Osteoporosis Research Paper

Introduction to Kinesiology

Optional Assignment

Amber Hosker

104316702

Osteoporosis is a disease of the bone. It is formed from a decrease of bone strength and bone mass. Due the reduction of bone density, it makes bones thinner and more fragile. Resulting from osteoporosis your bones become extremely weak and put you at a higher risk of bone fractures. Osteoporosis is often known as the “silent thief” because it can happen without feeling any symptoms until the bone is actually broken. It causes bones to become weak and brittle --- so brittle that a fall or even mild stresses like bending over or coughing can cause a fracture.

Bone is living tissue, which is constantly being absorbed and replaced. Osteoporosis occurs when the creation

of new bone doesn’t keep up with the removal of old bone. The most common fractures related to osteoporosis are fractures of the spine, hip and wrists. Osteoporosis does not only affect a specific gender, but postmenopausal women are most likely to get the disease.
Some children and adolescents develop osteoporosis that has no known cause, known as idiopathic juvenile osteoporosis (IJO). They will usually recover in 2 to 4 years. The basic treatment is to protect the spine and other bones from fracture, until recovery.
There have been a number of risk factors that have been noticed that increase the likelihood of getting osteoporosis. With this being said some are changeable and some cannot be avoided. Some non-modifiable risk factors include:
• Age- Bone density and strength is usually reached around age 30. Bone mass begins to decline naturally with age.
• Body Size- Petite and thin women have a greater risk of developing osteoporosis as well as small-boned, thin men.
• Race- Being Caucasian or Asian you have a higher chance of getting osteoporosis. Hip fractures are twice as likely in Caucasian women as in African American women, however women of colour who fracture their hips have a higher death rate.
• Gender-Women over the age of 50 have the greatest risk. Women are 4 times more likely than men to develop it. Women’s lighter, thinner bones and longer life span are part of the reason.
• Heredity- Condition is in the family. This is one of the most important risk factors for osteoporosis. Most commonly the parent would have this disease.
• Previous injuries (fractures)
• And even certain hormone levels. Hormones regulate bone reshaping which does have an effect on the bone mass. For women after the age of 50, the lessened amount of estrogen produced during and after menopause will increase the risk of osteoporosis.
There are some risk factors that you may be able to change.
• Sex Hormone Deficiencies- The most common estrogen deficiency in premenopausal women is amenorrhea, the abnormal absence of menstrual periods. Low estrogen levels in women after menopause and low testosterone levels in men increase the risk of osteoporosis.
• Diet- From childhood, a diet low in calcium and vitamin D can increase the risk.
• Medications- Some long term use of medications can lead to bone loss.
• Inactive Lifestyle or Extended Bed Rest- Low levels of physical activity and long periods of inactivity can contribute to bone loss.
• Excessive Alcohol- Heavy drinking is a significant risk factor.

Other factors also play a role. The amount of vitamins and calcium in a person’s food diet will affect the bones formation. Regular exercise will help increase a person’s bone mass. There are also some risk factors that can be eliminated by changing dietary routine, such as, smoking cigarettes which will decrease estrogen. Osteoporosis can also be caused by some other diseases such as rheumatoid arthritis, as well as some medications like steroids. This is a condition called Secondary Osteoporosis. Many people with diseases such as asthma or multiple sclerosis take corticosteroids, which are a primary cause of osteoporosis.
Prevalence of osteoporosis is starting to vary. It is the most common metabolic bone disease. About 80% of people that have osteoporosis, or will have it, are woman. Osteoporosis in the United States, causes about 1.5 million fractures each year and is the primary cause of hip fracture. The National Institutes of Health (NIH) stated that the amount of people that are hospitalized for fractures and other injuries caused by osteoporosis has dramatically increased in recent years. 254,000 of these injuries were reported in 2006 alone. Almost 2 million Canadians suffer from this disease. Ethnic and geographic differences are present in the prevalence of osteoporosis. There is a higher risk of hip fractures in whites than there is in blacks. Currently an estimate of 200 million people around the world suffer from this disease. About 30% of postmenopausal women have osteoporosis in the United States. It has been presented that an initial fracture is a causing risk factor for a new fracture. An increased risk of 86% of any kind of fracture has been shown in people who have already had a fracture. Many spine fractures often go untreated. Less than 10% of spine fractures result in hospitalization whether they cause pain or not. Hip fractures are associated with serious disability and surplus mortality. Women who have had a hip fracture in previous years have a 10-20% higher mortality than would be normally expected at their age. There are approximately 1.7 million hip fracture incidences. Hip fractures are more common in North American than in southern European or Asian countries. 90% of hip fractures occur in people over the age of 50. Distal forearm fractures most commonly occur in women over the age of 65. Only 15% of wrist fractures occur in men.
There has been no cause identified for osteoporosis.

Throughout our lives, our bodies break down the old bone and it replaces it with new bone. But as age increases, more and more bone is broken down than what is replaced. The bones in our bodies are constantly changing and never stay the same. Special cells called osteoclasts, located in the body have the main function of removing bone. These are different from another special cell called osteoblasts, which are bone-forming cells. If a person does not have osteoporosis, there is a balance between these two cells in the bone. But if the person is osteoporotic, osteoclasts will remove the bone faster than the osteoblasts can form the new bone. This will result in a net bone loss. Do you know what a honeycomb looks like? That is what the inside of the bone normally looks like, but when a person has osteoporosis the looks change. The spaces inside the bone become a lot larger, this showing the loss of bone strength and density. The outside of the bone also thins, making the bone even weaker. Osteoporosis causes permanent changes in the bone. There are some basic mechanisms that are responsible for the development of osteoporosis such as poor bone mass acquisition during growth and accelerated bone loss in the time period after one’s peak bone mass is achieved. Both are related with genetic factors. The risk of fracture in postmenopausal women is mainly determined by the peak bone mass during premenopausal stage. Peak bone mass

is higher in blacks than in whites and Asians, and it is also higher in men than women. About half of one’s bone mass is developed during puberty stages. Bone loss appears to be mostly determined by environment factors like nutrition, behaviour and medications.
However, genetic factors also play a huge role, mostly acting on a person’s estrogen. Like I earlier stated, Osteoporosis is known as the “silent thief” therefore pain is not noticeable until a fracture occurs. Some health issues that would arise from this condition could affect a person’s day-to-day life. Although bone fractures may heal within 6-8 weeks, other physical problems, such as pain and tiredness or fatigue may continue long after the healing of the fracture. Carrying weight, light or heavy, may be a problem now because of the pain felt in the bones and muscles of the back. Fractures in the spine can lead to deformity that can get worse over time. Such deformity would be a curve in the upper spine resulting in a hunchback. With this, it could affect your self-esteem. Hip fractures can also be a very serious situation. This would require long term care. Almost 1 out of every 4 women with hip fractures die within 6 months due to complications such as blood clots or pneumonia.
Besides affecting your bones, osteoporosis can affect your life in other ways also.
• Anxiety and depression
• Reduced self-image
• Limitations in the ability to work and enjoy leisure activities
• Acute or chronic pain
• Difficulties in performing daily activities
• Loss of independence
• Change in relationships with friends and family
It can also affect you emotionally. You may not want to go to crowded places such as malls or theatres. You might also feel self-conscious about your appearance. It may even affect couples with intimacy issues.
There are support groups that can help you with whatever issues you are experiencing and don’t be afraid to ask for help.
Exercise can play a very important role in the prevention of osteoporosis. Because bone is a dynamic living tissue that gets stronger when it is being used or stress is put on it and weak when it’s not being used, physically active people usually have a higher bone density at all ages, than people who are not physically active. Weight lifting exercise and strength training are the most effective way to increase bone mass. Exercise like walking, running, stair climbing, etc., forces stress on the bones. Strength training increases the amount of force that muscles exert onto the bones. This not only helps increase bone density, it also has been found to prevent falls. There is a lot of evidence that helps prove that exercise can and will increase the mineral bone content, raising to awareness that exercise could be a good therapy for the treatment of osteoporosis and prevention of fractures in the hip or spine. The exercise program must be designed considering the physical condition of the participants and their previous or current levels of activity.
A big part of loss of bone density observed in older people is due to the fact of disuse of the bone rather than the aging process. Although some mechanical stress in needed to help with bone density, it’s not clear which types of exercises can reduce the need for estrogen therapy in postmenopausal women. Physical activity, aerobic fitness and strength can all correlate to bone density. Younger people may have enhanced bone density in one region and not the other because of the intense exercise they are partaking in. Older people who have been psychically active throughout the years seem to present generally enhanced bone density. Excessive exercise can affect a person’s adaptive capacity, leading into stress fractures.
Exercise across someone’s life span should be encouraged to help maximize their peak bone mass, reduce bone loss related to age and maintain balance and muscle strength and coordination. Even though the effects of physical activity on bone density later on in life are not the biggest, evidence helps prove that being active can nearly halve the chance of fractures in the hips in older people.
The main priority that exercise has in the treatment of osteoporosis is to improve axial stability through muscle strength improvement. Strengthening of the major appendicular muscles will decreases fragility. The effect of strengthening exercise is based on the intake of calcium. Thus, an exercise program is to increase muscle strength safely, help immobility complications and prevent fracture.
Certain types of exercises have been proved to apply moderate benefits to bone mass of the wrist, spine and hip. Recent evidence suggests that high impact work such as stepping and jumping may be effective at the site of the hip. The combination of hormone therapy and exercise are more effective than either intervention on its own.
There are some major benefits of exercise on people who have osteoporosis. A lazy lifestyle can lead to a greater risk of fractures. A person can improve their health with exercise in important ways like:
 Reduction of bone loss
 Improved muscle strength
 Reduced pain
 Better coordination and balance
 Better mobility
 Reduced risk of bone fractures caused by falls
 Improved physical fitness
 And many more
Exercises that will help a person with osteoporosis are:
 Weight-bearing aerobics exercising (dancing)
 Resistance training using weights like barbells or dumbbells, elastic band resistance or weight training machines.
 Exercise that will improve balance (tai chi)
Ideally, they help improve the conditions of osteoporosis. All 3 of these types of workouts should be done weekly.
Although exercise does help people with osteoporosis, there are some exercises that people with the disease should avoid.
 Exercises that involved a load and forward flexion of the spine (sit ups)
 Exercises that may increase the risk of falling
 Exercises that require quick, sudden and forceful movement
 Exercises that require a forcing twisting motion (swinging a baseball bat)
The intensity of a workout should always start slow for a person with osteoporosis and then gradually pick up. This is because too much vigorous exercise to quickly can cause fractures.
If a person has osteoporosis, there are many types of medications you can take. There are anti-resorptive medications that will slow the bone loss down that occurs in the breakdown part of the remodeling bone cycle. When these drugs are ingested, people stop losing bone just as quickly as before but still make new bone at the same time. The goal of these medications is to prevent bone loss and lower the risk of breaking bones.
Bisphosphonates are the most commonly prescribed drugs to treat osteoporosis.
They are the workhorses of osteoporosis treatment. They offer an enormous number of options for patients.
Some of these are Fosomax, Actonel, Boniva and Zoledronic Acid.
Fosomax was the first FDA approved osteoporosis medicine 10 years ago. 3 years later came Actonel. Boniva and Reclast are the most recent FDA approvals.
All of these have shown to increase bone density.
Fosomax and Actonel lower the risk of spine and hip fractures. Actonel has been shown to work quickly.
Anabolic drugs, such as Teriparatide, increase the rate of bone formation. It is currently the only osteoporosis medicine approved by the FDA that rebuilds bone. The goal of this medication is to build bone and lower the risk of breaking bones.
Alendronate is an approved medication in the treatment and for prevention of osteoporosis in postmenopausal women and for the treatment of osteoporosis in men. Alendronate reduces bone loss, improves bone density, and reduces the risk of spine, hip and other bones being broken. For prevention, it is taken daily as a 5mg tablet, and for treatment it is taken as a 10mg tablet daily, or weekly as a 70mg tablet.
Ibandronate is another medication approved in the prevention and treatment of osteoporosis in postmenopausal women. It will reduce the probability of spine fractures by 50% over 3 years. This medication is taken once monthly, whether it being for treatment or prevention. For treatment, it can also be taken through an IV.
Risedronate is used for osteoporosis is both men and women. It slows down bone loss, improves bone density and reduces the risk of fractures of the spine and non-spine fracture. It is taken daily in a 5mg tablet. This medication does offer calcium intake which helps increase the bone density.
Zoledronic is a medication that increases bone density and reduces risk of hip fractures.

It also helps reduce more broken bones in people who have previously suffered from a broken hip. This medication is given to people with osteoporosis once a year through an IV.

Although these medications do help people who suffer from osteoporosis, they also have side effects. Some which include bone, joint or muscle pain. If the medications are consumed orally this can cause nausea, heartburn, difficulty swallowing the pills, or even a gastric ulcer. After receiving the medication through and IV, in can cause flu like symptoms like headache, fever and pain in muscles and joints. These symptoms will most likely go away in a couple of days.

Some other medication used in the prevention and treatment of osteoporosis are:

 Calcitonin-slows bone loss and increase the bone density in the spine as well as reduces the risk of spine fractures. This medication can be taken in as a nasal spray or an injection. Some side effects of the nasal spray are runny nose, back pain and nosebleeds.

 Adequate calcium-1500 milligrams and prescribed Vitamin D-1000 units are also helpful.

Vitamin D is recognised as a key

player.
In conclusion, writing this paper has opened my eyes to a disease that I could possibly obtain. Osteoporosis can start at a young age. I learned that this disease can cause a lot of problems and also a lot of pain (bones breaking and fractures). I never knew that I was at a greater risk being female and Caucasian. Due to the research I have done on osteoporosis I now know that exercise is a great thing. Considering I play a lot of sports, I feel like this will be beneficial to me in the long run when it comes to the chances of me getting osteoporosis.

CITATIONS

S J BIRGE, G. D.
The role of exercise in preventing osteoporosis.
In-text: (S J Birge, 1989)
Bibliography: S J Birge, G. (1989). The role of exercise in preventing osteoporosis. Public Health Reports, [online] 104(Suppl), p.54. Available at: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1580364/ [Accessed 19 Nov. 2014].

MJ, G.
Can vigorous exercise play a role in osteoporosis prevention? A rev... - PubMed - NCBI
In-text: (MJ, 2014)
Bibliography: MJ, G. (2014). Can vigorous exercise play a role in osteoporosis prevention? A rev... - PubMed - NCBI. [online] Ncbi.nlm.nih.gov. Available at: http://www.ncbi.nlm.nih.gov/pubmed/1536981 [Accessed 19 Nov. 2014].

RUTHERFORD, O.
Is there a role for exercise in the prevention of osteoporotic fractures?
In-text: (Rutherford, 1999)
Bibliography: Rutherford, O. (1999). Is there a role for exercise in the prevention of osteoporotic fractures?.British Journal of Sports Medicine, [online] 33(6), p.378. Available at: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1756218/ [Accessed 19 Nov. 2014].

SINAKI M, E. A.
The role of exercise in the treatment of osteoporosis. - PubMed - NCBI
In-text: (Sinaki M, 2014)
Bibliography: Sinaki M, e. (2014). The role of exercise in the treatment of osteoporosis. - PubMed - NCBI. [online] Ncbi.nlm.nih.gov. Available at: http://www.ncbi.nlm.nih.gov/pubmed/20574788 [Accessed 19 Nov. 2014].

OM, R.
Is there a role for exercise in the prevention of osteoporotic frac... - PubMed - NCBI
In-text: (OM, 2014)
Bibliography: OM, R. (2014). Is there a role for exercise in the prevention of osteoporotic frac... - PubMed - NCBI. [online] Ncbi.nlm.nih.gov. Available at: http://www.ncbi.nlm.nih.gov/pubmed/10597845 [Accessed 19 Nov. 2014].

• Niams.nih.gov
Osteoporosis and Related Bone Diseases ~ NIH National Resource Center
In-text: (Niams.nih.gov, 2014)
Bibliography: Niams.nih.gov, (2014). Osteoporosis and Related Bone Diseases ~ NIH National Resource Center. [online] Available at: http://www.niams.nih.gov/Health_Info/Bone/ [Accessed 20 Nov. 2014].

• Osteoporosis Risk Factors: Are You At Risk?
In-text: (Webmd.com, 2014)
Bibliography: Webmd.com, (2014). Osteoporosis Risk Factors: Are You At Risk?. [online] Available at: http://www.webmd.com/osteoporosis/guide/osteoporosis-risk-factors [Accessed 20 Nov. 2014].

• Webmd.com
Osteoporosis Medication Types, Home Remedies, and More
In-text: (Webmd.com, 2014)
Bibliography: Webmd.com, (2014). Osteoporosis Medication Types, Home Remedies, and More. [online] Available at: http://www.webmd.com/osteoporosis/guide/osteoporosis-treatments?page=3 [Accessed 20 Nov. 2014].
• Nof.org
Types of Osteoporosis Medications | National Osteoporosis Foundation
In-text: (Nof.org, 2014)
Bibliography: Nof.org, (2014). Types of Osteoporosis Medications | National Osteoporosis Foundation. [online] Available at: http://nof.org/articles/22 [Accessed 20 Nov. 2014].

• Nos.org.uk
Drug treatment - National Osteoporosis Society
In-text: (Nos.org.uk, 2014)
Bibliography: Nos.org.uk, (2014). Drug treatment - National Osteoporosis Society. [online] Available at: http://www.nos.org.uk/page.aspx?pid=264 [Accessed 20 Nov. 2014].
• Iofbonehealth.org
Epidemiology
In-text: (Iofbonehealth.org, 2014)
Bibliography: Iofbonehealth.org, (2014). Epidemiology. [online] Available at: http://www.iofbonehealth.org/epidemiology [Accessed 20 Nov. 2014].