Osteoporosis: A Disease of Choice

The following paper aims at discussing osteoporosis as a disease of choice and critically analyzing its effect on the various systems of the body. Lorentzon and Cummings (2015) discussed osteoporosis as a clinical syndrome from an early historical perspective. The first definition was implied by a British anatomist and surgeon, Sir Astley Cooper in 1822 where he noted an observed association between fractures and abnormal bones (Fallon, 2016). Thirteen years later Jean Lobstein, a French surgeon and pathologist, used the term osteoporosis for the first time. Fuller Albright founded the basis of defining postmenopausal osteoporosis in 1941 after establishing a link between vertebral fractures and osteoporosis (Lorentzon & Cummings, 2015).

            Sözen, Özışık, and Başaran (2017) described osteoporosis as a skeletal disease that is characterized by the disruption of the bones’ microarchitecture, deterioration of the bone tissue, and low bone mass. As a consequence, the condition increases the risk of fractures because of the compromised bone structure and strength. Research indicates that many people from all races and both sexes suffer from osteoporosis and the prevalence tend to elevate as the population ages. Sözen et al., (2017) describe osteoporosis as a “silent disease” until secondary health problems occur. Lorentzon and Cummings (2015) attribute bone strength to its quality and density; however, osteoporosis manifests with the deterioration of the trabecular microstructure and absence of connectivity between the cortical thinning and the trabeculae.

            Osteoporosis affects the anatomy and physiology of the bone along with other body systems that coordinate together. The body maintains the normal processes of the bone tissue through continuous remodelling through bone formation by osteoblasts, bone resorption by osteoclasts, and the incorporation of the osteocytes that are orchestrators and mechanosensors of the remodeling process (Florencio-Silva, Sasso, Sasso-Cerri, Simões, & Cerri, 2015). Systemic factors such as estrogen and estrogen and local factors that include cytokines and growth factors contribute to the homeostatic process of the bone. Normally, the bone

            Osteoporosis disrupts the normal anatomy and physiology of the bone in instances where there is an imbalance between the formation and resorption of the bone. Consequently, osteoporosis occurs leading to the weakening of the bones and reduction of skeletal muscle. (Florencio-Silva et al., 2015) As a person grows from childhood to adolescence, the body continues to produce bone more than it loses until bone mass density (BMD) is achieved at an approximate age of 18 to 25 years. When the bone mass is at the peak, the BMD remains constant or begins deteriorating if the imbalance noted above is present. Lorentzon and Cummings (2015) explained that the greater the BMD accumulated as the person grows, the lesser the risks of suffering from osteoporosis.

            There are many factors that cause osteoporosis. Estrogen deficiency contributes to the loss of bone structure in men and postmenopausal women (Tu et al., 2018). The deficiency results in excessive resorption and consequent inadequacy in the formation of the bone tissue. Osteoclasts, osteocytes, and osteoblasts express estrogen receptors (Kuru et al., 2014). The hormone has an indirect effect on the bones through local growth factors and cytokines. Noteworthy, the absence of estrogen promotes the T-cells activity in the recruitment, differentiation, and prolonged survival of osteoclasts. The other cause of osteoporosis is aging (Lorentzon & Cummings, 2015). The loss of bone after menopause is associated with increased activity of the osteoclasts and the continuous reduction in the supply of osteoblasts compared to the demand to maintain balance. Other etiologies of osteoporosis include vitamin D and calcium deficiency which disrupts bone homeostasis (Tu et al., 2018).

            Osteoporosis presents with various signs and symptoms that become apparent after sustaining a fracture. First, an individual suffers acute pain following a minor trauma. Secondly, there is a localized pain in a specific level on the vertebra. Thirdly, acute pain resolves in approximately six weeks but it may be chronic if the individual suffers multiple fractures. Fourthly, people who have sustained hip fracture exhibit a diminished range of movement in the flexion and rotation. Finally, patients exhibit tenderness to either percussion, palpation, or both (Lorentzon & Cummings, 2015).

            There are various laboratory studies that can be conducted to diagnose osteoporosis. Examples of the tests include liver function tests, serum chemistry levels, complete blood count to reveal anemia, tests to determine the levels of thyroid stimulating hormone associated with the disease, and 25-hydroxyvitamin D level tests (Lorentzon & Cummings, 2015). Other diagnostic measures considered include BMD assessment using dual-energy x-ray absorptiometry and vertebral imaging using radiography (Kuru et al., 2014).

            Osteoporosis is associated with multiple complications that emanate from fractures; that affect the quality of life. The most significant complications include disability and chronic pain due to spontaneous trauma. Also, the patient loses height due to fracture-associated compression of the vertebrae (Lorentzon & Cummings, 2015). The compression fractures are significantly imminent even with minimal stress on the vertebra such as bending or coughing. Pulmonary thromboembolism and nosocomial infections are some of the secondary complications of hip fractures due to osteoporosis (Kuru et al., 2014). 

            Treatment of osteoporosis involves both pharmacologic and non-pharmacologic approaches. Pharmacologic agents used in treatment include bisphosphates (zoledronic acid, ibandronate, and alendronate), selective estrogen receptor modulators (SERM) raloxifene, strontium ranelate, denosumab, and estrogen (Tu et al., 2018). The therapies are designed to decrease born resorption (antiresorptive) (Sözen et al., 2017).

            In conclusion, osteoporosis is a skeletal disorder that bears significant adverse effects that affect the quality of life. There are many studies on-going that have a significant impact on osteoporosis. Current research includes the use of stem cells to facilitate regeneration, treating the sources of chronic back pain using pain disruption therapy, and empirically determining the role of exercise and nutrition in promoting BMD development. The existing preventive strategies include initiation of therapy before fractures occur, intake of adequate vitamin-D and calcium, ceasing smoking, acquiring knowledge of fall-prevention techniques through patient education programs, and undertaking weight-bearing exercises (Sözen et al., 2017; Tu et al., 2018). From a personal opinion, patient education and early diagnosis are pivotal in reducing the number of victims of fractures. Implementing appropriate prevention strategies will reduce the prevalence of individuals suffering the adverse outcomes of osteoporosis.

References

Fallon, C. K. (2016). Chronic disease in the twentieth century: A history aging bones: A short history of osteoporosis. Journal of the History of Medicine and Allied Sciences, 71(2), 238–242. https://doi.org/10.1093/jhmas/jrv039

Florencio-Silva, R., Sasso, G. R. da S., Sasso-Cerri, E., Simões, M. J., & Cerri, P. S. (2015). Biology of bone tissue: structure, function, and factors that influence bone cells. BioMed Research International, 2015.

Kuru, P., Akyüz, G., Cerşit, H. P., Çelenlioğlu, A. E., Cumhur, A., Biricik, Ş., … Lüleci, E. (2014). Fracture history in osteoporosis: Risk factors and its effect on quality of life. Balkan Medical Journal, 31(4), 295–301. https://doi.org/10.5152/balkanmedj.2014.13265

Lorentzon, M., & Cummings, S. R. (2015). Osteoporosis: the evolution of a diagnosis. Journal of Internal Medicine, 277(6), 650–661. https://doi.org/10.1111/joim.12369

Sözen, T., Özışık, L., & Başaran, N. Ç. (2017). An overview and management of osteoporosis. European Journal of Rheumatology, 4(1), 46–56. https://doi.org/10.5152/eurjrheum.2016.048

Tu, K. N., Lie, J. D., Wan, C. K. V., Cameron, M., Austel, A. G., Nguyen, J. K., … Hyun, D. (2018). Osteoporosis: A review of treatment options. Pharmacy and Therapeutics, 43(2), 92–104.