-3451601176.html

Boughton, Barbara; Odle, Teresa. "Osteoporosis." Gale Encyclopedia of Medicine, 3rd ed.. 2006. Retrieved September 30, 2016 from Encyclopedia.com: http://www.encyclopedia.com/doc/1G2-3451601176.html

Osteoporosis

Osteoporosis

Definition

The word osteoporosis literally means porous bones. It occurs when bones lose an excessive amount of their protein and mineral content, particularly calcium . Over time, bone mass, and therefore bone strength, is decreased. As a result, the bones become fragile and break easily. Even a sneeze or a sudden movement may be enough to break a bone in someone with severe osteoporosis.

Description

Osteoporosis is a serious public health problem. Some 28 million people in the United States are affected by this potentially debilitating disease, which is responsible for 1.5 million fractures (broken bones) annually. These fractures, which are often the first sign of the disease, can affect any bone, but the most common locations are the hip, spine, and wrist. Breaks in the hip and spine are of special concern because they almost always require hospitalization and major surgery; and may lead to other serious consequences, including permanent disability and even death.

To understand osteoporosis, it is helpful to understand the basics of bone formation. Bone is living tissue

that's constantly being renewed in a two-stage process (resorption and formation) that occurs throughout life. In the resorption stage, old bone is broken down and removed by cells called osteoclasts. In the formation stage, cells called osteoblasts build new bone to replace the old. During childhood and early adulthood, more bone is produced than removed, reaching its maximum mass and strength by the mid-30s. After that, bone is lost at a faster pace than it's formed, so the amount of bone in the skeleton begins to slowly decline. Most cases of osteoporosis occur as an acceleration of this normal aging process. That is referred to as primary osteoporosis. The condition can also be caused by other disease processes or prolonged use of certain medications that result in bone loss; if so, it is called secondary osteoporosis.

Osteoporosis occurs most often in older people, especially in women after menopause . It affects nearly half of all adults, men and women, over the age of 75. Women, however, are five times more likely than men to develop the disease. They have smaller, thinner bones than men to begin with, and they lose bone mass more rapidly after menopause (usually around age 50), when they stop producing a bone-protecting hormone called estrogen. In the five to seven years following menopause, women can lose about 20% of their bone mass. By age 65 or 70, though, men and women lose bone mass at the same rate.

As an increasing number of men live longer, health professionals are increasingly aware that osteoporosis is an important health issue for men as well. In fact, men account for about 20% of all spinal fractures and up to 30% of all hip fractures due to osteoporosis.

Causes & symptoms

A number of factors increase the risk of developing osteoporosis. They include:

  • Age. Osteoporosis is more likely as people grow older and their bones lose strength.
  • Sex. Women are more likely to have osteoporosis because they start out with less bone. They also lose bone tissue more rapidly as they age. While women commonly lose 30%50% of their bone mass over their lifetimes, men lose only 20%33% of theirs.
  • Race. Caucasian and Asian women are most at risk for the disease, but African American and Hispanic women can get it too.
  • Body type. Women with small bones or thin frames are more liable to develop osteoporosis.
  • Early menopause. Women who begin menopause early because of heredity, surgery, or lots of physical exercise may lose large amounts of bone tissue early in life. Such conditions as anorexia and bulimia may also lead to early menopause and osteoporosis.
  • Lifestyle. People who smoke or drink too much, or do not get enough exercise, have an increased chance of getting osteoporosis.
  • Medications. Certain prescription medications may speed up the loss of bone. These drugs include methotrexate, cimetidine, corticosteroids, and heparin.
  • Diet. Adults who do not get enough calcium or protein may be more likely to have osteoporosis. People who constantly diet are more prone to the disease.

Osteoporosis is often called the silent disease, because bone loss occurs without symptoms. People often don't know they have the disease until a bone breaks, frequently in a minor fall that wouldn't normally cause a fracture. A common occurrence is compression fractures of the spine. These can happen even after a seemingly normal activity, such as bending or twisting to pick up a light object. The fractures can cause severe back pain , but sometimes they go unnoticed. Either way, the vertebrae collapse down on themselves, and the person actually loses height. The hunchback appearance of many elderly women, sometimes called dowager's hump or widow's hump, is due to the effect of osteoporosis on the vertebrae.

Diagnosis

Certain types of doctors may have more training and experience than others in diagnosing and treating people with osteoporosis. These include a geriatrician, who specializes in treating the aged; an endocrinologist, who specializes in treating diseases of the body's endocrine system (glands and hormones); and an orthopedic surgeon, who treats fractures, such as those caused by osteoporosis.

Before making a diagnosis of osteoporosis, the doctor usually takes a complete medical history, conducts a physical examination, and orders x rays, as well as blood and urine tests, to rule out other diseases that cause loss of bone mass. The doctor may also recommend a bone density test. This is the only way to know for certain if osteoporosis is present. It can also show how far the disease has progressed.

Several diagnostic tools are available to measure the density of a bone. The ordinary x ray is one, though it's the least accurate for early detection of osteoporosis, because it doesn't reveal bone loss until the disease is advanced and most of the damage has already been done. Two other tools that are more likely to catch osteoporosis at an early stage are computed tomography scans (CT scans) and machines called densitometers, which are designed specifically to measure bone density.

The CT scan, which takes a large number of x rays of the same spot from different angles, is an accurate test, but uses higher levels of radiation than other methods. The most accurate and advanced of the densitometers uses a technique called DEXA (dual energy x-ray absorptiometry). With the DEXA scan, a double x-ray beam takes pictures of the spine, hip, or entire body. It takes about 20 minutes to do, is painless, and exposes the patient to only a small amount of radiationabout 1/50 that of a chest x ray.

In late 2001, Medicare began reimbursing for a test that measures bone resorption, an important measure for tracking a patient's response to osteoporosis therapy. The relatively inexpensive test measures a baseline amount, then compares amounts from later tests to track progress. The test consists of simple urine collection.

People should talk to their doctors about their risk factors for osteoporosis and if and when to have a bone density test. Ideally, women should have bone density measured at menopause and periodically afterward, depending on the condition of their bones. Men should be tested around age 65. Men and women with additional risk factors, such as those who take certain medications, may need to be tested earlier.

Treatment

Alternative treatments for osteoporosis focus on maintaining or building strong bones. They include nutritional and herbal therapies and homeopathy .

Nutritional therapy

A healthful diet low in fats and animal products and containing whole grains, fresh fruits and vegetables, and calcium-rich foods (such as dairy products, dark-green leafy vegetables, sardines, salmon, and almonds), along with nutritional supplements (such as calcium, magnesium , and vitamin D ) are important components of nutritional approaches to treating this disease.

Women should also eat more soy products such as tofu, soy burgers, or miso. Soy beans contain a substance called isoflavones which have estrogen-like activity. Isoflavones may help to increase bone density, alleviate hot flashes and other menopausal symptoms, lower the risk of cancer , and even reduce the risk of heart attacks. Natural hormone therapy, such as the use of soy products, is a safer alternative to synthetic estrogenic hormones, which may increase the risk of breast cancer .

In addition, women should avoid foods that may accelerate bone loss. They should avoid having too much salt in their diet, not only because salt raises the blood pressure but also because it may contribute to osteoporosis. They should also cut down on coffee, caffeinated sodas, and alcohol. High consumption of these beverages, studies have shown, are associated with accelerated drop in bone density and increase risk of bone fracture in old age. Caffeinated sodas are especially bad for the bones because in addition to containing caffeine , they also have high amounts of phosphoric acid. Phosphoric acid increases bone resorption, thus decreasing bone density.

Herbal supplements

Herbal supplements for osteoporosis emphasize such calcium-containing plants as horsetail (Equisetum arvense ), oat straw (Avena sativa ), alfalfa (Medicago sativa ), licorice (Glycyrrhiza glabra ), marsh mallow (Althaea officinalis ), and sourdock (Rumex crispus ). There are, however, few data from clinical trials to support the use of these herbs.

Homeopathy

Homeopathic remedies for osteoporosis focus on treatments believed to help the body absorb calcium. These remedies may include such substances as Calcarea carbonica (calcium carbonate) or Silica (flint). Again, there are few data other than isolated case reports regarding the effectiveness of these remedies.

Allopathic treatments

There are a number of good treatments for primary osteoporosis, most of them medications. For people with secondary osteoporosis, treatment may focus on curing the underlying disease.

Drugs

For most women who've gone through menopause, the best treatment for osteoporosis is hormone replacement therapy (HRT), also called estrogen replacement therapy. In addition to alleviating hot flashes, synthetic estrogens protect women against heart disease and they help to relieve and prevent osteoporosis. HRT increases a woman's supply of estrogen, which helps build new bone while preventing further bone loss.

Some women, however, do not want to take hormones because they have been linked to an increased risk of breast or uterine cancer . Other studies suggest that the risk is due to increasing age. Whether or not a woman takes hormones is a decision she should make carefully with her doctor. Most women take estrogen along with a synthetic form of progesterone, another female hormone. The combination helps protect against cancer of the uterus.

For people who can't or decide not to take estrogen, two other medications can be good choices. These are alendronate and calcitonin. Alendronate and calcitonin both stop bone loss, help build bone, and decrease fracture risk by as much as 50%. Alendronate (sold under the name Fosamax) is the first nonhormonal medication for osteoporosis ever approved by the FDA. It attaches itself to bone that's been targeted by bone-eating osteoclasts. It protects the bone from these cells. Osteoclasts help your body break down old bone tissue.

Calcitonin is a hormone that's been used as an injection for many years. A new version is on the market as a nasal spray. It too slows down bone-eating osteoclasts. Side effects of these drugs are minimal, but calcitonin builds bone by only 1.5% a year. Fosamax (alendronic acid) has proven safe in very large multi-year studies, and is now indicated for treatment of osteoporosis in most men. Several medications under study include other biphosphonates that slow bone breakdown (like alendronate), sodium fluoride, vitamin D metabolites, and selective estrogen receptor modulators.

Surgery

Unfortunately, much of the treatment for osteoporosis is for fractures that result from advanced stages of the disease. For complicated fractures, such as broken hips, hospitalization and a surgical procedure are required. In hip replacement surgery, the broken hip is removed and replaced with a new hip made of plastic, or metal and plastic. Despite often-successful surgeries, a large percentage of those who survive are unable to return to their previous level of activity, and many end up moving from self-care to a supervised living situation or nursing home. That's why prevention, getting early treatment, and taking steps to reduce bone loss are vital.

Expected results

There is no cure for osteoporosis, but it can be controlled. Most people who have osteoporosis fare well once they get treatment. The medicines available now build bone, protect against bone loss, and halt the progress of this disease.

Prevention

Building strong bones, especially before the age of 35, and maintaining a healthy lifestyle are the best ways of preventing osteoporosis. To build as much bone mass as early as possible in life, and to help slow the rate of bone loss later in life:

Get calcium in foods

Experts recommend 1,500 milligrams (mg) of calcium per day for adolescents, pregnant or breast-feeding women, older adults (over 65), and postmenopausal women not using hormone replacement therapy. All others should get 1,000 mg per day. Foods are the best source for this important mineral. Milk, cheese, and yogurt have the highest amounts. Other foods that are high in calcium are green leafy vegetables, tofu, shellfish, Brazil nuts, sardines, and almonds.

Take calcium supplements

Many people, especially those who don't like or can't eat dairy foods, don't get enough calcium in their diets and may need to take a calcium supplement. Supplements should be taken with meals and accompanied by six to eight glasses of water a day.

Get vitamin D

Vitamin D helps the body absorb calcium. People can get vitamin D from sunshine with a quick (1520 minute) walk each day or from foods such as liver, fish oil , and vitamin D fortified milk. During the winter months it may be necessary to take supplements. Four hundred mg daily is usually the recommended amount.

Avoid smoking and alcohol

Smoking reduces bone mass, as does heavy drinking. To reduce risk, do not smoke; and limit alcoholic drinks to no more than two per day. An alcoholic drink is 1.5 ounces of hard liquor, 12 ounces of beer, or 5 ounces of wine.

Exercise regularly

Exercising regularly builds and strengthens bones. Weight-bearing exercises, in which bones and muscles work against gravity, are best. These include aerobics, dancing, jogging, stair climbing, tennis, walking, and lifting weights. People who have osteoporosis may want to attempt gentle exercise, such as walking, rather than jogging or fast-paced aerobics, which increase the chance of falling. Try to exercise three to four times per week for 2030 minutes each time.

Resources

BOOKS

Brown, Susan E. Better Bones, Better Body: A Comprehensive Self-Help Program for Preventing, Halting and Overcoming Osteoporosis. New Canaan, CT: Keats Publishing, 1996.

The Burton Goldberg Group. Alternative Medicine: The Definitive Guide. Fife, WA: Future Medicine Publishing, 1995.

Hammond, Christopher. The Complete Family Guide to Homeopathy: An Illustrated Encyclopedia of Safe and Effective Remedies. New York: Penguin Books, 1995.

Murray, Michael and Joseph Pizzorno. Encyclopedia of Natural Medicine. Rocklin, CA: Prima Health, 1998.

Notelovits, Morris, with Marsha Ware and Diana Tonnessen. Stand Tall! Every Woman's Guide to Preventing and Treating Osteoporosis, 2nd ed. Gainesville, FL: Triad Publishing Co., 1998.

Zand, Janet, Allan N. Spreen, and James B. LaValle. Smart Medicine for Healthier Living: A Practical A-to-Z Reference to Natural and Conventional Treatments for Adults. Garden City Park, NY: Avery Publishing Group, 1999.

PERIODICALS

"Brittle bone relief for men." Chemist and Druggist (December 15, 2001):25.

"Test Gains Mandatory National Medicare Coverage." Health and Medicine Week (December 31, 2001):29.

ORGANIZATIONS

Arthritis Foundation. 1330 W. Peachtree St. PO Box 7669. Atlanta, GA 30357-0669. (800) 283-7800. http://www.arthritis.org.

National Osteoporosis Foundation. Suite 500, 1150 17th Street, NW. Washington, DC 20036-4603. (800) 223-9994. http://www.nof.org.

Mai Tran

Teresa G. Odle

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Tran, Mai; Odle, Teresa. "Osteoporosis." Gale Encyclopedia of Alternative Medicine. 2005. Encyclopedia.com. 30 Sep. 2016 <http://www.encyclopedia.com>.

Tran, Mai; Odle, Teresa. "Osteoporosis." Gale Encyclopedia of Alternative Medicine. 2005. Encyclopedia.com. (September 30, 2016). http://www.encyclopedia.com/doc/1G2-3435100586.html

Tran, Mai; Odle, Teresa. "Osteoporosis." Gale Encyclopedia of Alternative Medicine. 2005. Retrieved September 30, 2016 from Encyclopedia.com: http://www.encyclopedia.com/doc/1G2-3435100586.html

Osteoporosis

OSTEOPOROSIS

Osteoporosis is a bone disease that affects over ten million Americans and 1.4 million Canadians. Persons with this disease have low bone mass and structural deterioration of bone tissue. This causes the bone to become more fragile and more likely to fracture. Osteoporosis is often referred to as a "silent disease" because most people are unaware that they have the disease until they actually sustain a fracture. Although awareness of the disease is growing, many persons remain undiagnosed and undertreated.

Consequences of osteoporosis

Although osteoporosis increases the likelihood of any bone breaking, the typical sites are the wrist, hip, and vertebrae. It is estimated that at least one-half of the women and one-eighth of the men over age fifty will suffer an osteoporotic fracture in their lifetimes. Hip fractures are among the most devastating consequences of osteoporosis. Twenty percent of persons die within one year of breaking a hip and only one-third will regain their pre-fracture functional level. The morbidity from vertebral fractures is also considerable. The pain from an acute fracture can last weeks to months, and elderly persons in particular may require admission to hospital for pain management. Chronic back pain may occur, and persons with multiple vertebral fractures may lose height to the extent that their ribs rest painfully on the top of their pelvic bones. Economically, osteoporosis resulted in $13.8 billion of nursing home and hospital costs in the United States in 1995 alone.

Risks

Osteoporosis is a multifactorial disease. Although osteoporotic fractures occur most commonly in old age, risk factors can be traced back to childhood. A person's peak bone strength is established by the age of twenty. Although many people think of bone as an inert object, it is actually a living tissue, continually renewing itself to correct defects that occur from wear and tear. Cells called osteoclasts break down areas of bone and create cavities, which are then filled with new bone that is produced by the osteoblast cells. As we age, the rate of bone breakdown exceeds the rate of bone formation, and bone loss occurs at a rate of 1 percent each year. This increases to 2 to 5 percent per year during the first five years after menopause and also increases somewhat after the age of seventy-five. By the age of eighty, the average woman will have lost 30 percent of her skeleton. Thus, it can be understood that the larger the peak bone mass established in early life, the more will remain after years of progressive bone loss. A diet low in calcium and vitamin D and low physical activity in childhood decrease the peak bone mass and therefore increase the risk of osteoporosis. Premature menopause (natural or surgically induced) causes the rapid bone loss period associated with estrogen deficiency to occur earlier. Women, because of menopause, and because of a relatively lower peak bone density, are at higher risk that men. As bone loss occurs progressively through life, age itself is an important risk. Other risk factors include excessive alcohol use, caffeine consumption, race (white or Asian), a thin small frame, and a positive family history. Medical conditions such as hyperthyroidism and hyperparathyroidism, and drugs such as steroids and anticonvulsants, are also important contributors to osteoporosis.

Diagnosis

The diagnosis of osteoporosis is often not made until a typical osteoporotic fracture has occurred. However, patients can be diagnosed earlier by measuring bone density. This is most commonly done using an X-ray technique called a DEXA (dual energy X-ray absorptiometry) scan. The bone density of the person is then calculated as the number of standard deviations (SD) above or below the average value of a healthy young adult. The lower the bone density, the higher the risk of fracture. The WHO (World Health Organization) defines osteoporosis as a bone mineral density 2.5 SD below the young adult average. Other methods such as heel ultrasound and CT scans can also be used, although they have not been as extensively studied. Screening for osteoporosis is a controversial area and guidelines vary, but all recommend individual consideration of the person's risk factors and the treatment being considered.

Treatment

The best treatment for any disease is prevention. To maximize bone density, attention must be paid to ensuring adequate calcium and vitamin D intake, frequent weight-bearing exercise, and minimal alcohol and cigarette use from an early age. Estrogen and other medications such as bisphosphonates can decrease the amount of bone lost at the time of menopause. Persons requiring steroids for prolonged periods of time can be treated with bisphosphonates. Even among persons with established osteoporosis, there is much that can be done to reduce further bone loss, increase bone density, and, most importantly, prevent fractures. As many persons have a diet deficient in calcium and vitamin D, supplements are often needed to ensure a daily intake of 12001500 mg of elemental calcium and 400800 IU of vitamin D. Medications that decrease bone turnover include estrogen, SERMs (selective estrogen receptor modulators, such as raloxifene), bisphosphonates (such as etidronate, alendronate, and risedronate), and calcitonin. These have been proven to increase bone density and to reduce vertebral fractures. Estrogen, risedronate, and alendronate have also been proven to decrease the risk of hip fracture. The selection of the best medication for the individual person depends on their other illnesses and risk factors, consideration of potential side-effects, and cost. Although much attention is focused on increasing bone density, equally, if not more important, are measures to reduce the falls that lead to fractures. Exercise, especially balance and resistance training, has been proven to reduce falls. Many medications such as benzodiazepines, antidepressants, and antipsychotics increase the risk of falls and should be stopped or reduced if possible. Vision should be checked. Attention should also be paid to home safety. Throw rugs should be discarded or taped down, grab bars should be installed in the bathroom and there should be adequate lighting. The person should wear sturdy flat shoes and be encouraged to use a walking aid if required. Hip protectors, which are shorts with pads over the hip bone, can also prevent hip fracture.

Conclusion

In summary, osteoporosis is a common and underdiagnosed disease. The consequences of osteoporotic fractures are serious and include pain, functional decline, institutionalization, and death. However, today much can be done both to prevent osteoporosis and to treat established disease. Effective treatment to prevent fractures includes both medications to increase bone density and measures to prevent falls.

Janet Gordon

See also Arthritis; Balance and Mobility; Hip Fracture; Menopause; Physiological Changes; Organ Systems; Bone.

BIBLIOGRAPHY

Lauritzen, J. B.; Petersen M. M.; and Lund B. "Effect of External Hip Protectors on Hip Fractures." Lancet 341(2 January 1993): 1113.

"Osteoporosis: Review of the Evidence for Prevention, Diagnosis and Treatment and Cost Effectiveness Analysis." Osteoporosis International 8, Suppl 4. (1998): S1S88.

"Prevention and Management of Osteoporosis: Consensus Statements from the Scientific Advisory Board of the Osteoporosis Society of Canada." Canadian Medical Association Journal 155, no. 7 (1996): 921965.

Reid, I. R. "Pharmacological Management of Osteoporosis in Postmenopausal Women." Drugs & Aging 15, no. 5 (1999): 349363.

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Osteoporosis

Osteoporosis

Osteoporosis , which is characterized by a decrease in the mass of otherwise normal bone is the most common metabolic bone disease. Normal bone is made of a hard outer shell (the cortex) and an inner network of spicules (fibers), called trabeculae, that give bone its characteristic strength. Bone mass is maintained at a progressive and then constant level until around the age of thirty-five. This maintenance is accomplished through bone remodeling, a cycle of breaking down and building up of bone. This cycle is controlled by osteoblast cells, which make bone, and osteoclast cells, which destroy bone. Beginning around age forty, the rate at which bone breaks down can exceed that at which it is built, resulting in diminished mass and a diminished amount of calcium in the bone. For women, in addition to this normal age-related bone loss, menopause and its subsequent reduction in female hormone levels (specifically estrogen ) cause a specific loss in cortical and trabecular bone. In those who develop osteoporosis, the reduction in cortical and trabecular bone can be up to 30-40 percent, resulting in fragile bones that are prone to fracture.

Several factors contribute to the development of osteoporosis. Smoking, alcohol, and a sedentary lifestyle have all been shown to increase the risk of developing the disorder. Age and gender are also contributory factors. Women who have low estrogen levels (e.g., after menopause) are more likely to develop osteoporosis than others. Also, men generally maintain a higher bone density than women, making them less susceptible to the condition. Race can also play a role. Africans and people of African descent, for example, have a naturally higher bone density than Europeans and people of European descent and are therefore less likely to develop osteoporosis. A family history of osteoporosis certainly predisposes an individual to the condition, and research is currently underway to identify genes linked to it. Other risk factors include long-term steroid therapy, Cushing's disease, hyperparathyroidism, and hyperthyroidism.

Traditionally, low intake of calcium and vitamin D , both of which are essential to bone building and maintenance, have been associated with osteoporosis as well. However, the role of dietary calcium remains controversial. Countries in Europe and North America, where the dietary intake of calcium is adequate, still show very high rates of osteoporosis. Studies have shown that high-protein diets, like those found in Europe and North America, raise the body's calcium requirement, thereby creating a calcium deficit in some.

One of the difficulties in understanding and managing osteoporosis is that its signs and symptoms are not apparent until the late stages of the disease, and many people with the osteoporosis are not diagnosed or treated until a fracture occurs. Hip and wrist fractures are very common, and vertebral compression fractures can occur with as little stress as that from sneezing or bending. These compressions can cause chronic backaches or cause patients to seemingly "lose height" as the vertebrae progressively curve into what is known as the "dowager's hump." Fractures also occur in the ribs, pelvis, and humerus (upper arm bone). Hip fractures can be the most devastating, often leading to death or long-term disability.

The most commonly used method to diagnose osteoporosis is to measure bone mineral density using dual energy X-ray absorbitometry (DEXA scans). This test is performed routinely in people who have risk factors or a prior diagnosis of osteoporosis. Density is usually measured in the lower spine or the hip, and the procedure is noninvasive and well tolerated. Quantitative CT (computerized tomography) scans and densitometry are also used, though less commonly. Blood levels of calcium, phosphorus , and parathyroid hormonethree hormones directly involved in bone building and remodelingare usually normal. A more recent test that measures calcium excretion in urine may prove to be a helpful way of identifying risks for osteoporosis.

Early intervention and treatment of osteoporosis can halt or slow its progress. In some cases treatment can even reverse changes in bone density due to osteoporosis at least to a certain degree. Research regarding primary prevention of osteoporosis is ongoing. Supplements of dietary calcium and vitamin D, as well as weight-bearing exercises for the upper body, have been shown to slow bone loss. The use of supplementary estrogen (hormone replacement therapy) is very controversial. While estrogen has been shown to decrease bone loss and reduce the risks of certain fractures, it may also increase the risk of certain cancers and heart disease . Drugs called bisphosphonates stop osteoclast activity, increase bone density, and decrease the risk of fracture. In addition, supplements of calcitonin, a protein naturally made by the thyroid, can inhibit bone resorption by osteoclasts. It is important to identify those who may be at risk as early as possible, so that a healthy lifestyle, including a diet high in calcium and vitamin D, as well as exercise and early screening can be instituted.

According to the National Osteoporosis Foundation, 10 million people in the United States suffer from osteoporosis, while 34 million have early signs of bone density loss that could lead to osteoporosis (as of 2003). But despite what is known about populations at risk and potential treatments for osteoporosis, some research reports that up to 40 percent of Caucasian women in the postmenopausal age group will sustain an osteoporotic fracture during the course of their lifetime (see Schnitzer). Approximately 20 percent of those women who sustain hip fractures will die within one year of the fracture, and those who survive will most likely require nursing-home care (see Andreoli). As populations around the world live longer, osteoporosis may continue to be an epidemic, and understanding how to identify, diagnose, and treat populations at risk will be of paramount importance.

see also Aging and Nutrition; Calcium; Osteomalacia; Osteopenia; Rickets; Vitamins, Fat-Soluble; Women's Nutritional Issues.

Seema P. Kumar Neela Pania

Bibliography

Andreoli T. E., ed. (2001). "Osteoporosis." In Cecil Essentials of Medicine, 5th edition. Philadelphia: W. B. Saunders.

Looker A. C.; Orwell, E. S.; Johnston C. C., Jr.; et al. (1997). "Prevalence of Low Femoral Bone Density in Older U.S. Adults from NHANES III." Journal of Bone Mineral Research 12:17611768.

Internet Resources

National Osteoporosis Foundation. <http://www.nof.org>

Schnitzer, T. J. (2002). "Diagnosis and Treatment for Osteoporosis: Current Status and Expectations for the New Millennium." Available from http://www.medscape.com/viewprogram/605.

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osteoporosis

osteoporosis is a condition in which the bones become porous and weak, and therefore fracture easily. The bone tissue is normal with a normal shape but it has lost mass and density and so lacks sufficient strength to withstand the forces which normally occur in daily life. There are no symptoms initially and the condition is often diagnosed only when a bone fracture occurs unexpectedly. These fractures occur in a third of all women and in one in twelve men. Post-menopausal and senile osteoporosis are recognized. The former is due to loss of oestrogen, the latter includes a time-dependent loss of bone common to men and women. Osteoporosis also occurs as a side-effect of some drug treatments, with oral corticosteroids for example, and occasionally, in a severe and little understood form at much younger ages.

Osteoporosis is often confused with osteoarthritis, another chronic problem of later life. However, osteoarthritis is a disease of the joints which is rare in those who have osteoporosis (unless they have been treated with corticosteroids).

Osteoporosis is not a disease like those caused by viral or bacterial infection, but a long term consequence of a small imbalance in the natural process of bone remodelling. Bone is a living tissue which constantly remodels itself through a process of resorption and formation known as bone turnover. Most processes in the body slow down as we grow older but bone turnover speeds up and the balance tips in favour of resorption, resulting in net bone loss. A greater imbalance develops in some people than in others and they are the ones who will suffer from osteoporosis, especially if they began with relatively low bone mass in middle age. This variation is to a large extent genetically determined, but lifestyle factors also contribute, including smoking, lack of exercise, low dietary calcium intake and, in the elderly, lack of vitamin D. Individuals who are small and thin are at greater risk because of their low bone mass compared with heavier individuals. Women who had an early menopause, or whose menstrual periods failed when they were young perhaps due to anorexia, are also at increased risk because the skeleton has had more prolonged exposure to a low oestrogen level. Although the process of resorption and formation is at the root of the osteoporotic condition, it is nevertheless a useful process which ensures that bone can repair minor damage and remodel itself in response to changing mechanical loads. It means that bone can respond positively to exercise and to drug treatments. Most of the effective drugs, such as bisphosphonates and hormone replacement therapy (HRT), act by slowing down resorption and therefore slowing the rate of loss of bone or tipping the balance in favour of formation.

The sites most commonly affected by osteoporosis are the wrist, the vertebrae in the spine, and the top of the femur (the hip). Vertebral fractures lead to collapse of the vertebrae which results in substantial loss of height or marked curvature of the spine (the Dowager's hump) and sometimes severe pain. Hip fractures occurring in the elderly in Britain cost the NHS nearly £1 billion in 1997 and the fracture rate has been rising faster than the increase in the number of elderly people in the population. The mortality rate following hip fracture is high and survivors usually suffer loss of independence and mobility. Both of these manifestations of osteoporosis were considered to be part of the normal ageing process until the middle of the twentieth century, and it was not until 1986 that the National Osteoporosis Society was established to provide support for sufferers, and advice and reliable information about the disease, which are still not widely available.

The osteoporotic condition develops slowly until so much bone has been lost that a threshold of vulnerability is reached and irreversible damage is likely. Preventative strategies are needed before this fragile state is reached. HRT is particularly useful for preventing post-menopausal loss in potentially vulnerable women. Adequate dietary calcium is essential. Dairy products such as cheese, yoghurt, and milk are rich in calcium. A pint of skimmed milk contains 700 mg which is the daily intake recommended in Britain. Smoking should be avoided, including passive smoking: it is known to interfere with the effect of oestrogen on bone. Excessive amounts of alcohol or caffeine (in tea, coffee, and coke) are also associated with a higher risk of osteoporosis.

The natural stimulus for bone to maintain its functional strength is the loading which results from gravitational forces and the tensions exerted by muscular activity. Astronauts lose bone while floating in space and so do patients who are confined to bed for long periods. Conversely, physically active people have higher bone mineral density compared with those who are sedentary. Exercise therefore has a role in reducing the long-term risk of osteoporotic fracture. The most effective exercise provides a regular series of varied short sharp loads to the sites which are most vulnerable for fracture. Brief exposure such as running up and down stairs a few times each day may be enough. Intermittent jogging (‘scouts' pace’) is useful, and so is weight-training, provided that over 70% of personal maximum effort is used in lifting slowly with a few repetitions. Research is still ongoing to find the best prescriptions. Improvements can probably occur at any age, but the increases appear to be largest before adolescence, and in later life vigorous exercise is obviously only safe for those who still have a robust skeleton. Bone changes slowly, improvements take months, and if the exercise is discontinued they are gradually lost again. In older people moderate exercise may prevent further loss of bone, and since fracture risk is only likely when bone density has fallen below a threshold value, maintenance is useful.

Joan Bassey

Bibliography

The National Osteoporosis Society publishes booklets. Helpline 01761 471771.


See also bone; hormone replacement therapy; menopause.

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COLIN BLAKEMORE and SHELIA JENNETT. "osteoporosis." The Oxford Companion to the Body. 2001. Retrieved September 30, 2016 from Encyclopedia.com: http://www.encyclopedia.com/doc/1O128-osteoporosis.html

Osteoporosis

OSTEOPOROSIS

Osteoporosis (literally "porous bone") is a condition characterized by bone fragility and fracturing. The World Health Organization (WHO) defines osteoporosis as a 25 percent reduction of bone mineral density (BMD) compared to that of a healthy young adult female.

Eight million Americans have osteoporosis, and over 20 million have osteopenia (thin bones, or a loss of 10 to 25% of bone mineral density). Osteoporosis is most prevalent in Caucasians, less prevalent in Hispanics, and least prevalent in African Americans. Key predisposing factors are early menopause and a family history of osteoporosis. Other medical, psychological, and social factors may also contribute to the condition.

Osteoporosis commonly leads to fractures. Medical, social, and environmental factors that predispose people to osteoporosis-related fractures include impairment of hearing, vision, balance and cognition; debilitating illnesses; medications; postoperative conditions; and unsafe environments. In the United States, one of three females over age sixty-five will have at least one vertebral fracture. The ratio of female to male fractures of a hip is 2.5 to one. Two hundred and fifty thousand hip or wrist fractures and 500,000 vertebral fractures occur annually in the United States. Up to 15 percent of hip fractures will result in death within one year, and one of three survivors become long-term nursing home residents. The annual cost of osteoporosis in the United States is estimated to be as high as $18 million and is projected to reach $240 million by the year 2040.

There are several methods to measure bone mineral density for osteoporosis detection. The most precise is dual energy X-ray absorptiometry (DXA) of the hip. Blood and urine tests for bone resorption and formation are also used to help measure the response to therapy.

The four components of treatment are nutrition, medication, exercise, and safety. Nutritional factors are particularly important during childhood and adolescence when the bones are growing. Key components are calcium and vitamin D, supplemented by magnesium; and vitamins C and K for individuals with chronic diarrhea or on a low-vegetable diet.

Hormonal therapiesestrogens for postmenopausal females and testosterone for hypogonadal malesare widely utilized. Estrogens may be contraindicated by breast or uterine cancer or by susceptibility to vascular clotting, and prostatic disorders may preclude the use of testosterone. Bisphosphonates are potent antiresorptive drugs that can yield reductions in hip and vertebral fracturing. Use of calcitonin, another antiresorptive drug, has also shown reductions in vertebral fracturing.

Exercise and safety are essential components of fracture prevention. Vigorous weight-bearing activities are beneficial but not feasible for the elderly or infirm. Walking has not proved efficacious. Resistive exercises increase the muscle strength and bone mineral density essential to fracture prevention. Balanceenhancing activities such as dancing, careful attention to minimizing hazards in the home and work environments, and selective use of padded hip protectors for the aged and infirm all help reduce the risk of osteoporosis-related fractures.

Osteoporosis is a major and growing public health concern. Appropriate screening to identify those who are susceptible, accurate diagnosis of osteoporosis and related disorders, and prompt institution and monitoring of appropriate therapies are all essential to minimize the risks of fracture and the attendant mortality and morbidity.

Robert L. Swezey

(see also: Hip Fractures )

Bibliography

Melton, L. J., III (2000). "Perspective: Who Has Osteoporosis? A Conflict Between Clinical and Public Health Perspectives." Journal of Bone and Mineral Research 15(12):23092314.

Scheiber, L. B., II, and Torregrosa, L. (1988). "Evaluation and Treatment of Postmenopausal Osteoporosis." Seminars in Arthritis and Rheumatism 27(4):245261.

Swezey, R. L. (2000). "Osteoporosis: Diagnosis, Pharmacological, and Rehabilitation Therapies." Critical Reviews in Physical and Rehabilitation Medicine 12(3):229269.

Youm, T.; Koval, K. J.; and Zuckerman, J. D. (1999). "The Economic Impact of Geriatric Hip Fractures." American Journal of Orthopedics 28(7):423428.

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osteoporosis

osteoporosis (ŏs´tēō´pərō´sĬs), disorder in which the normal replenishment of old bone tissue is severely disrupted, resulting in weakened bones and increased risk of fracture; osteopenia results when bone-mass loss is significant but not as severe as in osteoporosis. Although osteoporosis can occur in anyone, it is most common in thin white women after menopause.

Bone mass is typically at its greatest during a person's mid-twenties; after that point there is a gradual reduction in bone mass as bone is not replenished as quickly as it is resorbed. In postmenopausal women the production of estrogen, a hormone that helps maintain the levels of calcium and other minerals necessary for normal bone regeneration, drops off dramatically, resulting in an accelerated loss of bone mass of up to 3% per year over a period of five to seven years. Smoking, excessive alcohol consumption, and a sedentary lifestyle increase the risk of bone-mass loss; a diet high in protein and sodium also speed calcium loss. The disorder also has a genetic component. A vitamin D receptor gene that affects calcium uptake and bone density has been identified, and the different forms of this gene appear to correlate with differences in levels of bone density among osteoporosis patients.

Osteoporosis has no early symptoms and is usually not diagnosed until a fracture occurs, typically in the hip, spine, or wrist. A diagnostic bone density test is thus recommended as a preventive measure for women at high risk. Treatment can slow the process or prevent further bone loss. Estrogen replacement therapy for postmenopausal women is effective but has potential side effects. Calcitonin, a thyroid hormone, is administered in some cases. Nonhormonal drugs for the treatment of osteoporosis include alendronate (Fosamax) and risedronate (Actonel), bisphosphonates that decrease bone resorption, and raloxifene (Evista), a selective estrogen receptor modulator that can increase bone mineral density. Teriparatide (Forteo), which consists of the biologically active region of human parathyroid hormone, stimulates the activity of osteoblasts, the specialized cells that form new bone. Dietary and supplemental calcium and vitamin D are usually recommended for people at risk, but a seven-year study of more than 36,000 women over 50 that was released in 2006 found that supplements conferred little benefit. Exercise, including weight training, has been found to strengthen bones directly and to improve muscle strength and balance and thus minimize the chance of falls.

See M. Hegsted, Advances in Nutrition Research, Vol. 9: Nutrition and Osteoporosis (1994).

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Osteoporosis

OSTEOPOROSIS

DEFINITION


The word "osteoporosis" literally means "porous bones." Osteoporosis (pronounced OSS-tee-o-puh-RO-sis) occurs when bones begin to lose some of their essential elements. The most important of these elements is calcium. Over time, bone mass decreases. As a result, bones lose their strength, become fragile, and break easily. In extreme cases, even a sneeze or a sudden movement may be enough to break a bone.

DESCRIPTION


Osteoporosis is a serious health problem. About 28 million people in the United States have the condition. It is responsible for about 1.5 million fractures (broken bones) each year. The most common locations where breaks occur are the hip, spine, and wrist. Hip and spine injuries are the most serious. They often require hospitalization and major surgery. They may also lead to other serious consequences, including permanent disability and death.

Osteoporosis: Words to Know

Alendronate:
A drug used to treat osteoporosis in women who have passed through menopause.
Calcitonin:
A drug used to treat osteoporosis in women who have passed through menopause.
Calcium:
An essential mineral with many important functions in the body, one of which is in the formation of bone.
Computed tomography (CT) scan:
A diagnostic technique in which a specific region of the body is X-rayed from many angles. A computer then combines the various X-ray photographs.
Computerized axial tomography (CAT) scan:
Another name for a computed tomography (CT) scan.
Densitometry:
A technique for measuring the density of bone by taking photographs with low-energy X rays from a variety of angles around the bone.
Estrogen:
A female hormone with many functions in the body, one of which is to keep bones strong.
Hormone replacement therapy (HRT):
A method of treating osteoporosis by giving supplementary doses of estrogen and/or other female hormones.
Menopause:
The period in a woman's life when she stops menstruating.
Protein:
A type of chemical compound with many essential functions in the body, one of which is to build bones.
Resorption:
The process by which the elements of bone are removed from bone and returned to the body.

To understand osteoporosis, it is helpful to understand how bones form. Bone is living tissue that is constantly renewed in a two-stage process. The first stage is formation. During formation, new bone tissue is built up from nutrients present in the bloodstream. The second stage is resorption. In this stage, bone cells break down. The elements of which are returned to the blood and other body fluids.

For about the first thirty years of life, bone formation takes place faster than resorption. Bones grow to be larger and stronger during this period. After middle age, resorption takes place faster and bones become smaller and weaker.

Osteoporosis is a continuation of this process. The balance between resorption and formation becomes very one-sided. Almost no new bone is formed, but bone continues to be removed. When bones are made smaller and weaker by this mechanism, the process is called primary osteoporosis.

Osteoporosis can also occur in another way. Some drugs and diseases can increase the rate at which resorption occurs. The end result is the same: bones become smaller and weaker. In this case, however, the process is called secondary osteoporosis.

Osteoporosis occurs most commonly in older people. It affects nearly half of all men and women over the age of seventy-five. Women are five times more likely than men to develop the condition. They have smaller, weaker bones to begin with, so resorption of bone material in women's bodies has a greater effect than in men's bodies.

Another important factor in osteoporosis is menopause. Menopause is the period in a woman's life when she stops menstruating. During this period, she also stops producing the hormone estrogen. Estrogen helps prevent the resorption of bone. As levels of estrogen fall in a woman's body, she is at greater risk for osteoporosis.

CAUSES


As outlined, osteoporosis is caused when the rate of bone resorption becomes greater than the rate of bone formation. This process is a normal part of aging. There are certain factors, however, that increase a person's risk for osteoporosis. These factors include:

  • Gender. Women are more likely to have osteoporosis than men. Women commonly lose 30 percent to 50 percent of their bone mass over their lifetimes. Men lose about 20 percent to 35 percent of their bone mass.
  • Race. Caucasian and Asian women are at somewhat higher risk for osteoporosis than are African American and Hispanic women.
  • Body structure. Individuals with smaller, thinner bones are at higher risk for osteoporosis.
  • Early menopause. Women who go through menopause earlier start losing bone mass earlier. Early menopause may be caused by a number of factors, such as heredity, surgery, vigorous exercise, anorexia (see anorexia nervosa entry), and bulimia (see bulimia nervosa entry).
  • Lifestyle. Alcohol consumption and tobacco use are thought to increase risk for osteoporosis. Lack of exercise may have the same effect.
  • Diet. Two important nutrients needed for bone formation are protein and calcium. A diet low in either of these nutrients may lead to osteoporosis.

SYMPTOMS


Osteoporosis is sometimes called the "silent disease." The term reflects the fact that the condition usually has no symptoms. People often don't know they have the disorder until they break a bone during some minor accident.

As osteoporosis develops, changes in body structure may occur. A person may actually grow shorter. This change occurs when vertebrae (bones in

the spine) deteriorate and collapse. Loss of vertebrae mass can also result in the condition known as "dowager's hump" or "widow's hump." This condition is characterized by the hunchbacked appearance often seen in older women.

DIAGNOSIS


The only way to diagnose osteoporosis with certainty is with X rays. Ordinary X-ray techniques, like those used for chest X rays, are usually not very helpful. They do not show bone loss until the disease has progressed and extensive damage has occurred.

Computed tomography (CT) scans may be more helpful. In a CT scan, a specific region of the body is X-rayed from many angles. A computer then combines the various X-ray photographs. CT scans are not the best choice for diagnosing osteoporosis, however, because they require relatively high levels of radiation. Another common name for a CT scan is a computerized axial tomography (CAT) scan.

A better method for diagnosing osteoporosis is densitometry (pronounced DEN-si-TOM-i-tree). Densitometry is also a technique for X-raying bones. However, the amount of radiation used is very low. The X rays are taken from different angles and can show how much bone has been lost.

Some doctors recommend that people be tested on a regular basis for bone loss. For women, those tests should begin after menopause. For men, they should begin after the age of sixty-five. Such tests are important since there are seldom other signs of osteoporosis.

TREATMENT


Treatment depends on the form of osteoporosis a patient has. If a patient has secondary osteoporosis, treatment is aimed at curing the disease that has caused osteoporosis. In the case of primary osteoporosis, medications are used to adjust the balance between bone resorption and bone formation. Treatment may also be necessary for bone fractures resulting from osteoporosis. The most common treatment for such fractures is surgery.

Drugs

For women who have gone through menopause, the first line of treatment may be hormone replacement therapy (HRT). In hormone replacement therapy, a woman is given the estrogen that her body no longer produces on its own. The estrogen can be given orally (by mouth) or by injection. Many women choose HRT for other reasons as well. It helps ease the symptoms of menopause. It can also protect against heart disease, the number-one killer of women in the United States. HRT does have some harmful side effects, however. For example, it may increase a woman's risk for breast cancer (see breast cancer entry).

Other medications can be used to treat osteoporosis. These medications reduce the rate of bone resorption and/or increase the rate of bone formation. The two most common drugs used for these purposes are alendronate and calcitonin. These drugs may be given by injection or in the form of nose sprays.

Surgery

In advanced stages of osteoporosis, major fractures are common. In such cases, surgery may be required to repair the fracture. One of the most common procedures is hip replacement surgery. Hip replacement surgery is used to repair a broken hip. The original hip is removed and replaced with an artificial metal and/or plastic hip. Hip replacement surgery is usually quite successful. Patients can often return

to a relatively normal life. However, the surgery carries some serious risks. The death rate following such surgery may be 5 percent to 20 percent greater than for others of the same age group who have not had surgery.

Alternative Treatment

The primary approach for most alternative practitioners is the same as it is in traditional medicine. The goal is to make sure that individuals receive the nutrients they need to build strong bones in their daily diet. This means a diet rich in calcium and protein, including foods such as dairy products, dark-green leafy vegetables, sardines, salmon, and almonds. Nutritional supplements such as vitamin D, calcium, and magnesium may also be recommended.

Herbalists and Chinese medicine practitioners believe that certain herbs can slow the rate of bone loss. Among the products they recommend are horsetail, oat straw, alfalfa, licorice, marsh mallow, yellow dock, and Asian ginseng. Homeopathic practitioners recommend minerals such as Calcarea carbonica or silica. A substitute for HRT is to obtain hormones from natural sources, such as soybeans and wild yams.

PROGNOSIS


There is no cure for osteoporosis. However, it can be controlled quite well once it has been diagnosed. Medications, nutritional supplements, and a diet rich in calcium and protein can help slow the progress of the disorder.

PREVENTION


To a significant extent, osteoporosis is a preventable disease. People can take a number of steps beginning early in life to build strong bones. By continuing those practices as they grow older, they can reduce the rate of bone loss. Some of these steps include:

  • Get calcium in foods. Foods rich in calcium include milk, cheese, yogurt, and other dairy products; green leafy vegetables; tofu; shellfish; Brazil nuts; sardines; and almonds.
  • Take calcium supplements. A person can be certain of getting enough calcium by taking supplements in the form of pills.
  • Get enough vitamin D. Vitamin D helps the body absorb calcium. The easiest way to get vitamin D is from sunshine. A fifteen-minute walk each day usually provides all the vitamin D one needs. Foods rich in vitamin D include liver, fish oil, and milk fortified with vitamin D.
  • Avoid or limit smoking and the use of alcohol. Both smoking and alcohol use seem to increase the rate of bone loss. By limiting both activities, the risk of osteoporosis may be reduced.
  • Exercise. Regular exercise builds strong bones. The forms of exercise likely to be most effective include aerobics, dancing, jogging, stair climbing, tennis, walking, and lifting weights. Experts recommend twenty to thirty minutes of exercise three to four times a week.

FOR MORE INFORMATION


Books

Brown, Susan E. Better Bones, Better Body: A Comprehensive Self-Help Program for Preventing, Halting, and Overcoming Osteoporosis. New Canaan, CT: Keats Publishing, 1996.

Notelovits, Morris, with Marsha Ware and Diana Tonnessen. Stand Tall! Every Woman's Guide to Preventing and Treating Osteoporosis, 2nd ed. Gainesville, FL: Triad Publishing Co., 1998.

Periodicals

Bilger, Burkhard. "Bone Medicine." Health Magazine (MayJune 1996): pp. 12528.

Braun, Wendy. "Do Your Bones Pass the Test?" Saturday Evening Post (MarchApril 1997): pp. 1822+.

Organizations

Arthritis Foundation. 1330 West Peachtree Street, Atlanta, GA 30309. (404) 8727100. http://www.arthritis.org.

National Institutes of Health. Osteoporosis and Related Bone Diseases: National Resource Center. 1232 22nd St. NW, Suite 500, Washington, DC 20037-1292. (800) 624-BONE. http://www.osteo.org.

National Osteoporosis Foundation. 1232 22nd Street NW, Washington, DC 20037-1292. (202) 223-2226. http://www.nof.org.

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Osteoporosis

Osteoporosis

Prevalence of Osteoporosis

Types and Causes of Osteoporosis

Signs and Symptoms

Diagnosing Osteoporosis

Treatment Options

Early Prevention

Resources

Osteoporosis (os-te-o-po-RO-sis) is a disorder in which there is loss of bone density) which increases the likelihood of fracture.

KEYWORDS

for searching the Internet and other reference sources

Aging

Bones

Menopause

Skeletel System

Bone consists of two layers: a compact outer layer, called cortical bone, and a porous inner layer, called spongy (or cancellous) bone. Osteoporosis weakens mostly bones with a large percentage of spongy bone. These include the vertebrae (bones of the spine), the hips, and the wrists. Bones of this kind are more fragile and are especially prone to fracture when affected by osteoporosis.

Osteoporosis develops gradually over time, although rates vary in different individuals. It results from an imbalance in the normal process in which bone is constantly being broken down and replaced by new bone. In osteoporosis, the rate at which bone tissue is lost exceeds the rate at which it is replaced. This imbalance results in an overall loss of bone.

Prevalence of Osteoporosis

No one can say how many people have osteoporosis, because it develops gradually and merges with the natural process of aging. However, it is known that women are much more likely to develop the disorder than men, and that people of European ancestry have a higher incidence of osteoporosis than people of African ancestry.

Often, a person can have osteoporosis but not be aware of it until she fractures a bone. Typically, this happens in a fall that would not have caused the fracture to occur in a young adult. It has been estimated that in the United States osteoporosis is responsible for more than 1.2 million bone fractures each year. Among women, surveys indicate that at least 10 percent of those over age 50 have bone loss severe enough to increase the risk of fractures of the spine, hip, or long bones.

Types and Causes of Osteoporosis

Osteoporosis is classified as primary or secondary, depending on whether there is some other condition or abnormality causing the bone loss.

Primary osteoporosis

Primary osteoporosis is the most common form of the disorder. It has been divided further into age-related osteoporosis, postmenopausal osteoporosis, and idiopathic (of unknown cause) juvenile osteoporosis. Age-related (or senile) osteoporosis occurs mostly in elderly people whose bones have become significantly thinner owing to their advanced age. Postmenopausal osteoporosis results from the acceleration of bone loss in women after they have reached menopause*, when their ovaries have stopped producing estrogen, a hormone that helps maintain bone mass.

*menopause
(MEN-o-pawz) is the time of life when women stop menstruating (having their monthly period) and can no longer become pregnant.

The amount of bone mass a person has as a young adult when the skeleton is mature is believed to be related to the likelihood of developing osteoporosis after middle life. It is believed that the generally greater incidence* of osteoporosis in women than in men, and in people of European background than in those of African origin, is due largely to their lower skeletal density as young adults. Moreover, the density of bone in a persons skeleton in young adulthood is partly determined by his or her genes* (inherited), and people with lighter skeletons who develop osteoporosis in later life are likely to have relatives with the same condition.

*incidence
means rate of occurrence.
*genes
are chemicals in the body that help determine a persons characteristics, such as hair or eye color. They are inherited from a persons parents and are contained in the chromosomes found in the cells of the body

Juvenile osteoporosis is rare and occurs in boys and girls before they reach their teens. It may last 2 to 4 years until normal bone growth resumes. Another uncommon form occasionally develops in young adults.

Secondary osteoporosis

A condition is said to be secondary when it is caused by something else not functioning correctly. Secondary osteoporosis may have several causes. Immobility, as in someone with a paralytic disease, can cause the bones to thin and become brittle. This effect also has been observed in astronauts who have undergone prolonged periods of weightlessness in space. (It is difficult to get proper exercise when there is no gravity to work against.)

Additional causes of secondary osteoporosis include hormonal diseases, such as hyperthyroidism, and estrogen loss caused by failure or removal of the ovaries*. Nutritional disorders such as anorexia nervosa can also lead to osteoporosis. Smoking and heavy consumption of alcoholic beverages are thought to be strong contributing factors in some cases of osteoporosis.

*ovaries
are the sexual glands in which eggs are formed in women and the female hormone estrogen is produced.

Signs and Symptoms

Osteoporosis does not always produce obvious symptoms. That is why an older person may first learn of his or her condition after breaking a bone in a fall. An x-ray then reveals the decreased bone density.

It has been estimated that 70 percent of fractures in people age 45 and older can be attributed to osteoporosis. About one third of women older than age 65 will have fractures of the vertebrae. The ratio of women to men experiencing spinal fractures is about 8 to 1. By the time people reach very advanced age, one third of women and one sixth of men will have broken a bone in the hip. Another common site of fracture is the forearm bone (radius) just above the wrist.

The thinning vertebrae in a person with osteoporosis may collapse spontaneously. Called compression fractures, these breaks can cause severe pain, usually in the mid or lower back. Chronic, or long-lasting, pain may develop after several such fractures have occurred. The person may gradually lose inches of height, and the upper back often curves forward. These signs and symptoms typically develop in women within 20 years after menopause if osteoporosis is not treated.

Diagnosing Osteoporosis

A diagnosis of osteoporosis is usually made by noting the persons physical appearance in general and the spine in particular. X-rays can reveal that the bones are less dense than normal. Special imaging techniques, including photon densitometry (FO-ton den-si-TOM-e-tree), are also used to detect osteoporosis.

In some instances, a blood test and bone biopsy (removal of a tiny sample of bone for examination) may be used to rule out the possibility of osteomalacia (OS-te-o-ma-LAY-she-a), a closely related condition in adults that results from a lack of vitamin D.

Treatment Options

If osteoporosis is not treated, the loss of bone density may continue. The risk of fractures will increase correspondingly as the person ages. Treatment is aimed primarily at stopping the bone loss.

Medications

Calcium supplements in tablet form at recommended dosages are safe, inexpensive, and effective. Still more effective is treatment with the hormone estrogen, but this can have harmful side effects. Doctors may or may not prescribe estrogens, depending largely on other health considerations in individual patients. Other drugs such as calcitonin can prevent bone loss and may be given to women who do not take estrogen.

Certain drugs taken to treat other conditions may have the additional effect of causing bone loss. The use of such medications may have to be curtailed or adjusted for people who have osteoporosis. Cortisone, thyroid hormone, and diuretics (used for various disorders to increase the flow of urine) are examples of drugs that can cause loss of bone density.

Men who develop osteoporosis usually are not given hormone treatment but take calcium supplements and can be given some of the newer drugs available.

Lifestyle

General measures that can be taken to slow further loss of bone include undertaking a regular program of exercise (including long walks or some equivalent activity), quitting smoking, and drinking alcoholic beverages only in moderation. Good eating habits are important, and a balanced diet should include adequate calcium, vitamins, and other nutrients. Elderly people need to take precautionary measures to avoid falls.

Calcium Supplements

Calcium is essential for developing strong bones and teeth and for the proper function of heart, muscles, and the nervous system. Getting enough calcium is especially important for children, adolescent females, and pregnant women. Studies have shown that proper bone development in adolescent females can lessen the effects of osteoporosis later in life. If the diet does not provide enough calcium (for example, when someone is allergic to dairy products), calcium supplements can help make up the difference.

Calcium is usually found in foods and supplements as a saltthat is, the calcium is chemically combined with another element or compound. It is important to read the label of any calcium supplement to find out how much calcium it supplies and in what form of salt it is. Some peoples bodies have problems absorbing particular forms of calcium; such persons should avoid calcium supplements with those salts.

Pain Relief

Standard pain-relieving drugs, such as aspirin, and heat applications can be used for back pain. Posture training and special exercises for the stomach and back muscles can have long-term benefits in reducing pain and discomfort. Occasionally a back brace may be necessary to provide support.

Early Prevention

The best time to start taking steps to prevent osteoporosis is during the childhood and teen years. This is particularly so for young women with lightweight skeletons and small bones and who have close relatives with osteoporosis. As in older people, getting plenty of regular exercise is important, as is calcium in the diet. It is estimated that more than 70 percent of children and teenagers fail to consume adequate amounts of calcium in their diets. Foods rich in calcium include milk and other dairy products, green leafy vegetables, citrus fruits, fish such as sardines and mackerel, and shellfish. The aim is to achieve full, normal bone density in the skeleton at maturity

Lifestyle choices such as not smoking and limiting alcohol use are important. Also to be avoided are fad diets that promise rapid weight loss. While exercise, particularly supervised weight training, is important in the prevention of osteoporosis, excessive exercise in teenage girls and young women can have the opposite effect. Extreme amounts of exercise (especially if it is combined with dieting and weight loss) can cause the stopping of menstrual periods and decreased estrogen levels in the body. Significant bone loss can be a result.

Did You Know?

  • The thinning of bones due to osteoporosis is believed responsible for more than 1.2 million fractures in the United States each year.
  • Someone can have osteoporosis and not know it.
  • Spinal curvature in the elderly is a common sign of osteoporosis.
  • People can lose several inches of height as a result of osteoporosis.
  • The great majority of people with osteoporosis are women.
  • Young women in their teens with small bones can take important steps to avoid osteoporosis in later life.

See also

Broken Bones and Fractures

Eating Disorders

Thyroid Disease

Resources

Books

Bonnick, Sydney Lou. The Osteoporosis Handbook. Dallas, TX: Taylor Publishing Company, 1997. Provides further information on the disorder in nontechnical language and is fully illustrated.

Germano, Carl. The Osteoporosis Solution: New Therapies for Prevention and Treatment. New York: Kensington Publishing Corporation, 1999. Emphasizes nutrition as it relates to osteoporosis.

Organizations

The National Institutes of Health posts information about osteoporosis on its website.
http://www.nih.gov/niams/healthinfo/opbkgr.htm

The National Osteoporosis Foundation posts relevant information onits website.
http://www.nof.org

Osteoporosis and Related Bone DisordersNational Resource Center also maintains a website with useful information.
http://www.osteo.org

The U.S. Centers for Disease Control and Prevention (CDC), located in Atlanta, Georgia, posts information about osteoporosis at its website.
http://cdc.gov/nceh/

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osteoporosis

osteoporosis (osti-oh-por-oh-sis) n. loss of bony tissue, resulting in bones that are brittle and liable to fracture. Infection, injury, and synovitis can cause localized osteoporosis. Generalized osteoporosis is common in the elderly, and in women often follows the menopause. Increased calcium and vitamin D intake and exercise are preventative, and bisphosphonates or raloxifene can reduce or halt further bone loss.
osteoporotic adj.

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osteoporosis

osteoporosis Condition where there is loss of bone substance, resulting in brittle bones. It is common in older people, especially in women following the menopause; it may also occur as a side-effect of prolonged treatment with corticosteroid drugs. There is no cure, but it may be treated with calcium supplements. Hormone replacement therapy (HRT) may help to prevent its occurence in post-menopausal women.

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osteoporosis

os·te·o·po·ro·sis / ˌästēōpəˈrōsis/ • n. a medical condition in which the bones become brittle and fragile from loss of tissue, typically as a result of hormonal changes, or deficiency of calcium or vitamin D. DERIVATIVES: os·te·o·po·rot·ic / -ˈrätik/ adj.

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osteoporosis

osteoporosis Degeneration of the bones with advancing age due to loss of bone mineral and protein as a result of decreased secretion of hormones (oestrogens in women and testosterone in men). A high calcium intake in early life may be beneficial, since this may result in greater bone density at maturity.

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DAVID A. BENDER. "osteoporosis." A Dictionary of Food and Nutrition. 2005. Encyclopedia.com. 30 Sep. 2016 <http://www.encyclopedia.com>.

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osteoporosis

osteoporosisglacis, Onassis •abscess •anaphylaxis, axis, praxis, taxis •Chalcis • Jancis • synapsis • catharsis •Frances, Francis •thesis • Alexis • amanuensis •prolepsis, sepsis, syllepsis •basis, oasis, stasis •amniocentesis, anamnesis, ascesis, catechesis, exegesis, mimesis, prosthesis, psychokinesis, telekinesis •ellipsis, paralipsis •Lachesis •analysis, catalysis, dialysis, paralysis, psychoanalysis •electrolysis • nemesis •genesis, parthenogenesis, pathogenesis •diaeresis (US dieresis) • metathesis •parenthesis •photosynthesis, synthesis •hypothesis, prothesis •crisis, Isis •proboscis • synopsis •apotheosis, chlorosis, cirrhosis, diagnosis, halitosis, hypnosis, kenosis, meiosis, metempsychosis, misdiagnosis, mononucleosis, myxomatosis, necrosis, neurosis, osmosis, osteoporosis, prognosis, psittacosis, psychosis, sclerosis, symbiosis, thrombosis, toxoplasmosis, trichinosis, tuberculosis •archdiocese, diocese, elephantiasis, psoriasis •anabasis • apodosis •emphasis, underemphasis •anamorphosis, metamorphosis •periphrasis • entasis • protasis •hypostasis, iconostasis

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