The Bone Loss Conditions

This essay will address several types of bone loss diseases and the pros and cons of treatment or prevention techniques. I will first explore what the characteristics of healthy bone are and what the loss of bone mass and density can mean to a person’s health and well being. My sources will be from the internet, magazines, medical journals, several books, and the1998 Grolier Multimedia Encyclopedia. I have a personal interest in this subject because my paternal Grandmother and Grandfather suffered before they died with some of the debilitating symptoms of bone loss and weakening.

This included spinal fractures and posture slumping. Some of the prevention methods I will mention are exercise, diet, and drugs. I will talk about the use of estrogen replacement therapy and vitamins in the prevention of osteoporosis and their possible benefits and side effects. I will discuss the difference between osteoporosis and osteoarthritis as well as touch on some conditions in which the pain can be mistaken for them. My experience with a friend who has been crippled with arthritis since she was a child will open some topics for discussion. She has suffered several severe broken bone situations as a direct or indirect result of her disease and or treatments. An interview with her will be an informative and interesting addition to my sources on this subject.

What is bone and why is healthy bone essential to your health? Bone is a type of skeletal tissue and contains living cells embedded in a hard matrix. This matrix consists mostly of calcium phosphate and other calcium minerals held together by collagen and other organic substances. Bone tissue renews itself throughout life, constantly tearing down and rebuilding its mineralized framework. The balance between bone resorption and formation is regulated by the immune system and by hormones. The single most important function of bones is to support softer body tissues. The action of voluntary muscles on bones and joints produces locomotion in vertebrates. A second important function is the protection of softer structures, especially those of the nervous system.

In my research process for this essay, I was enlightened to the fact that osteoporosis and osteoarthritis are not the same disease. Osteoporosis is a condition of bone characterized by excessive porosity, or reduction of actual bone tissue. Osteoarthritis, the most common form of arthritis, is also called degenerative joint disease and involves the long-term destruction of cartilage in joints. It also involves the enlargement of the joint ends of bones. The other thing that became apparent fairly soon in the process was that many of the same preventative measures and treatments can be considered for both conditions.

With Osteoporosis, absorption of the old bone exceeds deposition of new bone. The result is an enlargement of normal spaces and a thinning of the bone from the inside. There may be no change in the outside dimensions, except in compression of weight-bearing bones. The most common type of osteoporosis (senile and postmenopausal, or primary) is found only in elderly persons and in women who have passed through menopause. It is characterized by compression of the vertebrae with resultant back pain and loss of height, back deformities (e.g., dowager’s hump), and by susceptibility to fractures. Often, there are no symptoms until a fracture occurs. The most common sites for fractures associated with osteoporosis are the hip, arm, and wrist. The hip is a common site of fractures in women with osteoporosis.

Often the problem is discovered when your doctor takes an x-ray for some other reason. The definitive test for diagnosing osteoporosis is a bone density study. One treatment developed for spinal osteoporosis is the use of slow-release fluorine tablets. Older women may receive estrogen therapy but with a possible increased risk of uterine cancer. Preventive measures include a diet high in calcium, calcium supplements in addition to food sources, and regular weight-bearing exercise. Estrogen replacement therapy may be used after menopause if you determine this is the right choice for you. One million women have fractures from osteoporosis annually; millions have silent osteoporosis. Each year the overall cost of acute and long-term care associated with osteoporosis exceeds $10 billion. (source: The American College of Obstetricians and Gynecologists)

Osteoarthritis is the most common form of arthritis and is also called degenerative joint disease. This involves the long-term destruction of cartilage in joints and the enlargement of the joint ends of bones. A characteristic sign of osteoarthritis is the development of bony spurs near joints, visible on X rays. The development of osteoarthritis is related to aging, but the direct cause is unknown. Genetic, metabolic, and endocrine factors have been suggested as possible causes. Osteoarthritis probably begins in the twenties, and an estimated 90 percent of the population over 50 years of age is affected to some degree.

The main symptoms are pain aggravated by motion or the pressure of weight, stiffness after inactivity, and limitation of motion. Major disability can result from severe involvement of the hands, hips, knees, or spine. Joints that have suffered a traumatic injury are also more prone to developing osteoarthritis. Treatment includes prescription anti-inflammatory drugs, but recent studies have shown that over-the-counter painkillers such as ibuprofen and acetaminophen may work just as well.

I will continue with more detailed discussion on preventative measures and treatments of both of these conditions of the bone after taking a moment to define fracture. In medicine, a fracture is a break in a bone. When an bone is normal, fractures can result from injury or from violent stress. This may occur as a result of an incident like falling at high velocity onto a hard surface. In bones already weakened by disease a condition called pathological fracture can occur. Under these conditions, fractures can occur spontaneously under ordinary stresses. The susceptibility of a bone to fracture under stress depends on its brittleness.

Brittleness of bone is determined by its mineral content, or degree of calcification. The bones of infants and young children have low calcification and are therefore softer and more flexible than those of older persons whose bones are highly calcified. Fractures in infants and young children are commonly incomplete fractures, called greenstick fractures. In this type of fracture, the bone cracks on one side and bends on the other. In contrast, brittle bones of older persons can shatter.

Although fractures of the extremities are painful and partially disabling, they are not as dangerous as fractures of the skull or spinal column. This type of fracture can result in permanent damage if bone fragments penetrate nerve tissue. Fractures are treated by aligning the ends of broken bones by traction or surgery and holding them in place for several weeks in plaster casts or splints; metal wires or screws may be needed for smaller bone fragments. Healing begins with the formation of special tissue called a callus. A bone is permanently thicker in the vicinity of a healed fracture because it grows in excess of need. A polymer has also been developed that is absorbed by the body as it holds bones in place without metal fixtures. Specially treated coral is also being used in this way.

Other methods to speed bone healing are also being researched. Treatment of a fracture is usually followed by physical therapy. My friend who has arthritis had a severe fracture of the bone immediately below a hip replacement. Because her bones have been weakened by her disease and she takes steroid drugs to help with the inflammation, she did not readily heal. She laid in a hospital bed for about two months and still hadn’t healed. What finally started the bone to knit was the use of a device that sends electrical impulses into the bone. It took months, while she was hospitalized in traction, for her insurance company to approve the apparatus for the treatment. I will find out more specifically the type of arthritis Candy has and what type of treatments she has tried when I interview her.

Some of the things that place you at risk for osteoporosis are; menopause before age 48, surgery to remove ovaries before normal menopause, inadequate calcium in your diet, lack of exercise, smoking, family history of osteoporosis, excessive alcohol consumption, small bone frame/thin build, fair skin, caucasian or asian race, hyperthyroidism, and the use of steroids. It’s advisable that you discuss your risks for osteoporosis and corresponding preventive measures, with your doctor well in advance of menopause. Teenage women and women in their twenties should pay careful attention to the amount of calcium they receive in their diets.

A woman reaches a point of maximum or peak bone mass by the time she’s in her late twenties or early thirties. How much calcium she has received prior to this time can have a significant effect on the health of her bones later on in life. Studies have shown that many women do not get all the calcium they need for optimum health. Adolescent females and young adult women (ages 11-24) need about1,200-1,500 milligrams (mg) of calcium daily; women between 25 and 50 years need 1,000 mg a day; pregnant or breast-feeding women need 1,200-1,500 mg a day. Menopausal women need 1,000 mg a day if they’re taking hormone replacement therapy, and 1,500 mg a day if they’re not.

Most nutritionists agree that it’s best for you to get your calcium from food sources because of the extra nutrients and minerals found in foods. If you can’t always get all the calcium you need from food, your doctor may well advise you to take daily calcium supplements to reach recommended levels. Some of the foods rich in calcium are: Nonfat or low fat yogurt, low fat milk, mozzarella cheese, part skim, tofu (especially tofu with calcium sulfate), canned sardines with bones, fresh cooked turnip greens, fresh cooked broccoli, dried beans, frozen cooked okra, and homemade waffles.

Hormone replacement therapy (usually a combination of estrogen and progestin) is one of the best ways to slow the development of osteoporosis once it begins. You should discuss the pros and cons, risks and benefits, of hormone replacement therapy with your doctor, especially if you are a high risk for osteoporosis, to help you in assessing your relative risk of developing the disease. In women who lose bone quickly, or in those whose skeletons aren’t particularly dense to begin with, it may take only a decade for bone to become so brittle that it starts to fracture and crush.

During the menopause years, a woman might lose six percent of her bone mass each year. Exercise and calcium, while helpful, won’t alone be enough to reverse the effects of osteoporosis once the disease has taken hold. That’s why it’s so important to do all you can to prevent osteoporosis before it starts. The old maxim, “an ounce of prevention equals a pound of cure,” rings true once again.

I have been personally advised to take estrogen and told that the benefits far outweigh the potential hazards of the preventative treatment. What follows are some quotes from a clinical trial regarding the use of low-dose esterfied estrogen therapy and its effects on bone, plasma estradiol concentrations, ednometrium, and lipid levels. The material from this study was so large that I had to choose only parts of it to quote here. BMD is used to abbreviate bone mass density and endometrial refers to tissue of the uterus, and equine estrogens refers to animal protein estrogens that are derived from horse byproducts.

Background: Prospective studies have shown that doses equivalent to conjugated equine estrogens of 0.625 mg/d or higher are needed to produce a significant increase in bone mineral density of the lumbar spine.

Methods: Four hundred six postmenopausal women were given calcium, 1000 mg/d, and randomly assigned to receive continuous esterified estrogens (0.3, 0.625, or 1.25 mg/d) or placebo for 24 months. Bone mineral density measurements and endometrial and laboratory assessments were conducted every 6 months; plasma estradiol concentrations were measured after 12, 18, and 24 months.