Osteoporosis and disability
The third week of July is National Disability Prevention and Rehabilitation Week.
Fractures are a common cause of disability in the elderly and in postmenopausal women.
Osteoporosis, which is characterized by decreased bone strength, is a risk factor for fractures.
The different types of osteoporosis are:
Senile osteoporosis. This occurs because of age-related calcium deficiency and imbalance between the rate of bone breakdown and bone formation. Hormonal changes have a role both in men and in women. There is abrupt decline in estrogen levels among menopause women and gradual decline in testosterone and estrogen levels in men with advancing age.
Other factors that may contribute and are being studied are oxidative stress, lipid peroxidation, cellular dysfunction, and DNA damage.
Senile osteoporosis may be asymptomatic because the changes occur gradually, but when bone density is significantly decreased, bones may collapse or break leading to deformities or aching bones. If bones in the back – the vertebrae become very weak, they may collapse.
A dowager’s hump or abnormal curvature of the back develops when several vertebrae are affected, and this hump is associated with soreness and chronic muscle strain.
Oxidative stress is a mechanism that decreases bone formation and increases bone resorption.
Age-related bone loss begins after peak bone mass is attained during the third decade of life for both men and women, but most bone loss occurs after age 65. Men are less likely to develop osteoporosis than women because they gain more bone mass during puberty.
Postmenopausal osteoporosis in women is due to lack of estrogen – the hormone that helps in the incorporation of calcium into the bone. Changes associated with aging overlap with hormonal changes. Between menopause and the age of 75, women lose about 22 percent of their total body bone minerals. Of this, it is estimated that 13.3 percent is due to aging, and 7.75 percent is due to lack of estrogen. In the femoral neck or hip bone, 14 percent of bone loss is due to aging and only about 5.3 percent is due to lack of estrogen.
In postmenopausal women, symptoms of osteoporosis generally develop at the age of 51 to 75 but can manifest earlier or later.
Hip fractures and fracture of the arm bone are common serious causes of disability among men and women with marked osteoporosis, and these are associated with slow healing.
Secondary osteoporosis occurs as a complication of diseases like kidney failure, disorders of the thyroid, parathyroid, or adrenal glands. It may also be caused by the use of drugs like corticosteroids, barbiturates, and anticonvulsants.
In rare cases, children and young persons develop idiopathic juvenile osteoporosis despite having normal hormones and vitamin levels. The cause is unknown.
Calcium and other minerals are needed in the process of bone formation, along with normal levels of parathyroid hormone, growth hormone, calcitonin, estrogen in women, and testosterone in men. Peak bone mass is affected by genetic, ethnic, hormonal, and environmental factors. Physical activity during childhood increases bone mass and density, while chronic diseases during childhood cause low peak bone mass and cause increased risk for fractures in adulthood. Factors that affect attainment of peak bone mass include poor growth, delayed maturation, malnutrition, muscle deficits, decreased physical activity, inflammation, and medications like steroids and anticonvulsants.
When attained, the peak bone mass can be maintained with physical activity. Preventive measures should thus be started at an early age and should continue throughout life.
Next week’s topic: Diagnosis and treatment of osteoporosis.
“See yourself as God sees you – a winner, an overcomer” – Joel Osteen, “Your Best Life Now”
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