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Lacey McKee Jean Widdison English 1010 April 10th, 2014

Osteoporosis or, The Silent Disease, is one of the most common chronic diseases in women over the age of 50, and has global impacts on all groups, genders and ethnicities. It is a disease of the bones and happens when you lose too much bone or make too little, resulting in weak bones that are easy to fracture or bruise. Osteoporosis is usually unnoticeable, thus is nicknamed The Silent Disease because it often goes undetected until the first bone fracture. Other signs of this disease include a loss of height, or a noticeable curvature of the spine. (What is Osteoporosis? NOF) Approximately 52 million Americans have Osteoporosis or low bone density. (What is Osteoporosis? NOF) Studies suggest that almost half of women and 25% of men (ages 50+) will break at least one bone in their lifetime due to Osteoporosis. Many dont realize this, but bones are living cells that grow and repair themselves. We are born with 300 soft bones and as we age, they harden and fuse together to become 206 hard adult bones. We have a peak bone mass in our early 20s meaning our bone is most dense at this age. (What is Osteoporosis? IOF) As we get older, our production slows and bone cells dissolve faster than they are being replaced. This process is known as formation, or remodeling and involves two cell types called osteoblasts and osteoclasts. The activity between these two cells dictates how much bone is lost or gained. The osteoclasts pump protein into our extracellular space, lowering the PH in our

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microenvironment, aiding in the absorption of bone minerals. The osteoblasts are essentially responsible for laying down the new bone material to be absorbed. (Introduction to Bone: IOF) There are a few crucial factors that influence the efficiency of our osteoblasts and osteoclasts. Our bodys levels of sex hormones like Estrogen and testosterone play a vital role in this formation. Estrogen receptors react with specific proteins to increase the activity of Osteoblasts, simultaneously stimulating Osteoclasts and driving bone mineral reabsorption. Prostaglandins also contribute by stimulating bone formation, a synthesis carried out by COX-2 enzymes. There are some long-acting steroid medications that are COX-2 inhibitors. These medications taken regularly can inhibit the bone remodeling and contribute to a loss of bone density. Evidence suggests that fracture risks are increased when these medications are taken. (Introduction to Bone: IOF) So what does Osteoporosis mean for those who have it? The word Osteoporosis literally means porous bone. Under a microscope, healthy bone looks much like a regular honeycomb. When an individual has Osteoporosis, the honeycomb appearance of the bone has much larger spaces and holes and is less dense, making the bone very brittle. The biggest risk associated with having Osteoporosis is the frequency and severity of bone fractures. Fractures in Osteoporosis patients are most likely to occur in the hip, spine, and wrist, but other areas are susceptible as well. (What is Osteoporosis? NOF) Fractures for Osteoporosis patients occur every 3 seconds, and studies show that 20 percent of seniors who break a hip die within the first year due to complications from surgery, or the broken bone itself. Many will end up needing long term care facilities. When fractures occur in the spine, a vertebra may break or collapse, affecting an individuals posture, causing a large hump in the spine. This deformity of the spine is also known as Dowagers Hump and gives a stooped or hunched effect. (What is Osteoporosis? IOF)

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Healthy bones are imperative to our health and provide the framework for our entire bodies. They also protect our vital organs, are a storage place for minerals, and play home to the bone marrow where our blood cells are produced. It is important for us to recognize associated risks and prevent the disease whenever possible. Although Osteoporosis does not have a cure, the good news is that in most cases it is preventable. There are many factors that can contribute to the risk of low bone density with some of these factors being changeable, while others are not. Simply being male or female dramatically affects your risk of getting the disease. Some factors that are uncontrollable may be gender, age, ethnicity, family history, and body build. Risk factors that are controllable are usually lifestyle habits such as diet, exercise, medications, along with other lifestyle choices. Unfortunately, Osteoporosis affects approximately 10 million Americans, with 80% of those being women. Although this disease is not as popularly talked about as other diseases among females, a womans risk of breaking a hip is equivalent to the combined risk of breast, uterine, and ovarian cancer. Though 2 million American men have this disease, there are two main reasons that it is so much more common in women. The first is that women have smaller and thinner bones than men, and a thinner frame increases the risk of getting Osteoporosis. The second is that the estrogen hormone in women that protects the bone, steeply decreases after menopause causing a dramatic loss of bone. Some women may even lose 20% of bone density in the 5-7 years following menopause. Among women, ethnicity also plays a role in your chances of contracting the disease. Osteoporosis is most prevalent among Asian and Caucasian women, with 20% of both Asian and Caucasian women ages 50 and older having Osteoporosis, and more than half having low bone mass. This may be partially due to the fact that approximately 15% of

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Caucasian women and nearly 90% of Asian women are lactose intolerant, making it difficult to get enough calcium. (What Women Need to Know. NOF) Another risk factor that many individuals have little control over is having too much or too little of certain hormones that aid in maintaining bone density. As mentioned earlier, testosterone, estrogen, thyroid hormones, and prostaglandins all play a role in bone formation. For men, a decrease in testosterone is common and slowly decreases with age. Cancer treatments for prostate cancer can also contribute to a drop in testosterone levels. In women, a drop in estrogen levels may be a result of menopause or certain cancer treatments. Having too little of the Thyroid hormone, or taking too much Thyroid medication can also result in a loss of bone. This can also happen when you have an overactive thyroid or adrenal glands. (Osteoporosis; Risk Factors Mayo Clinic) As mentioned early, COX-2 inhibitors or long term Corticosteroid medications can also interfere with bone making. Other medications associated with Osteoporosis are those used to treat seizures, depression, gastric reflux, cancer, or transplant rejection medications. Another risk factor that affects Osteoporosis is family history. Since genetics play a role in your bone structure, having a parent or sibling who has had Osteoporosis puts you at greater risk for the disease, especially if they have had hip fractures. (Osteoporosis; Risk Factors Mayo Clinic) Even with these uncontrollable factors affecting our bones, we have many ways in which we can contribute to our own bone health. One of the most important choices we can make in our bone health is to have a well-balanced diet full of Calcium and Vitamin D. Both of these dietary staples are crucial to the formation and protection of our bones. Vitamin D protects the bone and aids in the absorption of Calcium, while Calcium helps to build bones and keep them strong and

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dense. A lifetime lack of Calcium can lead to diminished bone density and increased risk of fractures. One of the easiest and best ways to get Calcium is through our diet. If you are lactose intolerant, your Calcium levels may be deficient as many dairy products are loaded with Calcium. Some of the best sources of Calcium are milk, cheese, yogurt, citrus fruit, and leafy green vegetables. If possible, make milk a diet staple for children to give them the greatest chance of building bone density throughout childhood. Building bone density when youre young is important as the bone-building process is mostly over by age 19. (Osteoporosis, Kids Health) If you are lactose intolerant and cannot get sufficient amounts of Calcium through your diet, supplements are always an option. Women under the age of 50 need 1,000mg/day while women over the age of 50 need 1200mg. Men ages 70 and above should get about 1000mg each day. When choosing a supplement, it is important to look for certified USP brands that ensure quality and purity. (Calcium and Vitamin D, NOF) When Vitamin D is insufficient, it is more likely that an individual will lose bone, have lower bone density, and are more likely to break bones as they get older. Children need Vitamin D to build up bone, while adults need it to keep the bones they have strong and healthy. Vitamin D also helps Calcium to absorb. While there are many different sources of Calcium, ways in which to obtain Vitamin D are much more limited. There are essentially three ways you can get Vitamin D; through sunlight, through our food, or through supplements. (Calcium and Vitamin D, NOF) Our skin helps us in the production Vitamin D by making it from UVB rays in sunlight, and storing it for later use. The amount that your skin can make depends upon many things

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including your skin pigment, or even the season, day, and latitude. Certain places in the globe get almost no sun in winter, and can leave individuals with absolutely no Vitamin D from sunlight. It is also easy to block out Vitamin D in the sun by using sunblock. Sunscreen can dramatically limit the ability of skin to make vitamin D, even with the smallest SPF. Because of the risks associated with skin cancer, sun may not always be the best source of Vitamin D, and individuals may need to resort to getting Vitamin D through diet and supplements only. Since Vitamin D is only a few foods, it is difficult to get it from food alone. A couple foods that have Vitamin D are wild fish such as salmon, or milk that is fortified with Vitamin D. It can also be in multivitamins as Ergocalciferol, or Cholecalciferol. Other risk factors that affect levels of Vitamin D are people who; are bed-rest or homebound, spend little time in the sun or cover up often, have Celiacs disease or Inflammatory Bowel disease, have very dark skin, and Obesity. (Calcium and Vitamin D, NOF) There are a few other dietary factors that can increase the chances of getting Osteoporosis. The first is excess alcohol consumption, meaning a consistent habit of more than 2 drinks per day. Research is not yet conclusive, but studies show that it is possibly due to the fact that alcohol can interfere with the bodys ability to absorb calcium. Another factor is tobacco which also contributes to having weak bones. Gastrointestinal surgery is also a risk, because the reduction in the size of the stomach or removal of part of the intestine, limits the surface area available to absorb nutrients such as Calcium. Another disease, Anorexia Nervosa, can also increase risk of Osteoporosis as low food intake reduces the amount of Calcium ingested. Anorexia can also stop menstruation which in turn, weakens bones. (Osteoporosis; Risk Factors Mayo Clinic)

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While maintaining a well-balanced diet is important to our bone health, another factor that is just as important is exercise. Studies show that sedentary lifestyles are not good for bones, and that weight-bearing and muscle-strengthening exercises help to build and maintain bone density. The most beneficial exercises for bones are dancing, weightlifting, running, jumping, walking and other high impact moves. For individuals who cannot perform high impact exercises, activities such as walking, aerobics, stair-step, or elliptical machines are also good for the bones. Additional activities that contribute to bone health are weight-bearing exercises using weights, elastic bands, weight machines, or an individuals body weight. Studies show a combination of these exercises for 30 min each day is optimal for bone health, balance, posture, and reduction of spine curvature. (Exercising for Strong Bones NOF) Now that we know all of the ways you can get or prevent Osteoporosis, its important to know what steps to take once Osteoporosis is detected. As mentioned above, Osteoporosis can easily go undetected until the first fracture or noticeable curvature of spine. Once it is suspected, the doctor may do a medical evaluation to diagnose the disease. The evaluation may include getting medical history, family history, physical exam, bone density test, a FRAX score, lab tests, or other means to evaluate bone health. Although there is no cure, in some cases the disease can reverse to a degree. Treatment usually involves Calcium and Vitamin D, along with other medications that can rebuild bone or at least slow/stop bone loss. Different drugs may be prescribed depending on the severity and stage of the disease, as well as associated risks from previous conditions such as breast cancer. (Making A Diagnosis NOF) To be informed and proactive in the prevention of Osteoporosis means a longer and more satisfactory life in retirement and old age. Even though common, it is not inevitable as doctors once thought. Although it is much more common than other diseases, it has not proved to be as

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popular, even as certain fractures can lead to death. White women show a 1 in 9 risk of developing breast cancer, but a 1 in 6 risk of hip fracture. Some may think that it can only happen in the older population, but it is important to know that it may happen at younger ages as well. Taking great care of your bones is just as important as the rest of your body, and working to strengthening them should be just as precious as the work we put into strengthening other aspects of our bodies and our lives.

WORKS CITED

Calcium and Vitamin D: What You Need to Know." National Osteoporosis Foundation. 2014. 2 Apr. 2014. <ww.nof.org>.

"Exercise For Strong Bones." National Osteoporosis Foundation. 2014. 12 Mar. 2014. <ww.nof.org>.

"Introduction to Bone Biology: All About our Bones ." International Osteoporosis Foundation. 2014. 15 Mar. 2014. <www.iofbonehealth.org>.

"Making A Diagnosis." Nation Osteoprosis Foundation. 2014. 1 Apr. 2014. <www.nof.org>.

"Osteoporosis." Kidshealth. 2014. 2 Apr. 2014 <http://kidshealth.org/kid/grownup/conditions/osteoporosis.html>.

"Osteoporosis: Risk Factors." Mayo Clinic. 2014. 3 Apr. 2014. <http://www.mayoclinic.org/diseases-conditions/osteoporosis/basics/risk-factors/con-

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20019924>.

"What Women Need to Know." National Osteoporosis Foundation. 2014. 18 Mar. 2014. <www.nof.org>.

"What is Osteoporosis?." International Osteoporosis Foundation. 2014. 5 Apr. 2014. <www.iofbonehealth.org>.

"What is Osteoporosis?." National Osteoporosis Foundation. 2014. 6 Apr. 2014. <www.nof.org>.