Free «Osteoporosis» UK Essay Paper
Description of the Pathology
Osteoporosis is a metabolic bone disorder (Bethel, 2016). Osteoporosis affects the skeletal bones and reduces their mass. The bone tissue microarchitecture deteriorates, resulting in increased fragility. The World Health Organization defines osteoporosis as the hip or spinal bone mineral density, at least 2.5 standard deviations below normal, as it is determined by X-ray absorptiometry (Bernabei, Martone, Ortolani, Landi, & Marzetti, 2014). The state of osteoporosis is painless, so there is no simple predictor when a person will develop a bone fracture. Osteoporosis was traditionally attributed to elderly women, but in reality, this disorder occurs in both genders, and of all races and ages. After the complications of osteoporosis develop, this condition causes pains, physical as well as social disabilities, financial burden and reduced quality of life.
Body System(s) Involved
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Osteoporosis attacks the skeletal bones. Almost any of the 200 skeletal bones can undergo dystrophy and fracture from osteoporosis. However, some bones tend to break more often than others. These include bones that carry the body strain and undergo intensive weight load – hips, pelvis and spine. When an individual falls down, he/she will most probably try to protect himself/herself from damage with the help of arms, so these will break commonly – wrists, forearms, upper arms. The typical examples of bone fractures from osteoporosis include:
- Femoral neck fracture – the part of the bone between the ball and the main shaft of the femur is narrow;
- Colles’ fracture – the lower end of the radius is the point of peak load when a person falls on his/her hands;
- Vertebral fracture, also known as wedge fracture, occurs in the lower part of the thoracic spine;
- Malleoli fractures of the tibia or fibula – the malleoli enwrap the ankle bone (talus) and when the ankle rolls out, this joint appears at high stress (AIHW, 2011).
Normal Anatomy of Major Body System Effected
Bones tissue is composed of connected rods and plates of bone tissue (called trabeculae) with numerous spaces in between. The pores contain red bonemarrow. The bone is strong, in spite of numerous spaces, because the trabeculae contain calcium phosphate and are accurately arranged to stand against the physical stress that the bones undergo. Trabeculae also change their shape during exercise to give maximum support to the body.
Normal Physiology of Body System Effected
The trabeculae are composed of cells to keep this tissue strong – osteoblasts, osteocytes and osteoclasts. Osteoblasts synthesize the extracellular matrix, which is arranged into lamellae around the feeding arteries. Next, calcium phosphate surrounds the matrix to add strength to the lamellae. Osteoblasts transfer into osteocytes when the bone tissue is ready and signal about the bone status. Osteoclasts destroy old bones for the osteoblasts to replace the ineffective tissue with fresh material. It is estimated that every year up to 25% of the trabecular bone is resorbed and replaced (Bethel, 2016).
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Mechanism of Pathophysiology
The greatest bone mass is achieved by 18-25 years (NOF, 2014). After that time, the balance between bone reabsorption and synthesis is achieved to remove older bones and to replace them with new ones. When the process is altered, degradation prevails over growth, and the bone density is lost. As a result, trabeculae are diminished, and the pores prevail in bones. The new structure loses its mass and decreases strength. The bone remodeling causes increased fracture risk and fragility (Bethel, 2016). The balance between resorption and replacement is shifted due to genetical factors, aging and gonadal factors. Estrogen is essential for the bone mass synthesis, its deficiency during the menopause (both in men and women), leads to excessive bone destruction. Other risk factors include dietary calcium and vitamin D deficiency, hormonal drugs, inflammatory diseases and endocrine disorders (AIHW, 2011; Bethel, 2016).
In spite of its devastating effects, less than 20% of women with diagnosed osteoporosis receive prevention in the U.S. (Bethel, 2016). In general, osteoporosis is a preventable disease; health care workers today can offer effective medical strategies. Universal recommendations for the general population were developed by the National Osteoporosis Foundation. Non-pharmacologic interventions for the primary prevention start in childhoood and include sufficient calcium and vitamin D intake, smoking cessation, regular muscle-strengthening exercise, limited intake of alcohol and caffeine, treatment of factors of falling (Bethel, 2016; NOF, 2014). Pharmacologic preventions include calcium and raloxifene or bisphosphonates. All men aged 50-70 should take 1,000 mg of calcium per day and women aged 51 and men after 71 need 1,200 mg of calcium every day (NOF, 2014). Raloxifene binds to estrogen receptors and activates gonadal protective mechanisms in individuals undergoing estrogen deficiency. Bisphosphonates are inorganic pyrophosphate that bind to the osteoclasts and inhibit bone resorption (Bethel, 2016). X-ray densitometry of the bones to assess the bone mass index in the elderly is the best way to prognose the disorder, but controversy still exists about how often the investigation should be performed (Bethel, 2016; NOF, 2014).
Unfortunately, established osteoporosis is irreversible (Bethel, 2016). Known medical treatments at best can only halt the started progression. Treatment of osteoporosis starts with elimination of the possible etiologies – inflammatory or endocrine conditions, hormonal drugs, etc. Non-pharmacological treatments are the calcium, vitamin D, physical activity and interventions on the risk of falls. Pharmacological interventions include raloxifene, bisphosphonates, calcitonin, estrogens (logical to use, but may provoke breast malignancies), parathyroid hormone (stimulates bone formation) and denosumab (blocks the receptor of activator of nuclear factor kB ligand and inhibits resorption rapidly) (Bernabei et al., 2014). Current first-line agents are denosumab, parathyroid hormones and bisphosphonates (Bethel, 2016). Bone fractures will require surgical techniques. Physical medicine and rehabilitation improve physical function and reduce disability in the affected clients (NOF, 2014).
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Osteoporosis is a chronic metabolic disorder that causes bone fractures and results in weakness and disability. This is thinning of the bone tissue because calcium loss and matrix resorption in the trabeculae prevail over their synthesis. Prevention strategies against osteoporosis are effective. The health caregiver should understand the underlying anatomy and physiology thoroughly to be able to explain to patients the benefits of early prevention of osteoporosis.
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