Risk of Bone Diseases Increases With Age: Osteoporosis & Fracture Risk - Essay Sample

Introduction

The risk of developing bone diseases increases as one grows older. According to Bono & Thomas (8), osteoporosis is the condition where the mass of bones drops to a critical level; at this level, the fracture risk is increasingly higher. Osteoporosis has also been described as a skeletal disorder that has been characterized by low bone strength, which acts as a predisposing factor to increased fracture risk. Most basically, osteoporosis arises due to an imbalance in bone formation and resorption (Bono & Thomas 9). However, being able to understand the distinct characteristics of osteoporosis compared to other bone disorders needs in-depth knowledge of pathophysiological mechanisms and bone biology (Bono & Thomas 10).

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Sozen et al. state that normal bone tissue is lost through resorption and rebuilt through the formation (48). However, in the case where the rate of resorption is higher compared to the rate of bone formation, bone loss is inevitable. According to Sozen et al., bone mass is modeled, meaning that bone mass grows from childhood to adulthood (52). Bone mass is at its peak during puberty; this bone mass is referred to as peak bone mass (PBM). The subsequent loss of bone mass starts after puberty. Genetic factors play a crucial role in determining the PBM. These factors include physical activity, nutrition, health during growth, and endocrine status. Certain factors increase the resorption rate compared to bone formation, consequently leading to bone loss. The result is the loss of the individual trabecular bone plates (Lorentzon &Cummings 650). This leads to weakened bone structure with reduced mass, which consequently increases fracture risk, which is also aggravated by other age-associated malfunctioning.

As one advance in terms of age, bone mineral density (BMD) decreases, and as a result, the risks of suffering from osteoporosis increase (Szulc 2). Moreover, other age-related factors such as increased falls from the past may also predispose for osteoporosis. Studies done by the International Osteoporosis Foundation indicate that 1 in 3 women above the age of 50 years is likely to suffer from osteoporotic fractures in their lifetime. Moreover,1 in 5 men also have the risk of suffering from Osteoporosis (Sozen et al. 47). According to Sozen et al., An overview and management of osteoporosis, every osteoporotic fracture indicates that there is an impending fracture on its way (48).

Signs and Symptoms

Osteoporosis is generally asymptomatic, meaning that only fragility fractures can bring the patient to clinical attention (Lorentzon &Cummings 651). Studies indicate that low energy trauma, such as falling, may indicate reduced bone strength. Moreover, back pains and limited physical functioning may be treated as symptoms during the investigation of patients with osteoporosis. Conditions such as rheumatoid arthritis may also be considered,

Endocrine Regulation of Bone Mass: Types of Osteoporosis

A proposal by Riggs and Melton indicated that the diagnosis of osteoporosis should be divided based on the following pathogenesis (Lorentzon &Cummings 652). There are two types of osteoporosis, according to the pathogenesis. Type 1 osteoporosis is attributed to a decrease in estradiol levels and the loss of the trabecular bone plates. The trabecular bone is essentially the major part of the human vertebrae. The result of the decrease and loss is 3-5 years after menopause, which subsequently leads to an increase in the risk of fractures (Lorentzon &Cummings 652). This type of osteoporosis is also referred to as postmenopausal osteoporosis (Bono &Thomas 11). There are also secondary causes of osteoporosis; this includes those caused by endocrinopathy or the long-term use of corticosteroids (Bono &Thomas 11).

On the other hand, Type 2 osteoporosis is basically, "a form of senile osteoporosis primarily due to advanced age with impaired calcium handling, resulting in reduced levels of circulating,25-OH -vitamin D, lower calcium absorption, and secondary hyperparathyroidism, coinciding with an increased risk of hip fracture." (Lorentzon &Cummings 650). Both types of osteoporosis have different effects on bone loss. For instance, Type 1 osteoporosis tends to affect the trabecular bone, whereas Type 2 osteoporosis has a significant impact in both trabecular and cortical bones.

Diagnosis of Osteoporosis/Procedure

The diagnostic test of osteoporosis can be done through the measurement of BMD or the occurrence of fragility fractures of the vertebrae (Sozen et al. 49). Bone strength is usually defined in two main ways: the BMD (bone mineral density), which accounts for 70%, and bone quality (20%) (Sozen et al. 50). Bone mineral density can be measured easily, unlike bone quality (Sozen et al. 48). BMD is determined through dual X-ray absorptiometry (DXA). BMD expresses the bone in terms of grams of mineral per square centimeter of the bone. BMD measurements done on the spine and hip are very crucial because they confirm the diagnosis of osteoporosis. The diagnostic test is vital in predicting fracture risks in the future and in monitoring patients (Sozen et al. 50). Osteoporosis is present when the BMD is 2.5SD or more below the average of a young woman. BMD with a T score of between -1 and -2.5 SD indicates that the patient has low bone mass.

Despite the extensive use of DXA in diagnosing low BMD, there are quite several limitations. The limitations of DXA include the effects on the results of the surrounding tissue, aortic calcification, degenerated discs, and compression fractures (Loremtzon & Cummings 654). Moreover, DXA is limited because it cannot be used to determine the bone microstructure, which influences the risk of fractures. Besides, DXA two-dimensional technique does not measure the real volumetric BMD (Lorentzon & Cummings 655). However, hip and spine examinations using DXA have multiple clinical advantages, these advantages include the increased effectiveness in anti-fracture treatment, uniformity with WHO T-score definition of osteoporosis and useful patient monitoring (Lorentzon &Cummings 650).

Conclusion

In conclusion, osteoporosis cannot be defined completely; however diagnostic tests on hip and spine fractures and BMD can be used to define osteoporosis. BMD measurements are significantly used in describing bone fractures and weaknesses. However, vertebral fractures remain very significant in indicating decreased bone mass due to high resorption rates compared to bone formation.

Works Cited

Bono, Christopher M., and Thomas A. Einhorn. "Overview of osteoporosis: pathophysiology and determinants of bone strength." The aging spine. Springer, Berlin, Heidelberg, 2005. 8-14. https://link.springer.com/chapter/10.1007/3-540-27376-X_3

Lorentzon, Mattias, and Steven R. Cummings. "Osteoporosis: the evolution of a diagnosis." Journal of internal medicine 277.6 (2015): 650-661. https://onlinelibrary.wiley.com/doi/full/10.1111/joim.12369

Sozen, Tumay, Lale Ozisik, and Nursel Calik Basaran. "An overview and management of osteoporosis." European journal of rheumatology 4.1 (2017): 46. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5335887/

Szulc, Pawel, and Mary L. Bouxsein. "Overview of osteoporosis: epidemiology and clinical management." Vertebral fracture initiative resource document (2011). http://www.iofbonehealth.org/sites/default/files/PDFs/Vertebral%20Fracture%20Initiative/IOF_VFI-Part_I-Manuscript.pdf