Osteoporosis: An Aging Process
Osteoporosis is a major public health problem in the U.S., costing an estimated $3.8 billion each year and affecting 15 to 20 million people. A nutritionally unbalanced diet, sedentary lifestyle, genetic factors, alcohol, caffeine, and nicotine abuse are cited as factors that contribute to the onset of this disease. Although osteoporosis often begins to exhibit noticeable symptoms in women between the ages of forty and forty-five, it can begin to develop at an earlier age.
With osteoporosis, bones become less dense, which weakens them and makes them brittle and more prone to fracture. During childhood and early adulthood, bone density increases steadily, peaking around age 35. From middle age on, everyone experiences some loss of bone density and strength. In women, the rate of bone loss increases significantly for about 10 years after menopause.
Risk
Even though anyone can suffer from osteoporosis, women are at higher risk, particularly those transitioning into menopause. According to the National Institutes of Health, populations at greater risk are women of white and Asian descent and people who are underweight, have had anorexia nervosa, have had and continue to have a low calcium intake, had early menopause or get little exercise. The risk of osteoporosis is much higher as women in these categories reach the age of menopause and for several years thereafter, the Cleveland Clinic notes.
Significance
Bones consist of an organic framework of calcium, minerals and other elements. In osteoporosis, a reduction in the organic framework causes a reduction in deposited calcium. Osteoporosis differs from osteomalacia, which is a reduction in calcium rather than a reduction in the organic framework. The two conditions often occur together, particularly through the aging process, resulting in severe weakness of bone.
Function
Throughout life, bone constantly builds up and breaks down. Bone cells called osteoblasts build up bone, while bone cells known as osteoclasts break down bone. While bones are growing, the rate of bone formation exceeds the rate of breakdown; by middle age, the rates are about equal.
According to the American Academy of Orthopaedic Surgeons, bones show a steady loss of mass and strength after age 35. Because estrogen is essential in maintaining bone mass in women, the rate of bone loss increases around the time of menopause.
Effects
The most obvious effect of osteoporosis is an increased tendency for bones to fracture. In the elderly, fractures often occur at the wrist, spine, hip, humerus, and tibia. Vertebrae weakened by osteoporosis can break and compress, often leading to loss of height and a humplike curvature of the spine. If a vertebra collapses, it can cause intense, debilitating back pain.
According to the National Institute on Aging, hormone replacement therapy helps reduce bone loss and is effective in preventing osteoporosis if taken just after menopause. Hormone replacement therapy cannot replace bone, however. Medications to treat osteoporosis are available, but none is without side effects. According to the Office of the Surgeon General, some medications can cause osteoporosis.
Identification
Often a fracture occurs before severe osteoporosis is diagnosed, leaving an elderly person to cope not only with the incapacities of the fracture but also with the disease itself. Radiography or X-rays assist the physician in making a definitive diagnosis. Other tests include dual photon densitometry, which measures the mineral density of bone and can help determine the severity of the condition. Blood and urine tests, and sometimes a bone biopsy, may be necessary to rule out other bone disorders, such as osteomalacia.
