osteoporosis introduction for assignment

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Osteoporosis causes bones to become weak and brittle — so brittle that a fall or even mild stresses such as bending over or coughing can cause a break. Osteoporosis-related breaks most commonly occur in the hip, wrist or spine.

Bone is living tissue that is constantly being broken down and replaced. Osteoporosis occurs when the creation of new bone doesn't keep up with the loss of old bone.

Osteoporosis affects men and women of all races. But white and Asian women, especially older women who are past menopause, are at highest risk. Medicines, healthy diet and weight-bearing exercise can help prevent bone loss or strengthen already weak bones.

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There typically are no symptoms in the early stages of bone loss. But once your bones have been weakened by osteoporosis, you might have signs and symptoms that include:

• Back pain, caused by a broken or collapsed bone in the spine.
• Loss of height over time.
• A stooped posture.
• A bone that breaks much more easily than expected.

When to see a doctor

You might want to talk to your health care provider about osteoporosis if you went through early menopause or took corticosteroids for several months at a time, or if either of your parents had hip fractures.

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• Osteoporosis weakens bone

Under a microscope, healthy bone has the appearance of a honeycomb matrix (top). Osteoporotic bone (bottom) is more porous.

Your bones are in a constant state of renewal — new bone is made and old bone is broken down. When you're young, your body makes new bone faster than it breaks down old bone and your bone mass increases. After the early 20s this process slows, and most people reach their peak bone mass by age 30. As people age, bone mass is lost faster than it's created.

How likely you are to develop osteoporosis depends partly on how much bone mass you attained in your youth. Peak bone mass is partly inherited and varies also by ethnic group. The higher your peak bone mass, the more bone you have "in the bank" and the less likely you are to develop osteoporosis as you age.

Risk factors

A number of factors can increase the likelihood that you'll develop osteoporosis — including your age, race, lifestyle choices, and medical conditions and treatments.

Unchangeable risks

Some risk factors for osteoporosis are out of your control, including:

• Your sex. Women are much more likely to develop osteoporosis than are men.
• Age. The older you get, the greater your risk of osteoporosis.
• Race. You're at greatest risk of osteoporosis if you're white or of Asian descent.
• Family history. Having a parent or sibling with osteoporosis puts you at greater risk, especially if your mother or father fractured a hip.
• Body frame size. Men and women who have small body frames tend to have a higher risk because they might have less bone mass to draw from as they age.

Hormone levels

Osteoporosis is more common in people who have too much or too little of certain hormones in their bodies. Examples include:

• Sex hormones. Lowered sex hormone levels tend to weaken bone. The fall in estrogen levels in women at menopause is one of the strongest risk factors for developing osteoporosis. Treatments for prostate cancer that reduce testosterone levels in men and treatments for breast cancer that reduce estrogen levels in women are likely to accelerate bone loss.
• Thyroid problems. Too much thyroid hormone can cause bone loss. This can occur if your thyroid is overactive or if you take too much thyroid hormone medicine to treat an underactive thyroid.
• Other glands. Osteoporosis has also been associated with overactive parathyroid and adrenal glands.

Dietary factors

Osteoporosis is more likely to occur in people who have:

• Low calcium intake. A lifelong lack of calcium plays a role in the development of osteoporosis. Low calcium intake contributes to diminished bone density, early bone loss and an increased risk of fractures.
• Eating disorders. Severely restricting food intake and being underweight weakens bone in both men and women.
• Gastrointestinal surgery. Surgery to reduce the size of your stomach or to remove part of the intestine limits the amount of surface area available to absorb nutrients, including calcium. These surgeries include those to help you lose weight and for other gastrointestinal disorders.

Steroids and other medicines

Long-term use of oral or injected corticosteroid medicines, such as prednisone and cortisone, interferes with the bone-rebuilding process. Osteoporosis has also been associated with medications used to combat or prevent:

• Gastric reflux.
• Transplant rejection.

Medical problems

The risk of osteoporosis is higher in people who have certain medical problems, including:

• Celiac disease.
• Inflammatory bowel disease.
• Kidney or liver disease.
• Multiple myeloma.
• Rheumatoid arthritis.

Lifestyle choices

Some bad habits can increase your risk of osteoporosis. Examples include:

• Sedentary lifestyle. People who spend a lot of time sitting have a higher risk of osteoporosis than do those who are more active. Any weight-bearing exercise and activities that promote balance and good posture are good for your bones, but walking, running, jumping, dancing and weightlifting seem particularly helpful.
• Excessive alcohol consumption. Regular consumption of more than two alcoholic drinks a day increases the risk of osteoporosis.
• Tobacco use. The exact role tobacco plays in osteoporosis isn't clear, but it has been shown that tobacco use contributes to weak bones.

Complications

• Compression fractures

The bones that make up your spine, called vertebrae, can weaken to the point that they crumple and collapse, which may result in back pain, lost height and a hunched posture.

Bone breaks, particularly in the spine or hip, are the most serious complications of osteoporosis. Hip fractures often are caused by a fall and can result in disability and even an increased risk of death within the first year after the injury.

In some cases, broken bones in the spine can occur even if you haven't fallen. The bones that make up your spine, called vertebrae, can weaken to the point of collapsing, which can result in back pain, lost height and a hunched-forward posture.

Keep Your Bones Healthy

While nearly everyone will lose bone over the course of their lifetime, there are several steps you can take to keep your bones healthy.

Matthew T. Drake, M.D., Ph.D.: Welcome to the Mayo Clinic. My name is Dr. Matthew Drake. I am one of the doctors who works in the Endocrine Clinic, where I provide care to patients with skeletal related issues. Bone loss occurs in both men and women with aging but can also occur for other reasons such as medications or lifestyle factors. While nearly everyone will lose bone over the course of their lifetime, there are several simple steps you can take to help maintain a strong skeleton and to limit your risk for having a broken bone.

Over the next several minutes, we will review some general ways in which you can optimize your bone health. These include making good choices to limit your risk of having a fall. Using good technique when lifting to avoid having a back fracture. Staying active with regular weight bearing activities such as walking. And ensuring you get enough calcium and vitamin D. Beyond these important factors which you can control, you and your provider may decide it is best to take a medication to limit your risk for bone loss and fractures. This question and others can be discussed with your provider today during your appointment. Remember, keeping your bones healthy and preventing fractures are important things for all adults. We hope the information you will view over the next several minutes will help you to better understand your own bone health and ways in which you can keep yourself fracture free in the future.

Woman: Bone loss occurs with aging in all adults. This can lead to osteopenia, which is moderate bone loss, or osteoporosis, which is severe bone loss. In both conditions, bones become thinner and more porous due to the loss of minerals stored in the bones.

Osteopenia and osteoporosis are usually painless until a bone breaks or fractures. These fractures usually occur in the spine, hip, or wrist, but can happen in other bones as well. Without medical treatment, men and women lose 1 to 3% of their bone mass each year over the age of 50. As bone strength or density decreases, people are much more likely to develop osteoporosis or have fractures.

Osteoporosis may develop over many years. As you age, you are more likely to develop osteoporosis. Loss of estrogen in women due to menopause, and lower testosterone levels in men also increase bone loss. Women who experience early menopause or have their ovaries removed at a younger age are more likely to have increased bone loss. Some medications, drinking too much alcohol, and smoking may also increase your risk.

People who have taken medications that are bad for the bone, have hypogonadism, have had a transplant, or have had a weight loss surgery, are more likely to have rapid bone loss. There are many other risk factors for osteoporosis, including a family history of osteoporosis, Caucasian or Asian descent, a small body frame or low dietary intake of calcium or vitamin D.

To help you have strong bones and prevent or slow bone loss as you age, there are two main things to focus on, keeping your bones healthy and preventing fractures. Everyone can take steps to help keep bones strong and healthy throughout life. You can start today. The top five things to keep your bones healthy are, being active or exercising, eating calcium rich foods, getting enough vitamin D, stopping smoking and limiting alcohol.

Exercise helps strengthen bones, slows bone loss, and improves fitness. Aim for 30 to 60 minutes a day with a combination of weight bearing, aerobic, muscle strengthening, and non-impact exercises. Weight bearing exercises are activities done while on your feet with your bones supporting your weight. Some of these types of exercises include walking, jogging, and dancing. Tai Chi is a good example of non-impact exercise. Talk to your doctor about what exercise may be best for your situation.

It is best to get calcium from your food rather than a pill. Dairy products, certain green vegetables such as spinach, broccoli, or kale, and calcium fortified fruit juices and soy beverages contain good amounts of calcium. Generally, the goal is to get at least three servings per day from your diet. You may have to take a calcium supplement if you are not getting enough calcium from your diet. Supplements are absorbed well, are typically inexpensive, and are easy to take. If you take a calcium supplement, it is best to combine it with vitamin D.

Vitamin D is important for calcium absorption and maintaining bone health. Vitamin D is normally made in the skin with enough sun exposure but is also found in some foods and vitamin supplements. Ask your health care provider for more information about how much vitamin D you need and what to do about supplements.

If you smoke, stop. Smoking increases your risk for osteopenia and osteoporosis. Alcohol use can also increase your risk for developing osteoporosis. Limit alcohol intake to one drink a day if you are a woman, and two drinks a day if you are a man.

You can help prevent fractures. The two main things you can do to help are avoiding falls and taking medications. Falls are the number one risk factor for fractures. Take steps to prevent falls in your home, have well-lit rooms and hallways. Do not climb ladders, keep electrical and phone cords out of the walkways, and remove rugs when possible.

Be careful of activities that put you at risk for fractures, such as lifting too much weight and snow shoveling. Use proper lifting technique and talk to your doctor about your specific lifting restrictions.

Several types of medication may prevent further loss of bone density by up to 5 to 10%. This can significantly reduce the risk of a fracture. Most osteoporosis medications can help stop bone loss. Other medications help build bone formation. Your provider can help you decide which treatment may be best for you.

Matthew T. Drake, M.D., Ph.D.: Osteoporosis and osteopenia are common conditions affecting over half of all people 50 years of age and older in the United States. It's often without symptoms until a bone breaks or someone develops deformity of the spine. Think about how many people you know, who have suffered a fracture and how it affected their life. Breaking a bone can be prevented. First, make sure you're getting enough calcium between diet and supplements. For most with osteoporosis or osteopenia, this will be around 1,200 milligrams.

The problem is, is that the average dietary calcium intake for people 50 years of age or older is half of what's recommended. Several studies have shown that calcium, combined with low daily doses of vitamin D reduces fracture risk and increases bone density.

Vitamin D is also important to help you absorb calcium efficiently. Vitamin D deficiency is very common, especially as you age. Weight bearing exercise combined with strengthening, also helps keep your bone strong. However, for some people who are at high risk, taking calcium and vitamin D along with exercise isn't enough to prevent fractures. Your provider may recommend taking medication in addition to calcium and vitamin D.

If your risk is high enough for fracture, then the benefits of taking medication will almost always outweigh the risks associated with medications. Your provider and pharmacist can review medication use with you. Remember, as you age, your risk for falls goes up, too. Most fractures occur after a fall. Did you know that 5% of falls result in a fracture, 10% result in serious injury, and 30% result in any type of injury? Don't fall. I often tell my patients if it looks like a bad idea, it probably is a bad idea. Do you really need to climb the ladder to remove the leaves from the gutter or can someone else help you? Do you really need to leave the light off, so you don't disturb your husband when you go to the bathroom in the middle of the night? Make sure your home is safe for you.

Balance exercises such as Tai Chi have also been shown to prevent falls if you do them at least twice a week. Keeping your bones healthy and preventing fractures are important for everyone as they age. I hope this information helps you and your bones stay healthy in the years to come.

Woman: If you have any questions about this information, talk with your healthcare provider.

Good nutrition and regular exercise are essential for keeping your bones healthy throughout your life.

Men and women between the ages of 18 and 50 need 1,000 milligrams of calcium a day. This daily amount increases to 1,200 milligrams when women turn 50 and men turn 70.

Good sources of calcium include:

• Low-fat dairy products.
• Dark green leafy vegetables.
• Canned salmon or sardines with bones.
• Soy products, such as tofu.
• Calcium-fortified cereals and orange juice.

If you find it difficult to get enough calcium from your diet, consider taking calcium supplements. However, too much calcium has been linked to kidney stones. Although yet unclear, some experts suggest that too much calcium, especially in supplements, can increase the risk of heart disease.

The Health and Medicine Division of the National Academies of Sciences, Engineering, and Medicine recommends that total calcium intake, from supplements and diet combined, should be no more than 2,000 milligrams daily for people older than 50.

Vitamin D improves the body's ability to absorb calcium and improves bone health in other ways. People can get some of their vitamin D from sunlight, but this might not be a good source if you live in a high latitude, if you're housebound, or if you regularly use sunscreen or avoid the sun because of the risk of skin cancer.

Dietary sources of vitamin D include cod liver oil, trout and salmon. Many types of milk and cereal have been fortified with vitamin D.

Most people need at least 600 international units (IU) of vitamin D a day. That recommendation increases to 800 IU a day after age 70.

People without other sources of vitamin D and especially with limited sun exposure might need a supplement. Most multivitamin products contain between 600 and 800 IU of vitamin D. Up to 4,000 IU of vitamin D a day is safe for most people.

Exercise can help you build strong bones and slow bone loss. Exercise will benefit your bones no matter when you start, but you'll gain the most benefits if you start exercising regularly when you're young and continue to exercise throughout your life.

Combine strength training exercises with weight-bearing and balance exercises. Strength training helps strengthen muscles and bones in your arms and upper spine. Weight-bearing exercises — such as walking, jogging, running, stair climbing, skipping rope, skiing and impact-producing sports — affect mainly the bones in your legs, hips and lower spine. Balance exercises such as tai chi can reduce your risk of falling especially as you get older.

More Information

• Exercising with osteoporosis
• Osteoporosis overview. National Institute of Arthritis and Musculoskeletal and Skin Diseases. https://www.bones.nih.gov/health-info/bone/osteoporosis/overview. Accessed June 3, 2021.
• Osteoporosis. Merck Manual Professional Version. https://www.merckmanuals.com/professional/musculoskeletal-and-connective-tissue-disorders/osteoporosis/osteoporosis?query=osteoporosis. Accessed June 3, 2021.
• Kellerman RD, et al. Osteoporosis. In: Conn's Current Therapy 2021. Elsevier; 2021. https://www.clinicalkey.com. Accessed June 3, 2021.
• Ferri FF. Osteoporosis. In: Ferri's Clinical Advisor 2021. Elsevier; 2021. https://www.clinicalkey.com. Accessed June 3, 2021.
• Goldman L, et al., eds. Osteoporosis. In: Goldman-Cecil Medicine. 26th ed. Elsevier; 2020. https://www.clinicalkey.com. Accessed June 3, 2021.
• Calcium fact sheet for health professionals. Office of Dietary Supplements. https://ods.od.nih.gov/factsheets/Calcium-HealthProfessional. Accessed June 8, 2021.
• Vitamin D fact sheet for health professionals. Office of Dietary Supplements. https://ods.od.nih.gov/factsheets/VitaminD-HealthProfessional. Accessed June 8, 2021.
• Rosen HN, et al. Overview of the management of osteoporosis in postmenopausal women. https://www.uptodate.com/contents/search. Accessed June 3, 2021.
• Osteoporosis treatment: Medications can help

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Osteoporosis: A Small-Group Case-Based Learning Activity

Affiliations.

• 1 Medical Student, Florida International University Herbert Wertheim College of Medicine.
• 2 Associate Professor, Department of Cellular Biology and Pharmacology, Florida International University Herbert Wertheim College of Medicine.
• 3 Assistant Professor, Department of Humanities, Health, and Society, Florida International University Herbert Wertheim College of Medicine.
• 4 Associate Professor, Department of Human and Molecular Genetics, Florida International University Herbert Wertheim College of Medicine.
• 5 Associate Professor, Department of Translational Medicine, Florida International University Herbert Wertheim College of Medicine.
• PMID: 34527808
• PMCID: PMC8403690
• DOI: 10.15766/mep_2374-8265.11176

Introduction: Osteoporosis is the most common bone disease in the world. Approximately 50% of women and 20% of men over 50 will suffer an osteoporosis-related fracture. Future health care providers must be equipped to prevent, recognize, and treat osteoporosis-related fractures.

Methods: To supplement instruction on osteoporosis, we designed a case-based session. Groups of 10-12 second-year medical students worked with a single facilitator in a roundtable discussion. The 120-minute session integrated foundational sciences (pathology, physiology, pharmacology) and clinical disciplines (clinical skills, radiology, geriatrics, evidence-based medicine). Knowledge gains were assessed by performance on nine session-relevant multiple-choice questions (MCQs) on the final exam. Student satisfaction was assessed by an anonymous postsession survey.

Results: There were 121 students that participated, and their average performance on nine session-relevant final exam MCQs was 84%. After removal of a single outlier MCQ (15% correct), average performance on the remaining eight MCQs was 93%. A total of 107 students (88%) responded to the postsession survey. On a 5-point Likert scale, 101 of 107 students (94%) agreed or strongly agreed with the statement "The basic science-clinical combination lecture on osteoporosis followed by the small-group case discussion on osteoporosis prepared me adequately to understand the topic" ( M = 4.56, SD = 0.63).

Discussion: We developed a case-based learning activity for preclinical medical students to enhance the clinical scaffolding of basic science and medical knowledge around osteoporosis. Students performed well on session-relevant exam questions, demonstrating competency in the educational objectives. Student satisfaction was high, with most students feeling well prepared.

Keywords: Case-Based Learning; Colles' Fracture; FRAX; Fracture Risk Assessment Tool; Metabolic Bone Diseases; Osteopenia; Osteoporosis; Problem-Based Learning; Virtual Learning.

© 2021 Nguyen et al.

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What is osteoporosis?

Osteoporosis is a disease where decreased bone strength and mass significantly increase the risk of fractures. Find out more about the causes, symptoms and risk factors.

Diagnosis Information

Osteoporosis patients can be symptom-free until a fracture occurs, but there are several diagnostic methods doctors use to detect its presence.

Get educated about medications and treatments that prevent, stop or slow osteoporosis.

Fractures/Fall Prevention

Learn to recognize signs of osteoporosis and how to protect yourself from dangerous falls.

Communicating With Your Doctor

Educate yourself about basic terms and know what questions to ask before speaking with your healthcare professional.

Clinical Trials/Registry

See if you qualify for an osteoporosis clinical study and find out how to register.

Patient Support

Access helpful resources dedicated to providing support and assistance for the millions of Americans living with osteoporosis.

Stay Connected

Join our community to learn more about osteoporosis, or connect with others near you who are suffering from the disease.

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Introduction to Osteoporosis

Cite this chapter.

• Claus Christiansen  

Part of the book series: Medical Science Symposia Series ((MSSS,volume 13))

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Osteoporosis is a major and growing health problem worldwide. It affects an estimated 75 million people in the United States, Europe, and Japan combined, including one in three postmenopausal women and a majority of the elderly, including a substantial number of men.

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© 1999 Kluwer Academic Publishers and Fondazione Giovanni Lorenzini

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Christiansen, C. (1999). Introduction to Osteoporosis. In: Women’s Health and Menopause. Medical Science Symposia Series, vol 13. Springer, Dordrecht. https://doi.org/10.1007/978-0-585-37973-9_16

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• About Osteoporosis

What is osteoporosis?

Osteoporosis is a disease which makes bones weak and fragile. This greatly increases the risk of breaking a bone even after a minor fall or bump. The disease has no obvious symptoms, so many people don’t know they have osteoporosis until they suffer a fracture. Fractures can be life-altering, causing pain, disability and loss of independence. That’s why it’s important to prevent osteoporosis!

RISK FACTORS

• Risk Factors

About Osteoporosis

Osteoporosis literally means ‘porous bone’. It is a condition where bones become thin and lose their strength, as they become less dense and their quality is reduced. This can lead to broken bones, which cause pain, disability, and make everyday activities extremely difficult. 

Around the world, one in three women and one in five men over the age of fifty will suffer a broken bone due to osteoporosis. 

The following information will help you to understand more about osteoporosis, what you can do to help prevent it, and how it can be diagnosed and treated .

Our bones are living tissue that give our body structure, allow us to move and protect our organs. Osteoporosis causes the bones to become more porous and fragile, greatly increasing the risk of painful and often disabling broken bones (known as fragility fractures). 

Osteoporosis is often called the ‘silent disease’ because most people don’t know they have osteoporosis until they suffer a broken bone from a minor fall or bump – something that would not normally have caused such a drastic injury. In fact, even after breaking a bone, around 80% of patients are still not diagnosed and treated for osteoporosis, the underlying disease which has caused the fracture. 

How osteoporosis develops

From birth to adulthood, our bones develop and grow until, in our early 20s, they reach what is called peak bone mass – the time when the bones are at their strongest, densest and least likely to fracture. Throughout life, bone is constantly being renewed, with new bone replacing old bone- and this helps to keep our skeleton strong. But for people with osteoporosis, more and more bone is lost and not replaced.  This means that the bones gradually become brittle and more likely to break.   

By being aware of osteoporosis and which factors could place you at risk , you can make sure that you get diagnosed and treated as soon as possible. Fractures that are most often associated with osteoporosis are at the hip, spine and wrist. Fractures of the spine are the most common, yet many people dismiss the back pain as just a sign of getting older and don’t get proper diagnosis. 

Early diagnosis is important because one broken bone increases the risk of suffering yet more broken bones - resulting in long-term disability and loss of independence. One in four women who have a new spine fracture will fracture again within one year. After a hip fracture, about one-quarter of people die or never walk again. 

By getting early diagnosis you can be treated more effectively, so that future fractures can be prevented.  

And remember, there are things you can do to help prevent the condition and keep your bones strong: follow a bone-healthy diet , exercise regularly, avoid negative lifestyle factors, and find out whether you have risk factors for osteoporosis.

Be informed and know how to help yourself!

Quick Osteoporosis Facts

How serious are broken bones.

It cannot be emphasized enough that broken bones due to osteoporosis are not just painful, they are all too often a cause of life-changing disability and loss of independence. That is why it is so important to ensure you are diagnosed and treated early, before fractures happen!

Here are just a few facts

Read the many real-life patient stories , which show the impact of fractures due to osteoporosis.

FACTS & STATISTICS

DESPITE ITS SEVERE IMPACT, OSTEOPOROSIS REMAINS VASTLY UNDERDIAGNOSED AND UNDERTREATED.

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