Osteoporosis: a disease of great concern

The disease that makes bones more susceptible to fractures and osteoporosis known as the name suggests porous bones. Bone mineral density (BMD) decreases followed by a deterioration of bone microarchitecture and alteration of the protein in bone. World Health Organization (WHO) defined as bone mineral density in osteoporosis is less than 2.5, measured by DXA. The disease can be classified as primary type 1, type 2 or primary school. Postmenopausal osteoporosis is a primary or very often in women after menopause. 2 primary or senile osteoporosis is common after the age of 75 years and is seen in men and women in the ration of 2:1. Secondary osteoporosis can affect men and women of all ages in the same proportion. This crop diseases due to prolonged use of glucocorticoids therefore also known as glucocoticoid induced osteoporosis. Lifestyle changes and medications can sometimes reduce the risk of this disease. Changes in lifestyle, including diet, exercise and fall prevention. Fall prevention includes exercises to tone muscles, improve balance proprioception Essercizi outpatient and therapies. Exercise and its anabolic effect can reduce the risk, and healing. Drugs involves calcium, vitamin D, bisphosphonates and others. This disease is actually a component of the syndrome of frailty.

Osteoporosis in the variation of bone strength that makes them brittle. The bones become abnormally porous like a sponge. The skeleton is weaker and more prone to fractures. Osteopenia is a condition where the bones are slightly less dense than normal bone, but this feature is not comparable to that observed in dense osteoporosis. Proteins, collagen and calcium are major constituents which are responsible for bone strength. Bones affected by osteoporosis can break very easily after a very slight injury that usually does not cause harm to normal bone. This rupture or fracture of the bone may be in the form of cracking or collapsing. The spine, hips, ribs and wrists are the main parts of the body that are frequently affected by this disease and may be broken by a small bump. The disease is characterized by specific symptoms, but the main signal is significantly increased risk of fractures. People with this disorder usually off the break after a very small lesion, normal people do not often encounter. These fractures are called fragility fractures.

Fractures are well identified symptom of osteoporosis. In older people of these fractures result in acute and chronic pain resulting in even more devastating disability and premature mortality. The fractures may be asymptomatic and symptoms of vertebral fractures are sudden back pain, sore radiculopathic and compression of the spinal cord. Multiple vertebral fractures result in a stooped posture, loss of height, chronic pain and reduced mobility. Long bone fractures often require surgery. Hip fracture surgery requires fast and many are also serious risks associated with deep vein thrombosis, pulmonary embolism and increased mortality. Fracture risk calculator into account a number of factors that are responsible are fractures and bone mineral density (BMD), age, smoking, alcohol consumption, weight and sex. FRAX and calculators are well known Dubbo fracture risk known at present.

Osteoporosis is also associated with increased risk of falls and fractures that cause the hip, wrist and spine. The risk of falls is increased by visual impairment can be caused by glaucoma and macular degeneration. Balance disorder, movement disorders, dementia, and sarcopenia are other factors that increase the risk of falls. The reduction may be due to cardiac arrhythmias, vasovagal syncope, orthostatic hypotension, and seizures. Removing obstacles in the environment can reduce the risk of falls. Risk factors for osteoporotic fractures can be placed in the category of non-modifiable and modifiable. Aside from these factors are also known diseases that occur with this disease and in some cases drug also increases the risk of osteoporosis. Caffeine is not a risk factor for this disease. Risk factors are more important for this disease are older age, female gender, and estrogen deficiency after menopause or oophorectomy causes the rapid change in bone mineral density in men, while reducing the levels testosterone can lead to osteoporosis. People with family history of this disease are at greater risk and the incidence is 25-80%. About 30 genes can be considered responsible for this disease and its small size may be responsible for osteoporosis.

A number of potentially modifiable factors responsible for osteoporosis in excessive consumption of alcohol, for example, although low doses of alcohol has a beneficial effect on the human body. Bone density starts to increase alcohol consumption increases. Chronic alcohol abuse also causes an increased risk of fractures. Vitamin D deficiency in the elderly is very common and this slight deficiency of vitamin D is due to increased production of parathyroid hormone (PTH). The increased secretion of the hormone cause bone resorption resulting in bone loss. There was an association between serum 1, 25-dihydroxyvitamin D levels and bone mineral density, while PTH is negatively associated with bone mineral density. Smoking is an independent risk factor for osteoporosis, since it inhibits the activity of osteoblasts. Smoking also damages the increase of exogenous estrogens, early menopause, low body weight and all these factors result in lower bone density. Research has shown that consumption of high protein diet also increases calcium loss from bones in the urine.

Nutrition plays an important role in maintaining strong bones. Low calcium, phosphorus, zinc, magnesium, iron, fluorine, boron, copper, and vitamins A, E, K and C also cause lower bone density. The excess sodium and high blood acidity have a negative effect on bone. Low protein intake for older people also increases the risk of lower bone density. The imbalance of omega 6 fatty acids and polyunsaturated fatty acids omega-3 are other risk factors. Low birth weight is another factor that causes this disease. Excessive exercise also has a negative effect on bone as noted in marathon runners in the future. In women, heavy exercise results in decreased estrogen levels, which increases the risk of osteoporosis. Heavy metals also play an important role in the onset of this disease. A strong association was found between cadmium, lead and bone disease. Low level exposure to cadmium results in increased bone mineral density loss in men and women that cause an increased risk of fracture is more common in women. Increased exposure to cadmium causes osteomalacia. Some studies have indicated that excessive consumption of soft drinks also increase the risk of osteoporosis.

Osteoporotic fractures cause a lot of bone pain, decreased quality of life, lost workdays and disability. Approximately 30% of people with hip fracture require long-term nursing care. Older people have developed pneumonia followed by blood clots in the veins of the legs. These blood clots can invade the lungs due to prolonged bed rest after a hip fracture. The risk of death of the patient also increases due to this disease. About 20% of women with hip fractures die soon. A person with a spine fracture due to osteoporosis are at increased risk for another fracture in the near future. About 20% of menopausal women suffering from vertebral fractures are also likely to suffer a new vertebral fracture in the following years.

Osteoporosis is a major health problem. United States around 44 million people suffer from low bone density from which 55% of individuals belong to the age of 50 years or more. Many dollars are spent on treating these people. One in two women will suffer a fracture caused by this disease white in your life. About 20% of persons suffering from hip fracture die within a year. About a third of people with hip fractures are transferred to nursing homes for long term care. With age increases the chances of this disease and fractures increases exponentially.

Bone density can calculate the total amount of bone in the skeleton. More bone density are stronger bones. It is strongly influenced by genetic factors, in turn also affected by environmental factors and medications. Men have a higher bone density than women and even African Americans have higher bone density than white Americans. Bone density begins to accumulate in childhood and peaked at the age of 25 years and can be maintained for about 10 years. Bone density begins to exhaust the annual rate of 0.3-0.5% due to aging in men and women after 35. Bone density is maintained by estrogen levels in women. Bone density decreases after menopause estrogen levels begin to decrease. During the early years of menopause after complying with the reduction of 5.10 in bone density with the rate of 2.4%. Thus, 20-30% of bone strength is lost during this period. The increased rate of bone loss in women after menopause is the main cause of osteoporosis in themselves and also known as postmenopausal osteoporosis.

The National Osteoporosis Foundation suggests that people belonging to specific groups should be dual-energy X-ray (DEXA or DXA) and these include all postmenopausal women who are below 65 years and are likely to be affected by osteoporosis. All women who are over 65 and postmenopausal women with fractures should undergo this therapy. Women who are about to start treatment for osteoporosis and those with 50 medical conditions associated with osteoporosis should be dual-energy X-ray absorptiometry A number of diseases and disorders were found to be coupled with osteoporosis. For some of these diseases the mechanism that affects bone metabolism is known, while for others the mechanism is rather complex and poorly understood. In terms of joint results in immobilization bone loss, for example, localized osteoporosis can occur after prolonged immobilization of a fractured limb. This condition is commonly seen in athletes.

Other examples include bone loss in space flight or persons who use wheelchairs for several reasons. The states with hypogonadism and cause secondary osteoporosis include Turner syndrome, Klinefelter syndrome, Kallmann syndrome and anorexia nervosa. Hypogonadism in crops due to the females to estrogen deficiency. It can appear as early menopause or prolonged amenorrhea before menopause. Bilateral oophorectomy or premature ovarian failure also causes the variation in estrogen levels. In men testosterone deficiency is responsible for secondary osteoporosis.

Endocrine disorders, ie, Cushing’s syndrome, hyperparathyroidism, hyperthyroidism, hypothyroidsm, diabetes mellitus type 1 and 2 of adrenal insufficiency and acromegaly may also cause osteoporosis. Reversible bone loss was observed during pregnancy and lactation. Malnutrition, malabsorption, and parenteral nutrition can also cause this disease. Celiac disease, Crohn’s disease, lactose intolerance, surgery and severe liver disease and other gastrointestinal disease can also cause osteoporosis. Inadequate absorption of calcium, vitamin D, vitamin K and vitamin B12 can also cause bone loss. Patients with rheumatoid arthritis, ankylosing spondylitis and systemic lupus erythematosus associated with certain systemic diseases such as amyloidosis and sarcoidosis may also cause osteoporosis. Kidney failure can cause osteodystrophy. Blood disorders including multiple myeloma, monoclonal gammopathy, lymphoma, leukemia, sickle cell anemia and thalassemia can also cause osteoporosis. Several inherited diseases such as Marfan syndrome, osteogenesis imperfecta, hemochromatosis, hypophosphatasia, the glycogen storage diseases, Ehlers-Danlos syndrome and Gaucher’s disease can also cause bone loss. Parkinson’s disease and chronic obstructive pulmonary disease also causes osteoporosis.

Some drugs are also found to be associated with an increased risk of osteoporosis and steroids and anticonvulsants only play an important role in this category. Steroid-induced osteoporosis (SIOP), which usually occurs due to the use of glucocorticoids. Barbiturates, phenytoin, antiepileptic drugs also increase the metabolism of vitamin D leads to bone loss. L-thyroxine taken to cure the thyrotoxicosis also increases the risk of bone loss. Several drugs such as aromatase inhibitors, methotrexate, some anti-drug metabolites and agonists of gonadotropin-releasing hormone also cause bone loss. Anticoagulants such as heparin and warfarin increase the risk of osteoporosis. Inhibitors, proton pump interfere with the absorption of calcium phosphate linkage resulting from chronic increases the risk of osteoporosis.

Chronic lithium treatment also causes osteoporosis. The imbalance between bone resorption and bone formation is the main mechanism underlying this disease. Is continuous remodeling of bone matrix and 10% of bone mass can undergo remodeling at any time. This remodeling process occurs in the bone multicellular units (BMU), which were first discovered by Frost in 1963. The bone is resorbed by osteoclasts derived from bone marrow and after the new bone is deposited by osteoblasts.

There are three main mechanisms that contribute to the development of osteoporosis. These include inadequate peak bone mass, in which the skeleton develops and insufficient strength of the mass during growth, excessive bone resorption and inadequate formation of new bone during remodeling. All these mechanisms contribute to the development of brittle bones. Hormonal factors strongly implicated in bone resorption, for example, estrogen deficiency increases bone resorption and decreases the deposition of new bone that is a normal process in the bones that support. The amount of estrogen needed to suppress this process is generally less than that required for stimulation of the uterus and breast. The α-form of the estrogen receptor appears to play an important role in bone remodeling and calcium metabolism plays an important role in this process. Deficiency of calcium and vitamin D, the results of bone formation and impaired parathyroid glands react very active when the calcium level is low and secrete parathyroid hormone increases bone resorption. Calcitonin is secreted by the thyroid gland is also involved in bone resorption, but the role is unclear.

Osteoclasts are activated by a number of molecular signals that RANKL is the best studied. This molecule is produced by osteoblasts and other cells that activate the cell molecule RANK is, everything. Osteoprotegerin (OPG) binds strongly to the results of bone resorption and increased RANKL. RANKL, RANK and OPG are closely related to tumor necrosis factor and its receptors. Local production of eicosanoids and interleukin also play an important role in bone remodeling and its excess production or reduction can play a positive role in the development of osteoporosis. The trabecular bone is a sponge which is present in the terminal part of long bones and vertebrae. The cortical bone is the hard outer shell of bone and long bone of the mean. As osteoblasts and osteoclasts mark the surface of trabecular bone is subject to rotation and remodeling and thus decreases bone density and bone microarchitecture is also distorted. The weaker spicules of trabecular bone is replaced by weak bones. The hip, wrist and spine are at increased risk of fractures that are what relate cortical trabecular bone. These areas of the body on the basis of trabecular bone strength and imbalance in the remodeling of any can lead to degeneration of these areas. Trabecular bone loss begins at age 35 years and 50% if the process common in women and 30% for men.

Osteoporosis can be diagnosed by radiation and by measuring bone mineral density (BMD) and the most popular because it is dual-energy X-ray abosorptiometry (DEXA). Some blood tests and investigations associated with bone cancer can do the same. Conventional radiotherapy, alone or in combination with MRI and CT is very effective for the diagnosis of osteopenia. A series of clinical decision rules have been made to predict the risk of fractures that occur in this disease. QFracture result was developed in 2009, based on age, BMI, smoking, alcohol consumption, rheumatoid arthritis, type 2 diabetes, cardiovascular disease, corticosteroids, liver disease and history of falls in men. In women, hormone replacement therapy, history of osteoporosis, menopausal symptoms and poor gastrointestinal absorption, are considered. Dual energy X-ray absorptiometry is now, today, considered the most powerful tool for the diagnosis of this disease. Osteoporosis is diagnosed when bone mineral density (BMD) is less than or equal to 2.5 and the values are usually indicated by using a T-score. World Health Organization (WHO) has established standards for the identification of certain diseases such as T-score is greater than 1.0, then the individual is normal, if it is between 1.0 to 2.5, then the person may have Osteopenia and if less than 2.5, then the condition is identified as osteoporosis. Chemical biomarkers are the perfect tools to identify the breakdown of bone. Cathepsin K plays enzyme protein degradation of collagen type 1 and therefore is an important element in the bone. Increased urinary excretion of C-telopeptide also serves as a biomarker of the disease.

Quantitative computed tomography provides an independent estimate of bone mineral density (BMD) in trabecular and cortical bones in mg/cm3. This technique can be performed in axial and peripheral sites, is sensitive to both, can scan a region of any shape and size, and exclude irrelevant tissues such as fat and muscle, but also suffers some drawbacks, since it requires a high radiation dose, CT scanners are large and expensive and the results are operator dependent. Quantitative ultrasound may be performed to diagnose diseases because it has many advantages as a method is small, no ionizing radiation is required, the results can be achieved very quickly with a higher precision and the cost of the device is also very low. Calcaneus is the most favored site used the skeleton to use this device. The U.S. Preventive Services Task Force (USPSTF) in 2011 recommended that all women who are 65 years or more should be examined with bone densitometry, as they have a higher risk of being affected by osteoporosis.

Changes in lifestyle can help prevent the risks associated with osteoporosis. Smoking and alcohol consumption are generally inadequate due to illness and if caught, then the risk can be minimized. A balanced diet and adequate exercise also slow the breakdown of bone. A balanced diet includes the effective contribution of calcium and vitamin D.

People with this disease are usually given tablets of vitamin D and calcium supplements, bisphosphonates, in particular. Vitamin supplements are the D alone are not sufficient to prevent the risk of fractures so as to mate with a calcium supplement to minimize the risk. Calcium supplements are generally available in two forms of calcium carbonate and calcium citrate. Calcium carbonate is generally very cheap, so most of my people and the general election is taken with food, while calcium citrate is expensive, more efficient and can be taken without food. Patients taking H2 blockers or inhibitors of the proton pump is suggested to take calcium citrate, as they are not able to absorb calcium carbonate. In patients with renal disease, the most active forms of vitamin D as cholecalciferol, it is recommended that the kidney is unable to generate calcitriol from calcidiol is the storage form of vitamin D. Vitamin D3 is generally recommended by doctors.

Protein intake of foods high is associated with increased calcium excretion in the urine so that the risk of fractures increases. Studies indicate that the protein is essential for absorption of calcium, but excessive protein inhibits this process.

The hormone estrogen after menopause showed positive results in preventing bone loss, increase bone loss and fracture risk. It is useful in preventing fractures in postmenopausal women. Estrogen can be taken orally or as a skin patch. Also available in combination with progesterone and can be taken orally as a skin patch. Progesterone with estrogen reduces the risk of uterine cancer. Women who had undergone hyeterectomy can also take estrogen, they have no risk of uterine cancer. The FDA has recommended that drugs that inhibit the absorption to be the most effective agents against osteoporosis, since it reduces the level of calcium loss from bones. Bisphosphonates are the most effective antiresorptive agents because they reduce the risk of fractures, particularly those related to the hip, wrist and spine.

Fosamax, Actonel, Boniva and Reclast Bisphosphonates are the most popularly available. To reduce the side effects are bisphosphonates by mouth usually 30 minutes before breakfast. Food, calcium supplements, iron pills, vitamins, antacids reduce absorption of oral bisphosphonates, which reduces their effectiveness. Therefore, be taken orally in the morning only.

Calcitonin is a hormone that is approved by the FDA for use against osteoporosis. Calcitonins can be derived from a number of animal species, but those obtained from salmon are more effective in preventing bone loss. Calcitonin can be administered by injection intravenously, subcutaneously or intransally. Intranasal administration is the most effective method. This hormone is very effective in preventing bone loss in postmenopausal women and also increases bone density by strengthening the spine. This is an agent of lower bone resorption than bisphosphonates. Is not as effective as estrogen in increasing bone density and bone strength. Is not very effective in preventing the spine and hip fractures. For these disadvantages, is not the first choice treatment for women with osteoporosis. The most common side effects are usually observed after a dose of calcitonin are nausea and flushing. Patients using Miacalcin nasal spray may experience nosebleeds or nasal discharge, rash and fushing can also develop when injected subcutaneously.

Vitamin K also plays an important role in encouraging collagen production, promote bone health and reduce the risk of fracture. Vitamin K is of two types, in particular, vitamin K1 and K2. K1 is found in green leafy vegetables and K2 is found in various forms particularly menaquinone-4 (MK4) and menaquinone-7 (MK7). MK4 is the most studied by researchers and found to be effective in reducing the risks associated with fractures in osteoporosis. MK4 is produced in the testes, pancreas, and the arterial walls by converting the body K1. MK7 does not occur in the human body, but is converted in the gut by bacterial action K1. MK7 MK4 and two are found in food supplements listed in the U.S. for bone health. The U.S. FDA has not adopted a form of vitamin K for the treatment of this disease. MK7 did not show efficacy in reducing fracture risk. In MK4 clinical trials has shown positive results in reducing risks associated with fractures and are used to treat patients with this disease, as it is approved by the Ministry of Health of Japan since 1995. In Japan, patients receiving daily doses of MK4 with the amount of up to 45 mg. Approximately 87% reduction in risk associated with fractures were observed. MK4 also reduces the risk of fractures caused by corticosteroids, anorexia nervosa, liver cirrhosis, of postmenopausal osteoporosis, Alzheimer’s and Parkinson’s disease in clinical trials.

A number of studies have shown that exercise of aerobics, weight lifting and resistance can increase bone mineral density in postmenopausal women. The estrogen-bone strength training (BEST), a project of the University of Arizona has identified six different weight exercises that are useful in maintaining bone mineral density in patients with osteoporosis. A normal jump year helped increase bone mineral density and the moment of inertia of the proximal tibia in normal postmenopausal women. Exercise combined with estrogen replacement therapy has also yielded positive results. When choosing the right drug for a patient with osteoporosis the doctor checks all aspects that are related to the family and the severity of the disease. If a postmenopausal woman suffering from hot flashes and vaginal dryness, and hormone replacement therapy is the best option as it can prevent osteoporosis. If prevention and treatment is the only option left to osteoporosis, then doses of bisphosphonates are given. Bisphosphonates are the best for the treatment of postmenopausal women with this disease.

Calcitonin is an agent of low absorption of bisphosphonates and is prescribed for people who do not respond to other medicines.

Patients with moderate to severe osteoporosis, bisphosphonates are recommended effective. The long-term use of corticosteroids may increase the risk of osteoporosis. These substances decrease the absorption of calcium from the intestine to increase calcium loss in urine by the kidneys to increase calcium loss from bones. To reduce these risks it is recommended that patients have an adequate intake of calcium and vitamin D. additional doses of other drugs along with calcium and vitamin D are also prescribed by doctors. The American Medical Association (AMA) and other medical associations recommend that these tests accredited repeat bone density should not be performed during follow-up treatment of osteoporosis. Patients with osteoporosis have higher mortality rates of fractures that can be fatal. Hip fractures decrease mobility and increase the risk of additional complications such as deep vein thrombosis and pneumonia. The odds of hip fracture increased by 13.5% in patients with fractures osteoporosis.Vertebral however reduce the risk of death, but increase the risk of chronic pain, like other neurogenic origin, multiple fractures may cause kyphosis associated with respiratory changes. Quality of life is also reduced.

The relationship between age and reduced bone mineral density and increased fracture risk was given by Astley Cooper and the pathological aspect of osteoporosis has been given by a French pathologist Jean Lobstein. American endocrinologist Fuller Albright first studied the relationship between osteoporosis and menopause. The discovery of bisphosphonates for the treatment of osteoporosis has been a revolution in medical science in the 1960s. A number of organizations working in the current scenario in raising awareness about the disease. The National Osteoporosis Society was established in 1986in the UK to raise awareness about the diagnosis, prevention and treatment of this disease. The National Osteoporosis Foundation works for the prevention of osteoporosis and fracture risk, promoting healthy bones and good general knowledge among the people against the disease through the use of health care and education. International Osteoporosis Foundation (IOF) is also working on programs related to bone health. The Orthopaedic Research Society also works in this field.

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