Chapter 1
What Is Osteoporosis?
Osteoporosis is Latin for âporous bone.â Itâs a silent condition with no outward symptoms, and that causes the bones to become weak, brittle, and easily breakable. In people with osteoporosis, bones can break from a minor fall, or even a simple cough can fracture a rib. In older men and women, osteoporosis can sometimes be an indirect cause of death, but more often itâs a cause of a decreased quality of life.
The good news is that today, treatments for osteoporosis, as well as methods to prevent it, are available. And one of the easiest, least expensive treatments is weight-bearing exercise.
What Are Bones?
After we grow up, most of us forget about our bones. But in order to understand osteoporosis, itâs important to think about our bones and understand what they really are.
Bone is living, growing tissue. Throughout our lives, our bodies are continually breaking down old bone and rebuilding new bone. When weâre young, we gain more bone than we lose. Bones then progressively increase in density until a maximum level is reached, usually around age 30. But after about age 35, things change, and we start to lose more bone than we make. Over time, this causes bone density to slowly decrease, and bones become more brittle. In a lifetime, a woman may lose up to 38% of peak bone mass, whereas a man may lose only 23%.
Bone density is much like a honeycomb. A person with good bone strength will have a tightly woven bone matrix, whereas someone with osteoporosis will have big gaps in the honeycomb that make it weak.
The Bone Bank Account
The bones you build today are the same ones youâll need to stand on in the future. Think of bone as a bank account where you âdepositâ and âwithdrawâ bone tissue. During childhood and the teenage years, new bone is added to the skeleton faster than old bone is removed. As a result, bones become larger, heavier, and denser. For most people, bone formation continues at a faster pace than removal until bone mass peaks during the third decade of life.
In order to be able to make âdepositsâ of bone tissue and reach the greatest possible peak bone mass, you need to get enough calcium, vitamin D, and exerciseâimportant factors in building bone. After age 35, bone âwithdrawalsâ can begin to exceed âdeposits.â For many people, this bone loss can be prevented by continuing to get calcium, vitamin D, and exercise, and by avoiding tobacco and excessive alcohol use. Osteoporosis develops when bone removal occurs too quickly or replacement occurs too slowly, or both. Youâre more likely to develop osteoporosis if you didnât reach your maximum peak bone mass during your bone-building years.
Bone Terminology
Throughout life, your bones are constantly renewed through a two-part process called remodeling. This process consists of reabsorption and formation. During reabsorption, old bone tissue is broken down and removed by special cells called osteoclasts. During bone formation, new bone tissue is laid down to replace the old. Special cells called osteoblasts perform this task. By the time most women, in particular, reach 35 years of age, their mass accumulation has reached its peak. After that, bone remodeling begins to reverse and more bone mass is lost than remodeled.
Several hormones regulate osteoclast and osteoblast function: parathyroid hormone, vitamin D, estrogen (in women), and testosterone (in men), among others. In women, after menopause and the loss of estrogen, bonesâ inner mesh becomes increasingly thinner, weaker, and more brittle.
OSTEOCLASTS: From the Greek words for âboneâ and âbroken,â osteoclasts are cells that invade the surface of bone and remove the matrix and minerals, leaving small cavities in the bone surface during bone reabsorption.
OSTEOBLASTS: From the Greek words for âboneâ and âgerm,â or âembryonic,â these are cells that fill small cavities in the bone surface with new bone during bone formation.
CORTICAL BONE: The hard, strong outer shell of bone.
TRABECULAR BONE: This is the interior portion of bone with a spongy, honeycomb-like appearance. Itâs found primarily in the wrist, spine, and hip.
KYPHOSIS: An outward manifestation of osteoporosis, kyphosis is an abnormal curve of the upper-back region. A person with a kyphotic curve displays a hunched-over appearance in the upper-back region. Another outward manifestation of osteoporosis is when a woman notices that her dress hems are longer than they were last year. This loss in height can be a result of compression fractures of her spine due to osteoporosis.
Who Gets Osteoporosis?
Just about everyone! Itâs an equal-opportunity disease.
Most people think that osteoporosis is only a concern for women, but did you know that one out of four men over the age of 50 could develop a fracture in his lifetime? While osteoporosis can lead to an increased risk of fractures of the hip, spine, and wrist in women, men are susceptible to the same effects from a less-than-ideal lifestyle as are women, including poor diet choices over a lifetime, smoking, drinking too much, and lack of weight-bearing exercise.
Unfortunately, men never seem to discuss this topic with their health professional. While 20% of all hip fractures occur in men, any bone can be affected. Men generally have a higher bone mass than do females overall and donât experience the rapid loss as do women as a result of menopause. Unfortunately, for men osteoporosis goes undetected until much later in life, often after preventive measures couldâve been employed. Menâs bones like the same things that womenâs bones do: a healthy diet including calcium and vitamin D, along with a sensible dose of weight-bearing exercise and resistance training. Both men and women should consult their health professional about the proper intake of calcium and vitamin D, which often depends upon age and health history. Nobodyâs bones needs to have their owner drink too much, and especially to be a smoker.
While osteoporosis is often thought of as an older personâs disease, it can strike at any age. Osteoporosis is a major public health threat for an estimated 44 million Americans, or 55% of the people 50 years of age and older. Of the 10 million Americans estimated to have osteoporosis, 8 million are women and 2 million are men. Osteoporosis is under- recognized and undertreated not only in Caucasian women, but in African-American women as well. Significant risk has been reported in people of all ethnic backgrounds.
Everybody gets weak bones as they age. So why care? As baby boomers get older, the incidence of bone density disease can lead to increased medical costs. In 2005, osteoporosis-related fractures were responsible for an estimated $19 billion in costs. By 2025, experts predict that these costs will rise to approximately $25.3 billion.
Chapter 2
Determining Your Risk
Risk Factors for Developing Osteoporosis
Factors that increase the likelihood of developing osteoporosis include: being female, being older, family history of osteoporosis, and being thin. Certain race/ethnicities such as Caucasians and Asians are generally believed to be of higher risk. Other risk factors include being post-menopausal, amenorrhea (missing menstrual cycles), having low sex hormones, poor diet (itâs believed that a high consumption of soda can negatively influence bone health), low calcium and vitamin D levels, and infrequent weight-bearing activities. Since certain medications, such as steroids, are also known to contribute to bone loss, itâs always wise to speak to your health provider about the medications youâre taking and what influence they have on your bones.
Some of the illnesses that can contribute to osteoporosis include long-term diseases of the liver or lungs; Celiac disease, a condition where your bowel canât digest gluten properly; hyperparathyroidism, when your body makes too much of a hormone that affects the amount of calcium in your bones; inflammatory bowel disease, another condition where your bowel canât digest food properly; having a low level of testosterone (in men only); and hypokinetic disease, where you sit or lie still for a long time.
How Do I Know If I Have Weakening Bone Disease?
People cannot feel their bones getting weaker. They may not know that they have osteoporosis until they break a bone. A person with osteoporosis can fracture a bone from a minor fall, or a simple action such as a sneeze can cause a spontaneous fracture. Vertebral (spinal) fractures may initially be felt or seen in the form of severe back pain, loss of height, or spinal deformities such as kyphosis, or stooped pos...
