The Osteoporotic Bone
A normal bone will have typical levels serum of calcium and phosphorus. The osteoporotic bone is normally mineralized with disruptions to its microstructure. Supportive bone loss and increased cortical porosity are properties of the osteoporotic bone as well. Low bone mass will result from increased bone resorption (WHO, 1994).
(Figure 2 Arthritis and Osteoporosis, the osteoporotic bone, 2013)
Who is at risk of having Osteoporosis?
It is estimated that osteoporosis or low bone mass (osteopenia) occurs in about 55% of the population aged 50 and over. According to the WHO (p000-p107, 1994) classification, it is estimated that up to 30% of postmenopausal women have osteoporosis. It is accepted that osteoporosis causes more than 8.9 million fractures annually worldwide, of which more than half occur in developed countries. The lifetime risk of a wrist, hip or vertebral fracture has been estimated to be in the order of 30-40%, which is very close to the risk for coronary heart disease . Moreover, in addition to fractures, osteoporosis carries a considerable risk of disability due to serious medical complications. With the population of the U.K living longer, the occurrence of osteoporosis is expected to increase creating medical, social and financial problems.
The international foundation of osteoporosis (2013) has listed a number of factors what increase the likelihood of contracting osteoporosis. Although these factors cannot be changed or altered, people should be aware of them so that they can take preventive steps to reduce bone mineral loss. The IFO also listed secondary risk factors. These secondary risk factors are variables meaning they can be prevented fully. The Fixed risk factors include: Age, being Female, hereditary osteoporosis, past injury, ethnicity, menopause, hysterectomy, long term glucocorticoid therapy, arthritis and hypogonadism in men. The Secondary risk factors are: Alcohol, smoking, low body mass, poor nutrition, vitamin D deficiency, eating disorders, lack of exercise, low dietary calcium intake and frequent falls.
Osteoporosis and Gender
There are studies suggesting that men and women are more likely to contract osteoporosis under certain circumstances.
The recent study by Dennison et al (2007) has concluded that later stages of bone deterioration associated with osteoporosis are more conclusive in men with poor lifestyles. Dennison et al conducted a study where 498 men and 468 women from the Hertfordshire Cohort Study attended a research clinic where a lifestyle questionnaire was administered, body measurements taken and x-ray performed at the neck and lumbar spine. The study found that men with unhealthy lifestyles would be more likely to develop osteoporosis.
Also in a recent study it was said that there is a direct relationship between the lack of estrogen after menopause and the development of osteoporosis. After menopause, the breakdown of bone outpaces the building of new bone. Early menopause and any prolonged periods in which hormone levels are low and menstrual periods are absent or infrequent can cause loss of bone mass (Van Der Kamp, 2012).
Osteoporosis and Race
Race is also a factor when processing someone’s risk of having Osteoporosis. Many studies show that black women lose bone mass more slowly than white or Asian women. The incidence of Osteoporosis and related fractures in African American Women is half that of Caucasian women. African American women who sustain osteoporosis-related fractures have increased disability and decreased survival than Asian or Caucasian women (Bohannon 1999).
Prevention through exercise
A lack of physical activity and poor muscle strength were found to be important risk factors for osteoporosis among the elderly. Weight-bearing exercise is advocated as a strategy for preventing osteoporosis (Lau et al, 1988).
A study conducted in 2006 found that weight resistance forced on the bone is more effective than walking. The study proposes the weight forced upon bone through exercises results in bone deformation. This deformation causes a fluid shift in bone, activating a cellular response that leads to an adjustment of bone mass and architecture to meet the imposed demands of the load. Bone responds to the weight bearing exercise. Cardiovascular exercises such as walking are ineffective for stimulating bone growth. Physical activity fires the bone through muscle pull and gravitational force from resistance training. Because of the increase in gravitational force upon bone in a weight-bearing position, strength-training exercises performed on the feet are considered to be more effective at stimulating bone than machine-based exercises performed in the seated position. In the weight-bearing position, there is an increased load at the hip and greater demand for postural control and balance, which in turn optimizes function in an upright position. Bone increases its response to high-impact, weight-bearing activity and strength training in the presence of adequate calcium consumption (Slawta, 2006).
The following study found that not the duration of an exercise but rather the frequency, combined with its intensity, seems to determine the level of the bone strengthening effect. Weight training is effective at those skeletal sites where an increase in bone mass is desired (Platen 2001).
To increase bone mass and strength, exercise should involve loads of high magnitude and rate and should be dynamic in nature, with varied and diverse patterns of stress. Relatively few cycles of loading would be required so you do not have to exercise for long periods. It is very important to cross train and not rely on one exercise for both cardiovascular and osteoporosis prevention. The exercise must be enjoyable, as it will only be of benefit if it is continued and is a programme for life. Poor compliance is a major problem. Strategies to prevent falls are important. Exercise in elderly people may enhance mobility, muscle strength, and co-ordination. The combination of exercise, calcium supplements, and hormone replacement therapy is the optimum treatment to prevent bone loss (Ferrari et al, 2012).
Physical inactivity and Osteoporosis
Looking at the opposite of exercise (inactivity) there was also evidence suggesting that this was detrimental for people with Osteoporosis. Bone tissue weakens after periods of inactivity, either from prolonged bed rest or from immobilization. During a study various therapeutic attempts, including the use of supplemental calcium and vitamin D, exercise, skeletal compression, and increased hydrostatic pressure to the lower extremities, were made to prevent bone mineral loss. The exercise program involved a daily 80-minute workout using a pulley system that offered 8 pounds of resistance. Despite these therapeutic interventions, urinary calcium increased rapidly, and calcaneal mineral losses of 5% were noted each month. It was concluded that a lack of weight-bearing activity causes skeletal loss. The authors suggested that the compressive and the impact of forces applied may not have simulated normal ambulation adequately in terms of quality and quantity (Aisenbrey, 1987). This suggests that inactivity can lead to weak bones and frequent weight bearing exercise is needed to keep bones strong.
What benefits would exercise bring to the person and their condition.
Exercise would benefit older women Van Der Kamp (2012) states that postmenopausal women with osteoporosis should be treated with pain relief and physiotherapy plan consisting of biomechanical movement and light exercise.
Compliance with exercise regimens is a very important factor in trying to increase bone mass density. The evidence for exercise having a protective role against hip fracture comes from large epidemiological studies conducted by the IFO (IFO, 2013).
In general, it is thought that disuse (not using the limbs or prolonged periods of inactivity) and unloading of the skeleton promotes reduced bone mass, whereas loading promotes increased bone mass. The effects of mechanical loading have been demonstrated in athletes undertaking high-impact exercise. Mechanical loading through exercise has the potential to be a safe and effective way to avert or delay the onset of osteoporosis in postmenopausal women. The IFO concluded that exercise has beneficial effects on bone density of the hip and spine, although long term-studies including fracture data are rare. In addition, strength and balance exercises contribute to fracture risk reduction through their efficacy in reducing falls risk (Kemmlar et al 2013).
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