Osteoporosis Classification and external resources
ICD-10	M80.-M82.
ICD-9	733.0
OMIM	166710
DiseasesDB	9385
MedlinePlus	000360
eMedicine	med/1693  ped/1683 pmr/94 pmr/95
MeSH	D010024

Osteoporosis is a disease of bone that leads to an increased risk of fracture. The International Statistical Classification of Diseases and Related Health Problems (most commonly known by the abbreviation ICD) provides codes to classify Diseases The International Statistical Classification of Diseases and Related Health Problems 10th Revision ( ICD -10) is a coding of diseases and signs symptoms abnormal findings M00-M99 - Diseases of the Musculoskeletal system and Connective tissue (M00-M25 Arthropathies (M00-M03 Infectious arthropathies M00-M99 - Diseases of the Musculoskeletal system and Connective tissue (M00-M25 Arthropathies (M00-M03 Infectious arthropathies The International Statistical Classification of Diseases and Related Health Problems (most commonly known by the abbreviation ICD) provides codes to classify Diseases The following is a list of codes for International Statistical Classification of Diseases and Related Health Problems. The Mendelian Inheritance in Man project is a Database that catalogues all the known Diseases with a genetic component, and—when possible—links them The Diseases Database is a free Website that provides information about the relationships between medical conditions Symptoms, and Medications. MedlinePlus, with the MedlinePlus Medical Encyclopedia, is a website network containing Health information from the world's largest medical Library eMedicine is an online clinical medical knowledge base that was founded in 1996 by Scott Plantz and Richard Lavely two medical doctors Medical Subject Headings ( MeSH) is a huge Controlled vocabulary (or metadata system for the purpose of indexing journal articles and books A disease is an abnormal condition of an organism that impairs bodily functions and can be deadly Bones are rigid organs that form part of the Endoskeleton of Vertebrates They function to move support and protect the various organs of the body produce A bone fracture (sometimes abbreviated # or Fx or Fx) is a medical condition in which a Bone is cracked or broken In osteoporosis the bone mineral density (BMD) is reduced, bone microarchitecture is disrupted, and the amount and variety of non-collagenous proteins in bone is altered. Collagen is the main Protein of Connective tissue in Animals and the most abundant protein in Mammals making up about 50% of the whole-body protein Osteoporosis is defined by the World Health Organization (WHO) in women as a bone mineral density 2. 5 standard deviations below peak bone mass (20-year-old healthy female average) as measured by DXA; the term "established osteoporosis" includes the presence of a fragility fracture. In Probability and Statistics, the standard deviation is a measure of the dispersion of a collection of values Dual energy X-ray absorptiometry ( DXA, previously DEXA is a means of measuring Bone mineral density (BMD In Traumatology, a fragility fracture is a Bone fracture that occurs as a result of a fall from standing height or less ^[1] Osteoporosis is most common in women after menopause, when it is called postmenopausal osteoporosis, but may also develop in men, and may occur in anyone in the presence of particular hormonal disorders and other chronic diseases or as a result of medications, specifically glucocorticoids, when the disease is called steroid- or glucocorticoid-induced osteoporosis (SIOP or GIOP). Menopause is the permanent shutting down of the female Reproductive system, a considerable length of time before the end of the lifespan In Medicine, a chronic disease is a Disease that is long-lasting or recurrent Medication, also referred to as medicine, can be loosely defined as any substance intended for use in the diagnosis cure mitigation treatment or prevention of disease Glucocorticoids (GC are a class of Steroid hormones characterised by an ability to bind with the glucocorticoid receptor ( GR) and trigger similar effects Given its influence on the risk of fragility fracture, osteoporosis may significantly affect life expectancy and quality of life. Life expectancy is the average number of years of life remaining at a given age Quality of life is the degree of well-being felt by an individual or group of people

Osteoporosis can be prevented with lifestyle advice and sometimes medication, and in people with osteoporosis treatment may involve lifestyle advice, preventing falls and medication (calcium, vitamin D, bisphosphonates and several others). Fall prevention is a variety of actions to help reduce the number of accidental falls suffered by older people Calcium (Ca2+ plays a vital role in the Anatomy, Physiology and Biochemistry of Organisms and of the cell, particularly Vitamin D is a group of fat-soluble Prohormones, the two major forms of which are vitamin D2 (or Ergocalciferol) and vitamin D3 (or In Pharmacology, bisphosphonates (also called diphosphonates) are a class of drugs that inhibit Osteoclast action and the resorption of bone

Contents 1 Signs and symptoms 1.1 Fractures 1.2 Falls risk 2 Risk factors 2.1 Nonmodifiable 2.2 Potentially modifiable 2.3 Diseases and disorders 2.4 Medication 3 Diagnosis 3.1 Dual energy X-ray absorptiometry 3.2 Screening 4 Pathogenesis 5 Treatment 5.1 Medication 5.2 Nutrition 5.3 Mechanical stimulation 6 Prognosis 7 Epidemiology 7.1 Hip fractures 7.2 Vertebral fractures 7.3 Wrist 7.4 Rib Fractures 8 Prevention 8.1 Lifestyle 8.2 Medication 9 History 10 See also 11 References 12 External links

Signs and symptoms

Osteoporosis itself has no specific symptoms; its main consequence is the increased risk of bone fractures. Osteoporotic fractures are those that occur in situations where healthy people would not normally break a bone; they are therefore regarded as fragility fractures. A fracture is the (local separation of an object or material into two or more pieces under the action of stress. In Traumatology, a fragility fracture is a Bone fracture that occurs as a result of a fall from standing height or less Typical fragility fractures occur in the vertebral column, rib, hip and wrist. In Human anatomy, the vertebral column ( backbone or spine) is a column of 34 Vertebrae the Sacrum, Intervertebral In Vertebrate Anatomy, ribs ( Latin costae) are the long curved Bones which form the ribcage. A hip fracture is a fracture in the Proximal end of the Femur (the long bone running through the Thigh) near the hip joint. In Human anatomy, the wrist is the flexible and narrower connection between the Forearm and the palm.

Fractures

The symptoms of a vertebral collapse ("compression fracture") are sudden back pain, often with radiculopathic pain (shooting pain due to nerve compression ) and rarely with spinal cord compression or cauda equina syndrome. A vertebra (plural vertebrae) is an individual Irregular bone in the spinal or Vertebral column ( aka ischis a flexuous and flexible column A compression fracture is a collapse of a Vertebra. It may be due to trauma or due to a weakened vertebra in a patient with Osteoporosis or Osteogenesis Imperfecta Back pain (also known " dorsalgia " is Pain felt in the back that usually originates from the Muscles Nerves Bones Radiculopathy is not a specific condition but rather a description of a problem in which one or more nerves are affected and do not work properly (a Neuropathy) A nerve is an enclosed cable-like bundle of peripheral Axons (the long slender projections of Neurons. Spinal cord compression develops when the Spinal cord is compressed by bone fragments from a vertebral fracture a Tumor, Abscess, ruptured Intervertebral Cauda equina syndrome is a serious neurologic condition in which there is acute loss of function of the neurologic elements ( Nerve roots of the spinal Multiple vertebral fractures lead to a stooped posture, loss of height, and chronic pain with resultant reduction in mobility. ^[2]

Fractures of the long bones acutely impair mobility and may require surgery. Surgery (from the χειρουργική cheirourgikē, via chirurgiae meaning "hand work" is a medical specialty that uses operative manual and instrumental Hip fracture, in particular, usually requires prompt surgery, as there are serious risks associated with a hip fracture, such as deep vein thrombosis and a pulmonary embolism, and increased mortality. A hip fracture is a fracture in the Proximal end of the Femur (the long bone running through the Thigh) near the hip joint. In Medicine, deep vein thrombosis (also known as deep-vein thrombosis or deep venous thrombosis and usually abbreviated as DVT) is the formation Pulmonary embolism (PE is a blockage of the Pulmonary artery or one of its branches usually occurring when a venous Thrombus (blood clot from a vein

Falls risk

The increased risk of falling associated with aging leads to fractures of the wrist, spine and hip. The risk of falling, in turn, is increased by impaired eyesight due to any cause (e. g. glaucoma, macular degeneration), balance disorder, movement disorders (e. Glaucoma is a group of diseases of the Optic nerve involving loss of retinal ganglion cells in a characteristic pattern of optic neuropathy. Macular degeneration is a medical condition usually of older adults which results in a loss of vision in the center of the visual field (the Macula) because A balance disorder is a disturbance that causes an individual to feel unsteady giddy woozy or have a sensation of movement spinning or floating Movement disorders include Akathisia Akinesia ( lack of movement) Athetosis ( contorted torsion g. Parkinson's disease), dementia, and sarcopenia (age-related loss of skeletal muscle). Parkinson's disease (also known as Parkinson disease or PD) is a degenerative disorder of the Central nervous system that often impairs the sufferer's Dementia (from Latin de- "apart away" + Mens ( genitive mentis) "mind" is the progressive decline Sarcopenia (from the Greek meaning "poverty of flesh" is the degenerative loss of Skeletal muscle mass and strength associated with Senescence. Skeletal muscle is a type of Striated muscle, which usually attaches to tendons Collapse (transient loss of postural tone with or without loss of consciousness) leads to a significant risk of falls; causes of syncope are manifold but may include cardiac arrhythmias (irregular heart beat), vasovagal syncope, orthostatic hypotension (abnormal drop in blood pressure on standing up) and seizures. Collapse is a sudden and often unannounced loss of postural tone (going weak often but not necessarily accompanied by loss of consciousness. Dysrhythmia redirects here For the American band see Dysrhythmia (band. Orthostatic hypotension (also known as postural hypotension, and colloquially as head rush or a dizzy spell) is a form of Hypotension in which An epileptic seizure is caused by excessive and/or hypersynchronous electrical Neuronal activity and is usually self-limiting Removal of obstacles and loose carpets in the living environment may substantially reduce falls. Those with previous falls, as well as those with a gait or balance disorder, are most at risk. ^[3]

Risk factors

Risk factors for osteoporotic fracture can be split between non-modifiable and (potentially) modifiable. In addition, there are specific diseases and disorders in which osteoporosis is a recognized complication. Medication use is theoretically modifiable, although in many cases the use of medication that increases osteoporosis risk is unavoidable.

Nonmodifiable

The most important risk factors for osteoporosis are advanced age (in both men and women) and female sex; estrogen deficiency following menopause is correlated with a rapid reduction in BMD, while in men a decrease in testosterone levels has a comparable (but less pronounced) effect. Female (♀ is the Sex of an Organism, or a part of an organism which produces ova (egg cells Estrogens (US otherwise oestrogens or œstrogens) are a group of Steroid compounds named for their importance in the Estrous cycle, Menopause is the permanent shutting down of the female Reproductive system, a considerable length of time before the end of the lifespan Testosterone is a Steroid hormone from the Androgen group In mammals testosterone is primarily secreted in the testes of males and the Ovaries While osteoporosis occurs in people from all ethnic groups, European or Asian ancestry predisposes for osteoporosis. The European peoples are the various Nations and Ethnic groups of Europe. Asian or Asiatic is a Demonym for people from Asia. However the use of the term varies by country and person often referring to people from a particular ^[4] Those with a family history of fracture or osteoporosis are at an increased risk; the heritability of the fracture as well as low bone mineral density are relatively high, ranging from 25 to 80 percent. In Medicine, a family history consists of information about disorders that a patient's direct blood relatives have suffered from In Genetics, Heritability is the proportion of phenotypic variation in a population that is attributable to genetic variation among individuals There are at least 30 genes associated with the development of osteoporosis. ^[5] Those who have already had a fracture are at least twice as likely to have another fracture compared to someone of the same age and sex. ^[6]

Potentially modifiable

• Excess alcohol - small amounts of alcohol do not increase osteoporosis risk and may even be beneficial, but chronic heavy drinking(Alcohol intake greather than ≥ 3 units/day)^[7], especially at a younger age, increases risk significantly. ^[8]
• Vitamin D deficiency^[9] - low circulating Vitamin D is a common among the elderly world wide. Vitamin D is a group of fat-soluble Prohormones, the two major forms of which are vitamin D2 (or Ergocalciferol) and vitamin D3 (or ^[10] Mild vitamin D insufficiency is associated with increased Parathyroid Hormone (PTH) production. Parathyroid hormone (PTH, or parathormone, is secreted by the Parathyroid glands as a Polypeptide containing 84 Amino acids. ^[10] PTH increases bone reabsorption, leading to boneloss. A positive association exists between serum 1,25-dihydroxycholecalciferol levels and bone mineral density, whilst PTH is negatively associated with bone mineral density. ^[10]
• Tobacco smoking - tobacco smoking inhibits the activity of osteoblasts, and is an independent risk factor for osteoporosis. Tobacco Smoking is the inhalation of smoke from burned dried or cured leaves of the Tobacco plant most often in the form of a Cigarette. ^[7][11] Smoking also results in increased breakdown of exogenous oestrogen, lower body weight and earlier menopause, all of which contribute to lower bone mineral density. ^[10]
• Low body mass index - being overweight protects against osteoporosis, either by increasing load or through the hormone leptin. The body mass index ( BMI) or Quetelet index, is a statistical measurement which compares a person's weight and height Leptin (Greek leptos meaning thin is a 16 kDa ^[12]
• Malnutrition - low dietary calcium intake, low dietary intake of vitamins K and vitamin c ^[9] Also low protein intake is associated with lower peak bone mass during adolescence and lower bone mineral density in elderly populations. Malnutrition is a general term for a medical condition caused by an improper or insufficient diet. Calcium (ˈkælsiəm is the Chemical element with the symbol Ca and Atomic number 20 ^[10]
• Physical inactivity - bone remodeling occurs in response to physical stress. Bone remodeling is a life long process where old Bone is removed from the Skeleton (a sub-process called bone resorption and new bone is added (a sub-process called Weight bearing exercise can increase peak bone mass achieved in adolescence. In Orthopedics, weight bearing is the amount of Weight a patient puts on the leg on which surgery has been performed ^[10] In adults, physical activity helps maintain bone mass, and can increase it by 1 or 2%. Conversely, physical inactivity can lead to significant boneloss. ^[10]
• Excess physical activity - excessive exercise can lead to constant damages to the bones which can cause exhaustion of the structures as described above. There are numerous examples of marathon runners who developed severe osteoporosis later in life. In women, heavy exercise can lead to decreased estrogen levels, which predisposes to osteoporosis. Intensive training is often associated with low body mass index.
• Heavy metals - a strong association between cadmium, lead and bone disease has been established. Cadmium (ˈkædmiəm is a Chemical element with the symbol Cd and Atomic number 48 Low level exposure to cadmium is associated with an increased loss of bone mineral density readily in both genders, leading to pain and increased risk of fractures, especially in elderly and in females. Higher cadmium exposure results in osteomalacia (softening of the bone). Osteomalacia is the general term for the softening of the bones due to defective Bone mineralization. ^[13]
• Soft drinks - some studies indicate that soft drinks (many of which contain phosphoric acid) may increase risk of osteoporosis;^[14] others suggest soft drinks may displace calcium-containing drinks from the diet rather than directly causing osteoporosis. Soft drink is a beverage that does not contain Alcohol. Carbonated soft drinks are commonly known as soda soda pop pop, or Phosphoric acid, also known as orthophosphoric acid or phosphoric(V acid, is a mineral (inorganic acid having the Chemical formula ^[15]

Diseases and disorders

Many diseases and disorders have been associated with osteoporosis. ^[16] For some, the underlying mechanism influencing the bone metabolism is straight-forward, whereas for others the causes are multiple or unknown.

• In general, immobilization causes bone loss (following the 'use it or lose it' rule). Immobilization in Soil science, is when organic matter Decomposes and is absorbed by Micro-organisms, therefore preventing it being accessible to plants For example, localized osteoporosis can occur after prolonged immobilization of a fractured limb in a cast. This is also more common in active patients with a high bone turn-over (for example, athletes). Other examples include bone loss during space flight or in people who are bedridden or wheelchair-bound for various reasons. Spaceflight is the use of Space technology to fly a Spacecraft into and through Outer space.
• Hypogonadal states can cause secondary osteoporosis. Hypogonadism is a medical term for a defect of the Reproductive system that results in lack of function of the Gonads ( ovaries or testes) These include Turner syndrome, Klinefelter syndrome, Kallmann syndrome, anorexia nervosa, andropause^[17], hypothalamic amenorrhea or hyperprolactinemia^[17]. Turner syndrome or Ullrich-Turner syndrome encompasses several conditions of which monosomy X is the most common Klinefelter's syndrome, 47XXY or XXY syndrome is a condition caused by a Chromosome Aneuploidy. Kallmann syndrome is an example of Hypogonadism (decreased functioning of the sex hormone-producing glands caused by a deficiency of Gonadotropin-releasing hormone Anorexia Nervosa is a psychiatric Diagnosis that describes an Eating disorder characterized by low Body weight and Body image distortion Andropause (or male Menopause) is a rather misleading word and a controversial concept The hypothalamus links the Nervous system to the Endocrine system via the Pituitary gland (hypophysis Amenorrhoea ( BE) amenorrhea ( AmE) or amenorrhœa, is the absence of a Menstrual period in a woman of reproductive age Hyperprolactinaemia ( BrE) or hyperprolactinemia ( AmE) is the presence of abnormally-high levels of Prolactin in the blood In females, the effect of hypogonadism is mediated by estrogen deficiency. Estrogens (US otherwise oestrogens or œstrogens) are a group of Steroid compounds named for their importance in the Estrous cycle, It can appear as early menopause (<45 years) or from prolonged premenopausal amenorrhea (>1 year). Menopause is the permanent shutting down of the female Reproductive system, a considerable length of time before the end of the lifespan A bilateral oophorectomy (surgical removal of the ovaries) or a premature ovarian failure cause deficient estrogen production. Oophorectomy (or ovariectomy) is the surgical removal of an Ovary or ovaries Premature Ovarian Failure (POF also known as primary ovarian insufficiency, is the loss of function of the Ovaries before age 40 In males, testosterone deficiency is the cause (for example, andropause or after surgical removal of the testes). Testosterone is a Steroid hormone from the Androgen group In mammals testosterone is primarily secreted in the testes of males and the Ovaries The testicle (from Latin testiculus, diminutive of testis, meaning "witness" virility plural testes) is the male
• Endocrine disorders that can induce bone loss include Cushing's syndrome^[10], hyperparathyroidism^[10], thyrotoxicosis^[10], hypothyroidism, diabetes mellitus type 1 and 2,^[18] acromegaly and adrenal insufficiency. Hyperparathyroidism is overactivity of the Parathyroid glands resulting in excess production of Parathyroid hormone (PTH Hyperthyroidism is the term for overactive tissue within the Thyroid gland resulting in overproduction and thus an excess of circulating free thyroid hormones Thyroxine Hypothyroidism is the disease state in humans and animals caused by insufficient production of Thyroid hormone by the Thyroid gland. Diabetes mellitus (ˌdaɪəˈbiːtiːz or /ˌdaɪəˈbiːtəs/ /məˈlaɪtəs/ or /ˈmɛlətəs/ often referred to simply as diabetes ( Ancient Greek: grc Acromegaly (from Greek akros "extreme" or "extremities" and megalos "large" - extremities enlargement is a Syndrome Adrenal insufficiency is a condition in which the Adrenal glands located above the Kidneys do not produce adequate amounts of steroid hormones (chemicals produced by the In pregnancy and lactation, there can be a reversible bone loss. Pregnancy ( Latin graviditas) is the carrying of one or more offspring known as a Fetus or Embryo, inside the Uterus of a Female Lactation describes the secretion of Milk from the Mammary glands the process of providing that milk to the young and the period of time that a Mother ^[16]
• Malnutrition, parenteral nutrition^[10] and malabsorption can lead to osteoporosis. Malnutrition is a general term for a medical condition caused by an improper or insufficient diet. Total Parenteral nutrition (TPN is the practice of feeding a person Intravenously bypassing the usual process of Eating and Digestion. Malabsorption is a state arising from abnormality in Digestion or Absorption of food nutrients across the gastrointestinal(GI tract. Nutritional and gastrointestinal disorders that can predispose to osteoporosis include coeliac disease^[10], Crohn's disease, lactose intolerance, surgery^[17] (after gastrectomy, intestinal bypass surgery or bowel resection) and severe liver disease (especially primary biliary cirrhosis)^[17]. Coeliac Crohn's disease is a Disease of the Digestive system which may affect any part of the Gastrointestinal tract from Mouth to Anus A gastrectomy is a partial or full surgical removal of the Stomach. A bowel resection is a Surgical procedure in which a part of the large or small intestine is removed Liver disease is a broad term describing any number of Diseases affecting the Liver. Primary biliary cirrhosis is an Autoimmune disease of the Liver marked by the slow progressive destruction of the small bile ducts ( Bile canaliculi) within Patients with bulemia can also develop osteoporosis. Bulimia nervosa is an Eating disorder characterized by recurrent Binge eating, followed by compensatory behaviors referred to as "purging" Those with an otherwise adequate calcium intake can develop osteoporosis due to the inability to absorb calcium and/or vitamin D. Other micro-nutrients such as vitamin K or vitamin B12 deficiency may also contribute. Vitamin K (K from "Koagulations-Vitamin" in German Danish Swedish and Norwegian denotes a group of Lipophilic, Hydrophobic Vitamins that B12 deficiency is a reduction in Vitamin B12 from inadequate dietary intake or impaired absorption
• Patients with rheumatologic disorders like rheumatoid arthritis^[17], ankylosing spondylitis^[17], systemic lupus erythematosus and polyarticular juvenile idiopathic arthritis are at increased risk of osteoporosis, either as part of their disease or because of other risk factors (notably corticosteroid therapy). Rheumatoid arthritis ( RA) is a chronic systemic autoimmune disorder that causes the Immune system to attack the Joints, where Ankylosing spondylitis ( AS; previously known as Bechterew's disease, Bechterew syndrome, Marie Strümpell disease and a form of Spondyloarthritis Systemic lupus erythematosus ( SLE or lupus,) is a chronic autoimmune disease that can be fatal though with recent medical advances fatalities are becoming This article does not deal with the more general topic of Childhood arthritis. Systemic diseases such as amyloidosis and sarcoidosis can also lead to osteoporosis. In Medicine, amyloidosis refers to a variety of conditions in which Amyloid Proteins are abnormally deposited in organs and/or tissues Sarcoidosis, also called sarcoid (from the Greek sarx, meaning "flesh" or Besnier-Boeck disease, is an immune system disorder characterized
• Renal insufficiency can lead to osteodystrophy. Renal failure or kidney Osteodystrophy is a general term for a dystrophic growth of the bone
• Hematologic disorders linked to osteoporosis are multiple myeloma^[17] and other monoclonal gammopathies,^[18] lymphoma and leukemia, mastocytosis^[17], hemophilia, sickle-cell disease and thalassemia. Multiple myeloma (also known as MM, myeloma, plasma cell myeloma, or as Kahler's disease after Otto Kahler) is a type of Lymphoma a type of Neoplasm that originates in Lymphocytes (a type of White blood cell in the vertebrate Immune system) Leukemia or leukaemia (Greek leukos λευκός, "white" aima αίμα, "blood" is a Cancer of the Blood Mastocytosis is a group of rare disorders of both children and adults caused by the presence of too many Mast cells ( mastocytes) and CD34 + mast Haemophilia (also spelled as hemophilia Sickle-cell disease or sickle-cell anaemia (or anemia) is a Blood disorder characterized by Red blood cells that assume an abnormal rigid Thalassemia (from Greek θαλασσα thalassa sea + αίμα haima blood British spelling "thalassaemia" is an inherited Autosomal recessive
• Several inherited disorders have been linked to osteoporosis. These include osteogenesis imperfecta^[17], Marfan syndrome^[17], hemochromatosis^[10], hypophosphatasia, glycogen storage diseases, homocystinuria^[17], Ehlers-Danlos syndrome^[17], porphyria, Menkes' syndrome, epidermolysis bullosa and Gaucher's disease. Osteogenesis imperfecta ( OI and sometimes known as Brittle Bone Disease) is a genetic bone disorder Marfan syndrome (or Marfan's syndrome is a genetic disorder of the Connective tissue. Haemochromatosis, also spelled hemochromatosis (see spelling differences) also called siderophilia Hypophosphatasia is a rare inherited Metabolic disorder of decreased tissue nonspecific Alkaline phosphatase (TNSALP and defective Bone mineralization Glycogen storage disease (synonyms glycogenosis, dextrinosis) is any one of several inborn errors of metabolism that result from Enzyme defects Homocystinuria, also known as Cystathionine beta synthase deficiency, is an inherited disorder of the Metabolism of the Amino acid Methionine Ehlers-Danlos syndrome is a group of rare Genetic disorders affecting humans caused by a defect in Collagen synthesis Porphyrias are a group of inherited or acquired disorders of certain Enzymes in the Heme biosynthetic pathway (also called Porphyrin pathway Menkes disease (also called the kinky hair disease or Menkes kinky hair syndrome) is a disorder that affects Copper levels in the body Epidermolysis Bullosa ( EB) is a rare Genetic disease characterized by the presence of extremely fragile Skin and recurrent Blister Gaucher's disease ( is the most common of the Lysosomal storage diseases It is caused by a deficiency of the enzyme Glucocerebrosidase, leading to an accumulation
• People with scoliosis of unknown cause also have a higher risk of osteoporosis. Scoliosis is a medical condition in which a person's spine is curved from side to side and may also be rotated Idiopathic is an Adjective used primarily in Medicine meaning arising spontaneously or from an obscure or unknown cause. Bone loss can be a feature of complex regional pain syndrome. Complex Regional Pain Syndrome (CRPS is a chronic progressive disease characterized by severe pain swelling and changes in the skin It is also more frequent in people with Parkinson's disease and chronic obstructive pulmonary disease. Parkinson's disease (also known as Parkinson disease or PD) is a degenerative disorder of the Central nervous system that often impairs the sufferer's Chronic obstructive pulmonary disease ( COPD) is a Disease of the lungs in which the Airways become narrowed

Medication

Certain medications have been associated with an increase in osteoporosis risk; only steroids and anticonvulsants are classically associated, but evidence is emerging with regard to other drugs.

• Steroid-induced osteoporosis (SIOP) arises due to use of glucocorticoids - analogous to Cushing's syndrome and involving mainly the axial skeleton. Glucocorticoids (GC are a class of Steroid hormones characterised by an ability to bind with the glucocorticoid receptor ( GR) and trigger similar effects The synthetic glucocorticoid prescription drug prednisone is a main candidate after prolonged intake. Prednisone is a synthetic Corticosteroid drug that is usually taken orally but can be delivered by Intramuscular injection and can be used for a great number Some professional guidelines recommend prophylaxis in patients who take the equivalent of more than 30 mg hydrocortisone (7. 5 mg of prednisolone), especially when this is in excess of three months. ^[19] Alternate day use may not prevent this complication. ^[20]
• Barbiturates, phenytoin and some other enzyme-inducing antiepileptics - these probably accelerate the metabolism of vitamin D. Barbiturates are drugs that act as central nervous system Depressants and by virtue of this they produce a wide spectrum of effects from mild Sedation Phenytoin sodium is a commonly used Antiepileptic. Phenytoin acts to dampen the unwanted runaway brain activity seen in seizure by reducing electrical conductance among brain The anticonvulsants, also called antiepileptic drugs (abbreviated "AEDs" are a diverse group of pharmaceuticals used in the treatment of epileptic ^[21]
• L-Thyroxine over-replacement may contribute to osteoporosis, in a similar fashion as thyrotoxicosis does. The thyroid hormones, Thyroxine ( T4) and Triiodothyronine ( T3) are Tyrosine -based Hormones produced Hyperthyroidism is the term for overactive tissue within the Thyroid gland resulting in overproduction and thus an excess of circulating free thyroid hormones Thyroxine ^[16] This can be relevant in subclinical hypothyroidism.
• Several drugs induce hypogonadism, for example aromatase inhibitors used in breast cancer, methotrexate and other anti-metabolite drugs, depot progesterone and gonadotropin-releasing hormone agonists. Hypogonadism is a medical term for a defect of the Reproductive system that results in lack of function of the Gonads ( ovaries or testes) Aromatase inhibitors ( AI) are a class of drugs used in the treatment of Breast cancer and Ovarian cancer in postmenopausal women that Depot medroxyprogesterone acetate ( DMPA) is a Progestin -only hormonal contraceptive Birth control drug which is injected every 3 months A gonadotropin-releasing hormone agonist ( GnRH agonist) is a synthetic Peptide modeled after the hypothalamic Neurohormone GnRH that interacts
• Anticoagulants - long-term use of heparin is associated with a decrease in bone density,^[22] and warfarin (and related coumarins) have been linked with an increased risk in osteoporotic fracture in long-term use. An anticoagulant is a substance that prevents coagulation; that is it stops Blood from clotting Warfarin (also known under the brand names Coumadin, Jantoven, Marevan, and Waran) is an Anticoagulant. ^[23]
• Proton pump inhibitors - these drugs inhibit the production of stomach acid; it is thought that this interferes with calcium absorption. Proton pump inhibitors (or "PPI"s are a group of drugs whose main action is pronounced and long-lasting reduction of Gastric acid production Gastric acid is one of the main Secretions of the Stomach, together with several Enzymes and Intrinsic factor. ^[24] Chronic phosphate binding may also occur with aluminum-containing antacids. A phosphate, an Inorganic chemical, is a salt of Phosphoric acid. WikipediaNaming An antacid is any substance generally a base or Basic salt, which counteracts stomach acidity. ^[16]
• Thiazolidinediones (used for diabetes) - rosiglitazone and possibly pioglitazone, inhibitors of PPARγ, have been linked with an increased risk of osteoporosis and fracture. The Medication class of thiazolidinedione (also called glitazones) was introduced in the late 1990s as an adjunctive therapy for Diabetes mellitus (type Rosiglitazone is an Anti-diabetic drug in the Thiazolidinedione class of drugs Pioglitazone is a prescription drug of the class Thiazolidinedione with hypoglycemic (antihyperglycemic antidiabetic action Peroxisome proliferator-activated receptor gamma ( PPAR-gamma) ^[25]
• Chronic lithium therapy has been associated with osteoporosis. Lithium (ˈlɪθiəm is a Chemical element with the symbol Li and Atomic number 3 ^[16]

Diagnosis

The diagnosis of osteoporosis is made on measuring the bone mineral density (BMD). The most popular method is dual energy X-ray absorptiometry (DXA or DEXA). In addition to the detection of abnormal BMD, the diagnosis of osteoporosis requires investigations into potentially modifiable underlying causes; this may be done with blood tests and X-rays. A blood test is a laboratory analysis performed on a Blood sample that is usually extracted from a Vein in the arm using a needle, or via X-radiation (composed of X-rays) is a form of Electromagnetic radiation. Depending on the likelihood of an underlying problem, investigations for cancer with metastasis to the bone, multiple myeloma, Cushing's disease and other above mentioned causes may be performed. Cancer (medical term Malignant Neoplasm) is a class of Diseases in which a group of cells display uncontrolled Metastasis ( Greek: displacement μετά=next + στάσις=placement, plural metastases) sometimes abbreviated mets, Multiple myeloma (also known as MM, myeloma, plasma cell myeloma, or as Kahler's disease after Otto Kahler) is a type of

Dual energy X-ray absorptiometry

Dual energy X-ray absorptiometry (DXA, formerly DEXA) is considered the gold standard for the diagnosis of osteoporosis. Dual energy X-ray absorptiometry ( DXA, previously DEXA is a means of measuring Bone mineral density (BMD In Medicine, a gold standard test or criterion standard test is a Diagnostic test or benchmark that is regarded as definitive Osteoporosis is diagnosed when the bone mineral density is less than or equal to 2. 5 standard deviations below that of a young adult reference population. This is translated as a T-score. The World Health Organization has established the following diagnostic guidelines:^[1][10]

• T-score -1. 0 or greater is "normal"
• T-score between -1. 0 and -2. 5 is "low bone mass" (or "osteopenia")
• T-score -2. Osteopenia is a condition where Bone mineral density is lower than normal 5 or below is osteoporosis

When there has also been an osteoporotic fracture (also termed "low trauma-fracture" or "fragility fracture"), defined as one that occurs as a result of a fall from a standing height, the term "severe or established" osteoporosis is used. ^[1]

The International Society for Clinical Densitometry takes the position that a diagnosis of osteoporosis in men under 50 years of age should not be made on the basis of densitometric criteria alone. It also states that for pre-menopausal women, Z-scores (comparison with age group rather than peak bone mass) rather than T-scores should be used, and that the diagnosis of osteoporosis in such women also should not be made on the basis of densitometric criteria alone. ^[26]

Screening

The U.S. Preventive Services Task Force (USPSTF) recommended in 2002 that all women 65 years of age or older should be screened with bone densitometry. Screening, in medicine is a strategy used in a Population to detect a Disease in individuals without signs or Symptoms of that disease ^[27] The Task Force recommends screening only those women ages 60 to 64 years of age who are at increased risk. The best risk factor for indicating increased risk is lower body weight (weight < 70 kg), with less evidence for smoking or family history. There was insufficient evidence to make recommendations about the optimal intervals for repeated screening and the appropriate age to stop screening. Clinical prediction rules are available to guide selection of women ages 60-64 for screening. A clinical prediction rule is type of medical research study in which researchers try to identify the best combination of Medical sign, Symptoms, and other findings The Osteoporosis Risk Assessment Instrument (ORAI) may be the most sensitive strategy^[28]

Regarding the screening of men, a cost-analysis study suggests that screening may be "cost-effective for men with a self-reported prior fracture beginning at age 65 years and for men 80 years and older with no prior fracture". ^[29] Also cost-effective is the screening of adult men from middle age on to detect any significant decrease in testosterone levels, say, below 300.

Pathogenesis

The underlying mechanism in all cases of osteoporosis is an imbalance between bone resorption and bone formation. Bone resorption is the process by which Osteoclasts break down Bone and release the Minerals resulting in a transfer of calcium from bone fluid to the blood Bones are rigid organs that form part of the Endoskeleton of Vertebrates They function to move support and protect the various organs of the body produce In normal bone, there is constant matrix remodeling of bone; up to 10% of all bone mass may be undergoing remodeling at any point in time. In Biology, matrix (plural matrices) is the material between animal or plant cells, the material (or tissue in which more specialized structures are embedded The process takes place in bone multicellular units (BMUs) as first described by Frost in 1963. ^[30] Bone is resorbed by osteoclast cells (which derive from the bone marrow), after which new bone is deposited by osteoblast cells. An osteoclast (from the Greek words for "bone" and "broken" is a type of Bone cell that removes Bone tissue by removing its Mineralized matrix Bone marrow is the flexible tissue found in the hollow interior of Bones In adults marrow in large bones produces new Blood cells It constitutes 4% of An osteoblast (from the Greek words for " Bone " and "germ" or embryonic is a mononucleate cell that is responsible for bone formation ^[5]

The three main mechanisms by which osteoporosis develops are an inadequate peak bone mass (the skeleton develops insufficient mass and strength during growth), excessive bone resorption and inadequate formation of new bone during remodeling. An interplay of these three mechanisms underlies the development of fragile bone tissue. ^[5] Hormonal factors strongly determine the rate of bone resorption; lack of estrogen (e. Estrogens (US otherwise oestrogens or œstrogens) are a group of Steroid compounds named for their importance in the Estrous cycle, g. as a result of menopause) increases bone resorption as well as decreasing the deposition of new bone that normally takes place in weight-bearing bones. The amount of estrogen needed to suppress this process is lower than that normally needed to stimulate the uterus and breast gland. The uterus (from the Latin word for womb) is the major Female reproductive organ of most Mammals including Humans One end the Mammary glands are the organs that in Mammals produce Milk for the sustenance of the young The α-form of the estrogen receptor appears to be the most important in regulating bone turnover. The estrogen receptor (ER is a member of the nuclear hormone family of Intracellular receptors which is activated by the Hormone 17β-estradiol ^[5] In addition to estrogen, calcium metabolism plays a significant role in bone turnover, and deficiency of calcium and vitamin D leads to impaired bone deposition; in addition, the parathyroid glands react to low calcium levels by secreting parathyroid hormone (parathormone, PTH), which increases bone resorption to ensure sufficient calcium in the blood. Calcium metabolism or calcium homeostasis is the mechanism by which the body maintains adequate Calcium levels Calcium (Ca2+ plays a vital role in the Anatomy, Physiology and Biochemistry of Organisms and of the cell, particularly Vitamin D is a group of fat-soluble Prohormones, the two major forms of which are vitamin D2 (or Ergocalciferol) and vitamin D3 (or The parathyroid glands are small endocrine Glands in the neck usually located behind the Thyroid gland, which produce Parathyroid hormone. Parathyroid hormone (PTH, or parathormone, is secreted by the Parathyroid glands as a Polypeptide containing 84 Amino acids. The role of calcitonin, a hormone generated by the thyroid that increases bone deposition, is less clear and probably not as significant as that of PTH. Calcitonin is a 32-amino acid linear polypeptide Hormone that is produced in Humans primarily by the parafollicular (also known as C-cells of the The thyroid is one of the largest Endocrine glands in the body ^[5]

The activation of osteoclasts is regulated by various molecular signals, of which RANKL (receptor activator for nuclear factor κB ligand) is one of best studied. RANKL ( Receptor Activator for Nuclear Factor κ B Ligand) also known as TNF-related activation-induced cytokine (TRANCE osteoprotegerin ligand (OPGL and ODF (osteoclast NF-κB ( nuclear factor-kappa B) is a protein complex that is a Transcription factor. This molecule is produced by osteoblasts and other cells (e. g. lymphocytes), and stimulates RANK (receptor activator of nuclear factor κB). A lymphocyte is a type of White blood cell in the Vertebrate Immune system. RANK (Receptor Activator of Nuclear Factor κ B, also known as TRANCE Receptor is a type I membrane protein which is expressed on the surface of Osteoclasts and is involved Osteoprotegerin (OPG) binds RANKL before it has an opportunity to bind to RANK, and hence suppresses its ability to increase bone resorption. Osteoprotegerin (OPG, also known as osteoclastogenesis inhibitory factor (OCIF is a Cytokine, which can inhibit the production of Osteoclasts. RANKL, RANK and OPG are closely related to tumor necrosis factor and its receptors. The role of the wnt signalling pathway is recognized but less well understood. The Wnt '''signaling pathway''' describes a complex network of Proteins most well known for their roles in Embryogenesis and Cancer Local production of eicosanoids and interleukins is thought to participate in the regulation of bone turnover, and excess or reduced production of these mediators may underlie the development of osteoporosis. In biochemistry eicosanoids are signaling molecules made by Oxygenation of twenty-carbon Essential fatty acids (EFAs Interleukins are a group of Cytokines (secreted Signaling molecules) that were first seen to be expressed by White blood cells ( Leukocytes hence ^[5]

Trabecular bone is the sponge-like bone in the ends of long bones and vertebrae. Cancellous Bone is a type of Osseous tissue with a low density and strength but very high Surface area, that fills the inner cavity of long bones Cortical bone is the hard outer shell of bones and the middle of long bones. Cortical bone, or compact bone, is one of two main types of Osseous tissue. Because osteoblasts and osteoclasts inhabit the surface of bones, trabecular bone is more active, more subject to bone turnover, to remodeling. Not only is bone density decreased, but the microarchitecture of bone is disrupted. The weaker spicules of trabecular bone break ("microcracks"), and are replaced by weaker bone. Common osteoporotic fracture sites, the wrist, the hip and the spine, have a relatively high trabecular bone to cortical bone ratio. These areas rely on trabecular bone for strength, and therefore the intense remodeling causes these areas to degenerate most when the remodeling is imbalanced.

Treatment

There are several alternatives of medication to treat osteoporosis, depending on gender, though lifestyle changes are also very frequently an aspect of treatment.

Medication

Bisphosphonates are the main pharmacological measures for treatment. However, newer drugs have appeared in the 1990s, such as teriparatide and strontium ranelate.

Bisphosphonates

In confirmed osteoporosis, bisphosphonate drugs are the first-line treatment in women. In Pharmacology, bisphosphonates (also called diphosphonates) are a class of drugs that inhibit Osteoclast action and the resorption of bone The most often prescribed bisphosphonates are presently sodium alendronate (Fosamax) 10 mg a day or 70 mg once a week, risedronate (Actonel) 5 mg a day or 35 mg once a week and or ibandronate (Boniva) once a month. Year 2005 ( MMV) was a Common year starting on Saturday (link displays full calendar of the Gregorian calendar. Ibandronic acid ( INN) or ibandronate sodium ( USAN) marketed under the trade names Boniva, Bondronat and Bonviva, is a

A 2007 manufacturer-supported study suggested that in patients who had suffered a low-impact hip fracture, annual infusion of 5 mg zoledronic acid reduced risk of any fracture by 35% (from 13. 9 to 8. 6%), vertebral fracture risk from 3. 8% to 1. 7% and non-vertebral fracture risk from 10. 7% to 7. 6%. This study also found a mortality benefit: after 1. 9 years, 9. 6% of the study group (as opposed to 13. 3% of the control group) had died of any cause, indicating a mortality benefit of 28%. ^[31]

Oral bisphosphonates are relatively poorly absorbed, and must therefore be taken on an empty stomach, with no food or drink to follow for the next 30 minutes. They are associated with esophagitis and are therefore sometimes poorly tolerated; weekly or monthly administration (depending on the preparation) decreases likelihood of esophagitis, and is now standard. Esophagitis (or Oesophagitis) is Inflammation of the Esophagus. Although intermittent dosing with the intravenous formulations such as zolendronate avoids oral tolerance problems, these agents are implicated at higher rates in a rare but unpleasant mouth disease called osteonecrosis of the jaw. Osteonecrosis of the Jaws ( ONJ') is a severe Bone disease that affects the jaws including the Maxilla and the Mandible ^[32] For this reason, oral bisphosphonate therapy is probably to be preferred, and prescribing advice now recommends any remedial dental work to be carried out prior to commencing treatment. ^[33]

Teriparatide

Recently, teriparatide (Forteo, recombinant parathyroid hormone residues 1–34) has been shown to be effective in osteoporosis. Teriparatide ( Forteo) is a Recombinant form of Parathyroid hormone, used in the treatment of advanced Osteoporosis. Parathyroid hormone (PTH, or parathormone, is secreted by the Parathyroid glands as a Polypeptide containing 84 Amino acids. It acts like parathyroid hormone and stimulates osteoblasts, thus increasing their activity. It is used mostly for patients with established osteoporosis (who have already fractured), have particularly low BMD or several risk factors for fracture or cannot tolerate the oral bisphosphonates. It is given as a daily injection with the use of a pen-type injection device. Teriparatide is only licensed for treatment if bisphosphonates have failed or are contraindicated (however, this differs by country and is not required by the FDA in the USA. However, patients with previous radiation therapy, or Paget's disease, or young patients should avoid this medication).

Strontium ranelate

Oral strontium ranelate is an alternative oral treatment, belonging to a class of drugs called "dual action bone agents" (DABAs) by its manufacturer. Strontium ranelate, a strontium(II salt of Ranelic acid, is a medication for Osteoporosis marketed as Protelos or Protos It has proven efficacy, especially in the prevention of vertebral fracture. ^[34] In laboratory experiments, strontium ranelate was noted to stimulate the proliferation of osteoblasts, as well as inhibiting the proliferation of osteoclasts.

Strontium ranelate is taken as a 2 g oral suspension daily, and is licenced for the treatment of osteoporosis to prevent vertebral and hip fracture. Strontium ranelate has side effect benefits over the bisphosphonates, as it does not cause any form of upper GI side effect, which is the most common cause for medication withdrawal in osteoporosis. In studies a small increase in the risk of venous thromboembolism was noted,^[35] the cause for which has not been determined. Thrombosis is the formation of a blood Clot ( Thrombus) inside a Blood vessel, obstructing the flow of Blood through the Circulatory This suggests it may be less suitable in patients at risk for thrombosis for different reasons. The uptake of (heavier) strontium in place of calcium into bone matrix results in a substantial and disproportionate increase in bone mineral density as measured on DXA scanning^[36], making further followup of bone density by this method harder to interpret for strontium treated patients. A correction algorithm has been devised. ^[37]

Although strontium ranelate is effective, it's not approved for use in the United States yet. However, strontium citrate is available in the U. S. from several well-known vitamin manufacturers. Most researchers believe that strontium is safe and effective no matter what form it's used. The ranelate form is simply a device invented by the Servier company of France so that they could patent their version of strontium.

Strontium, no matter what the form, must be water-soluble and ionized in the stomach acid. Stontium is then protein-bound for transport from the intestinal tract into the blood stream. Unlike drugs like Fosamax, strontium doesn't inhibit bone recycling and, in fact, may produce stronger bones. Studies have shown that after five years alendronate may even cause bone loss, while strontium continues to build bone during lifetime use.

Strontium must not be taken with food or calcium-containing preparations as calcium competes with strontium during uptake. However, it's essential that calcium, magnesium, and vitamin D in theraputic amounts must be taken daily, but not at the same time as strontium. Strontium should be taken on an empty stomach at night.

Hormone Replacement

Estrogen replacement therapy remains a good treatment for prevention of osteoporosis but, at this time, is not recommended unless there are other indications for its use as well. Hormone replacement therapy may refer to Hormone replacement therapy (menopause Hormone replacement therapy (female-to-male There is uncertainty and controversy about whether estrogen should be recommended in women in the first decade after the menopause.

In hypogonadal men testosterone has been shown to give improvement in bone quantity and quality, but, as of 2008, there are no studies of the effects on fractures or in men with a normal testosterone level. Testosterone is a Steroid hormone from the Androgen group In mammals testosterone is primarily secreted in the testes of males and the Ovaries ^[18]

Nutrition

Calcium

Calcium is required to support bone growth, bone healing and maintain bone strength and is one aspect of treatment for osteoporosis. Calcium (ˈkælsiəm is the Chemical element with the symbol Ca and Atomic number 20 Ossification is the process of Bone formation in which connective tissues such as Cartilage are turned to bone or bone-like tissue Bone healing or fracture healing is a proliferative Physiological process in which the body facilitates repair of Bone fractures Physiology Recommendations for calcium intake vary depending country and age; for individuals at higher risk of osteoporosis (after fifty years of age) the amount recommended by US health agencies is 1,200 mg per day. The United States of America —commonly referred to as the Calcium supplements can be used to increase dietary intake, and absorption is optimized through taking in several small (500 mg or less) doses throughout the day. A dose is a quantity of something ( Chemical, physical or Biological) that may impact an organism biologically the greater the quantity the larger the dose ^[38] The role of calcium in preventing and treating osteoporosis is unclear - some populations with extremely low calcium intake also have extremely low rates of bone fracture, and others with high rates of calcium intake through milk and milk products have higher rates of bone fracture. Milk is an opaque white liquid produced by the Mammary glands of female Mammals (including Monotremes. Other factors, such as protein, salt and vitamin D intake, exercise and exposure to sunlight, can all influence bone mineralization, making calcium intake one factor among many in the development of osteoporosis. ^[39]

A meta-analysis of randomized controlled trials involving calcium and calcium plus vitamin D supported the use of high levels of calcium (1,200 mg or more) and vitamin D (800 IU or more), though outcomes varied depending on which measure was used to assess bone health (rates of fracture versus rates of bone loss). In Statistics, a meta-analysis combines the results of several studies that address a set of related research hypotheses A randomized controlled trial (RCT is a type of scientific Experiment most commonly used in testing the Efficacy or Effectiveness of Healthcare ^[40] The meta-analysis, along with another study, also supported much better outcomes for patients with high compliance to the treatment protocol. Compliance (or Adherence) is a medical term that is used to indicate a patient's correct following of medical advice ^[41] In contrast, despite earlier reports in improved high density lipoprotein (HDL, "good cholesterol") in calcium supplementation, a possible increase in the rate of myocardial infarction (heart attack) was found in a study in New Zealand in which 1471 women participated. High-density lipoproteins ( HDL) is one of the 5 major groups of Lipoproteins ( Chylomicrons, VLDL, IDL, LDL, HDL Myocardial infarction ( MI or AMI for acute myocardial infarction) also known as a heart attack, occurs when the blood supply New Zealand is an Island country in the south-western Pacific Ocean comprising two main landmasses (the North Island and the South Island If confirmed, this would indicate that calcium supplementation in women otherwise at low risk of fracture may cause more harm than good. ^[42]

Vitamin D

Some studies have shown that a high intake of vitamin D reduces fractures in the elderly,^[40][43] though the Women's Health Initiative found that though calcium plus vitamin D did increase bone density, it did not affect hip fracture but did increase formation of kidney stones. Vitamin D is a group of fat-soluble Prohormones, the two major forms of which are vitamin D2 (or Ergocalciferol) and vitamin D3 (or Kidney stones, also called renal calculi, are solid concretions (crystal aggregations of dissolved minerals in Urine; calculi typically form ^[44]

Mechanical stimulation

Exercise

Multiple studies have shown that aerobics, weight bearing, and resistance exercises can all maintain or increase BMD in postmenopausal women. ^[45] Many researchers have attempted to pinpoint which types of exercise are most effective at improving BMD and other metrics of bone quality, however results have varied. One year of regular jumping exercises appears to increase the BMD and moment of inertia of the proximal tibia^[46] in normal postmenopausal women. This article is about the moment of inertia of a rotating object. The tibia, shinbone, or shankbone is the larger and stronger of the two Bones in the Leg below the Knee in vertebrates and connects Treadmill walking, gymnastic training, stepping, jumping, endurance, and strength exercises all resulted in significant increases of L2-L4 BMD in osteopenic postmenopausal women. ^[47][48][49] Strength training elicited improvements specifically in distal radius and hip BMD. In fields of Anatomy, anatomical terms of location are descriptive terms to help identify relative positions or directions within a species Remote Authentication Dial In User Service ( RADIUS) is a networking protocol that provides centralized access authorization and accounting management for people or computers ^[50] Exercise combined with other pharmacological treatments such as hormone replacement therapy (HRT) has been shown to increases BMD more than HRT alone. Hormone replacement therapy may refer to Hormone replacement therapy (menopause Hormone replacement therapy (female-to-male ^[51]

Additional benefits for osteoporotic patients other than BMD increase include improvements in balance, gait, and a reduction in risk of falls. ^[52]

Low-level mechanical signals

Low-level high-frequency mechanical signals have been studied as signals stimulating bone turnover. Anabolism is the set of Metabolic pathways that construct molecules from smaller units Studies in animals show that this form of 'passive exercise' results in increased bone strength. Preliminary studies in humans (using for example vibrating platforms to produce whole body vibration) indicate that they might prevent BMD loss. Whole Body Vibration function and effects Whole-Body Vibration (WBV was developed by Russian scientist Vladimir Nazarov to prevent astronauts muscles and bones wasting when they ^{[53] [54][55][56]}

Prognosis

Hip fractures per 1000 patient-years^[57]

WHO category	Age 50-64	Age > 64	Overall
Normal	5. 3	9. 4	6. 6
Osteopenia	11. Osteopenia is a condition where Bone mineral density is lower than normal 4	19. 6	15. 7
Osteoporosis	22. 4	46. 6	40. 6

Although osteoporosis patients have an increased mortality rate due to the complications of fracture, most patients die with the disease rather than of it.

Hip fractures can lead to decreased mobility and an additional risk of numerous complications (such as deep venous thrombosis and/or pulmonary embolism, pneumonia). In Medicine, deep vein thrombosis (also known as deep-vein thrombosis or deep venous thrombosis and usually abbreviated as DVT) is the formation Pulmonary embolism (PE is a blockage of the Pulmonary artery or one of its branches usually occurring when a venous Thrombus (blood clot from a vein Pneumonia is an inflammatory illness of the Lung. Frequently it is described as lung Parenchyma / alveolar inflammation and abnormal The 6-month mortality rate following hip fracture is approximately 13. 5%, and a substantial proportion (almost 13%) of people who have suffered a hip fracture need total assistance to mobilize after a hip fracture. ^[58]

Vertebral fractures, while having a smaller impact on mortality, can lead to severe chronic pain of neurogenic origin, which can be hard to control, as well as deformity. Though rare, multiple vertebral fractures can lead to such severe hunch back (kyphosis) that the resulting pressure on internal organs can impair one's ability to breathe. Kyphosis (Greek - kyphos, a humpalso called "hunch back" in general terms is a common condition of a Curvature of the upper (thoracic spine

Apart from risk of death and other complications, osteoporotic fractures are associated with a reduced health-related quality of life. Quality of life is the degree of well-being felt by an individual or group of people ^[59]

Epidemiology

It is estimated that 1 in 3 women and 1 in 12 men over the age of 50 worldwide have osteoporosis. It is responsible for millions of fractures annually, mostly involving the lumbar vertebrae, hip, and wrist. A vertebra (plural vertebrae) is an individual Irregular bone in the spinal or Vertebral column ( aka ischis a flexuous and flexible column Fragility fractures of ribs are also common in men.

Hip fractures

Main article: hip fractures

Hip fractures are responsible for the most serious consequences of osteoporosis. A hip fracture is a fracture in the Proximal end of the Femur (the long bone running through the Thigh) near the hip joint. In the United States, osteoporosis causes a predisposition to hip fractures -- more than 250,000 occur annually. It is estimated that a 50-year-old white woman has a 17. 5% lifetime risk of fracture of the proximal femur. The femur is the thigh bone In Humans, it is the longest, most voluminous and strongest Bone. The incidence of hip fractures increases each decade from the sixth through the ninth for both women and men for all populations. The highest incidence is found among those men and women ages 80 or older.

Vertebral fractures

Between 35-50% of all women over 50 had at least one vertebral fracture. In the United States, 700,000 vertebral fractures occur annually, but only about a third are recognized. In a series of 9704 of women aged 68. 8 on average studied for 15 years, 324 had already suffered a vertebral fracture at entry into the study; 18. 2% developed a vertebral fracture, but that risk rose to 41. 4% in women who had a previous vertebral fracture. ^[60]

Wrist

In the United States, Osteoporosis is a predisposing factor in 250,000 wrist fractures. A distal radius fracture is a common bone fracture of the radius in the forearm Wrist fractures are the third most common type of osteoporotic fractures. ^[61] The lifetime risk of sustaining a Colles' fracture is about 16% for white women. By the time women reach age 70, about 20% have had at least one wrist fracture. ^[61]

Rib Fractures

Fragility fractures of the ribs are common in men as young as age thirty-five on. These are often overlooked as signs of osteoporosis as these men are often physically active and suffer the fracture in the course of physical activity. An example would be as a result of falling while water skiing or jet skiing. However, a quick test of the individual's testosterone level following the diagnosis of the fracture will readily reveal whether that individual might be at risk.

Prevention

Methods to prevent osteoporosis include changes of lifestyle. However, there are medications that can be used for prevention as well. As a different concept there are osteoporosis ortheses which help to prevent spine fractions and support the building up of muscles. Fall prevention can help prevent osteoporosis complications. Fall prevention is a variety of actions to help reduce the number of accidental falls suffered by older people

Lifestyle

Lifestyle prevention of osteoporosis is in many aspects inversions from potentially modifiable risk factors. As tobacco smoking and unsafe alcohol intake have been linked with osteoporosis, smoking cessation and moderation of alcohol intake are commonly recommended in the prevention of osteoporosis. Tobacco Smoking is the inhalation of smoke from burned dried or cured leaves of the Tobacco plant most often in the form of a Cigarette.

Exercise

Achieving a higher peak bone mass through exercise and proper nutrition during adolescence is important for the prevention of osteoporosis. Exercise and nutrition throughout the rest of the life delays bone degeneration. Jogging, walking, or stair climbing at 70-90% of maximum effort three times per week, along with 1,500 mg of calcium per day, increased bone density of the lumbar (lower) spine by 5% over 9 months. Individuals already diagnosed with osteopenia or osteoporosis should discuss their exercise program with their physician to avoid fractures. ^[62]

Nutrition

A proper nutrition is a diet sufficient in calcium and vitamin D. Calcium (ˈkælsiəm is the Chemical element with the symbol Ca and Atomic number 20 Vitamin D is a group of fat-soluble Prohormones, the two major forms of which are vitamin D2 (or Ergocalciferol) and vitamin D3 (or Patients at risk for osteoporosis (e. g. steroid use) are generally treated with vitamin D and calcium supplements and often with bisphosphonates. A steroid is a Terpenoid Lipid characterized by a Carbon skeleton with four fused rings generally arranged in a 6-6-6-5 fashion Vitamin D is a group of fat-soluble Prohormones, the two major forms of which are vitamin D2 (or Ergocalciferol) and vitamin D3 (or In renal disease, more active forms of Vitamin D such as paracalcitol or (1,25-dihydroxycholecalciferol or calcitriol which is the main biologically active form of vitamin D) is used, as the kidney cannot adequately generate calcitriol from calcidiol (25-hydroxycholecalciferol) which is the storage form of vitamin D. The kidneys are complicated organs that have numerous biological roles Calcitriol ( INN) (ˌkælsɨˈtraɪɒl/ /ˌkælˈsɨtriːɒl or 125-dihydroxycholecalciferol (abbreviated 125-(OH2D3) (also

High dietary protein intake increases calcium excretion in urine and has been linked to increased risk of fractures in research studies. Proteins are broken down in the Stomach during Digestion by Enzymes known as Proteases into smaller Polypeptides to provide Urine is a liquid waste product of the body secreted by the Kidneys by a process of filtration from Blood and Excreted through the Urethra. ^[63] Other investigations have shown that protein is required for calcium absorption, but that excessive protein consumption inhibits this process. No interventional trials have been performed on dietary protein in the prevention and treatment of osteoporosis. ^[64]

Medication

Just as for treatment, bisphosphonate can be used in cases of very high risk. In Pharmacology, bisphosphonates (also called diphosphonates) are a class of drugs that inhibit Osteoclast action and the resorption of bone Other medicines prescribed for prevention of osteoporosis include raloxifene (Evista), a selective estrogen receptor modulator (SERM). Raloxifene is an oral Selective estrogen receptor modulator (SERM that has estrogenic actions on bone and anti-estrogenic actions on the uterus and breast Selective Estrogen Receptor Modulators ( SERMs) are a class of Medication that acts on the Estrogen receptor.

Estrogen replacement therapy remains a good treatment for prevention of osteoporosis but, at this time, is not recommended unless there are other indications for its use as well. Hormone replacement therapy may refer to Hormone replacement therapy (menopause Hormone replacement therapy (female-to-male There is uncertainty and controversy about whether estrogen should be recommended in women in the first decade after the menopause.

In hypogonadal men testosterone has been shown to give improvement in bone quantity and quality, but, as of 2008, there are no studies of the effects on fractures or in men with a normal testosterone level. Testosterone is a Steroid hormone from the Androgen group In mammals testosterone is primarily secreted in the testes of males and the Ovaries ^[18]

History

The link between age-related reductions in bone density and fracture risk goes back at least to Astley Cooper, and the term "osteoporosis" and recognition of its pathological appearance is generally attributed to the French pathologist Jean Lobstein. Sir Astley Paston Cooper 1st Baronet ( August 23, 1768 &ndash February 12, 1841) English surgeon and Anatomist Jean Georges Chrétien Frédéric Martin Lobstein (German spelling Johann Friedrich Georg Christian Martin Lobstein) ( May 8, 1777 - March 7, ^[65] The American endocrinolgist Fuller Albright linked osteoporosis with the postmenopausal state. Fuller Albright ( January 12 1900 – December 8 1969) was an American endocrinologist who made numerous contributions to ^[66] Bisphosponates, which revolutionized the treatment of osteoporosis, were discovered in the 1960s. ^[67]

See also

• Back pain
• Hip protector
• Osteoporosis Orthesis
• Dental X-ray
• Osteopetrosis
• Osteoimmunology
• Ovariectomized rat model for osteoporosis research

References

External links

• Osteoporosis at the Open Directory Project
• Osteoporosis risk assessment tools
• Diet, Nutrition and the prevention of osteoporosis the World Health Organization and Food and Agriculture Organization (2003)
• Bone Health and Osteoporosis: A Report of the Surgeon General distributed by the U. The Open Directory Project ( ODP) also known as dmoz (from directory S. Department of Health and Human Services
• [1] The National Osteoporosis Foundation

The United States Department of Health and Human Services ( HHS) is a Cabinet department of the United States government with the goal of protecting The National Osteoporosis Foundation (NOF is an American voluntary health organization dedicated to Osteoporosis and Bone health

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