Term Paper on "Osteoporosis in U.S"

Term Paper 10 pages (3143 words) Sources: 10

[EXCERPT] . . . .

Osteoporosis in the U.S.

Osteoporosis is the loss of bone mass because of a loss of calcium (American Family Physician 2004). In this condition, the inside of the bone becomes weak and makes the bone likelier to break. It occurs more in women than in men because women have less bone mass than men, have greater longevity and less intake of calcium and need the female hormone estrogen to keep their bones strong. The risk of developing osteoporosis grows as a person lives longer. Total bone mass reaches a peak on the late 20s or early 30s and the person begins to lose bone mass. The rate of bone loss in women increases after menopause when the level of estrogen decreases. Bone loss may also occur after the surgical removal of the ovaries. Symptoms include broken bones, low back pain, a hunched back or reduced height. These often show up only after a lot of bone calcium has already been lost. Risk factors include menopause before age 48, removal of the ovaries before menopause, insufficient dietary calcium and vitamin D, insufficient exercise, smoking, family history, alcohol abuse, thinness and small bone frame, white or Asian skin, hyperthyroidism, long-term use of oral steroids and prior bone fracture as an adult (American Family Physician).

Records say that osteoporosis affects more than 25 million Americans (Mangels 2005). In 2001 alone, the approximate national direct expenditure for osteoporosis and fractures related to the condition was $17 billion and still rising. A person, especially a woman, needs 1,000 mg of calcium daily before menopause and 1,500 mg after menopause if she is not taking estrogen (American Family Physician 2004). Good sources of calcium are nonfat and low-fat dairy products, dried beans, sardines, broccoli, juices and cereals, which are fortified with calcium. Vitamin D helps the body absorb calcium and a woman needs 400-800 IU of the vitamin daily. Treatment of osteoporosis includes proper diet, exercising, quitting smoking and medicines, such as hormones (American Family Physician).

A telephone survey found that most women were not taking adequate steps to prevent osteoporosis (AORN Journal 2004). According to the National Women's Health Resource Center, osteoporosis can cause bone weakness and women beyond 50 will experience osteoporosis-related fracture in their lifetime. The telephone survey revealed that 59% of the participants had not been checked out for bone mineral density; 65% of them were aware of the seriousness of the condition but only 1% of them expressed concern that they could die of it; and almost two-thirds of them did not believe they were at risk for developing the disease. Ninety percent of them were taking calcium supplements to protect against bone loss, but the Resource Center said that the supplements were insufficient for women in the postmenopausal years (AORN Journal).

Statistics showed that 1.5 fractures each year in the U.S. are traceable to osteoporosis and likely to increase as the population continues to age (Wellbery 2005). There are guidelines to identify older women who may be at high risk through the bone mineral density screening, but predicting osteoporosis, osteopenia and spinal fracture risk in younger patients was not conclusive. Researchers said that no single examination was enough to make a diagnosis of osteoporosis. Furthermore, it was unlikely that women at risk were being screened according to recommendations. A study conducted on clinical guidelines revealed that almost a third did not provide information on how they were to be established and more than a half did not define "consensus." The guidelines were inconsistent at what age women should be screened and what risk factors should be considered. Another intervention found that improved rating rates were likelier to lead to bone mass density tests if the patients received positive-focused counseling than negative-focused. In summary, screening guidelines for osteoporosis lacked uniform recommendations, the screening rates were generally low and few interventions made or studied to improve these screening rates (Wellbery).

Surgeon General Richard Carmona prescribed exercise to prevent or even reverse bone disorder osteoporosis (Shelton 2005). Although the skeleton weakens when the person reaches age 40 or 50 on account of a deficit of bone minerals, such as calcium, he or she can improve bone health by increasing calcium and Vitamin D intake and through exercise. Foods high in calcium include yogurt, milk, broccoli and almonds and those rich in Vitamin D include fortified dairy products. Otherwise, multivitamins will fill this requirement. On the other hand, exercise can be performed through weightlifting and weight-bearing aerobic exercises, like walking, climbing stairs, and running. These activities are important for building and rebuilding bone. Dr. Carmona said that, like muscle, bone gets stronger and tougher with exercise. Exercise wards osteoporosis off by overloading the bones with weight and by working many muscle groups. It increases bone density at any age, reduces the risk of fractures and enhance longevity (Shelton).

The scaffolding for bone is made from a protein called collagen (Mangels 2005). Calcium and phosphorus combine to produce hydroxyapatite, which is a mineral-rich substance, which crystallizes on the collagen scaffold and turns it into a strong and rigid material. But this material does not remain permanently in the bone. When another part of the body needs calcium, it is taken from the body to that other part needing calcium. But when more calcium is available, it is used by the body to rebuild the bone. In the early life stages, more bone is built by the body than broken down, but this process slows down by age 30 and results in a net loss of bone. Although this occurs with aging, the normal loss of bone will not be too severe if the person has had larger and stronger bones at the start of life. Women face a greater risk of osteoporosis than men because women naturally have less bone and lose them more quickly, especially after menopause. At ages 20 to 29, women have 76% of men's bone matter and this amount decreases to 60% when they reach 70s. At this time, women start losing bone mass and develop very fragile bone. Genetics also plays a role in determining the risk of osteoporosis. Gender and genetics cannot be changed but the risk can be managed markedly through diet and exercise, as previously mentioned. In addition to calcium, the diet should include the right amount of Vitamin D, protein, phosphorus, fluoride, Vitamin A and Vitamin K (Mangels).

Children with low-calcium diets may develop osteoporosis as adults and a greater risk of fracture (Mangels 2005). Some studies suggested that older adults with high calcium intake develop stronger bones and have lower fracture risk. Some studies on vegetarians with low bone density and low calcium intake said that calcium was well-absorbed from a vegetarian or vegan diet. Sources of well-absorbed calcium include calcium-fortified soymilk and juice, calcium-set tofu, soybeans and soynuts, bok choy, broccoli, collards, Chinese cabbage, kale, mustard greens and okra. But a high-calcium diet is insufficient without adequate Vitamin D to absorb calcium (Mangels, Hudson 2006). This vitamin is necessary throughout life to build the bones of childhood and adolescence as well as throughout adulthood. The skin produces natural Vitamin D by exposure to the sun but factors, like the season, the time of day, age and use of sunscreen and pollution, can stand on the way. Hence, most people should include it in their diet. Vitamin D occurs only in very small amounts in plant sources, so that vegetarians should rely on other foods fortified with the vitamin, such as non-dairy milks, juices and breakfast cereals (Mangels). Some popular publications have made erroneous claims that the animal protein content of vegan diets would minimize calcium losses. Other studies contended that a higher protein intake would be needed to promote calcium absorption, reduce the risk of fracture, and increase bone density. These conflicting claims require additional research but, at the moment, the consensus is that the diet must include 0.8 grams of calcium and protein per kilogram of weight to assure the best level of bone health. Phosphorus is a major part of the bone found in many foods and in abundance in vegan diets. Fluoride enhances the accumulation of calcium and phosphate in the bone and comes primarily from fluoridated water. Vitamin A aids bone growth but its overuse can increase the risk of fracture when there are excessive amounts of retinol, a form of Vitamin A found in many animal foods. Vitamin K is needed to produce a protein, which strengthens the bone. It comes from green vegetables and other plant foods (Mangels). And exercise can help stimulate bone size and strength. Running, dancing, weight training and roller-blading are examples. Even 30 minutes of exercise twice a week can achieve the effect and reduce the risk of developing osteoporosis later in life (Mangles).

Treatment of osteoporosis includes anti-resorptive agents and agents, which stimulate the growth and formation of bones (Hudson 2006). Anti-resorptive agents decrease the imbalance between bone resorption and bone formation by reducing excessive osteoclast activity. These agents affect the trabecular bone… READ MORE

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