Sample Essay on Osteoporosis

Abstract

While decades of research have revealed a lot on the causation, etiology, pathophysiology, prevention, and treatment of osteoporosis, it still remains an issue of significant public health concern for both the developed and the developing countries. There is no single cause of osteoporosis, although an inter-play between genetic factors and environmental factors has been linked to the two key processes of its pathophysiology (Ongphiphadhanakul, 2007).  Diagnostic testing enables health care practitioners to know who has osteoporosis, and those at a significant risk from it, on account of their bone mineral density. African-Americans have a higher bone mass density than their white or Asian counterparts, and hence have a lower risk of developing osteoporosis. On the other hand, the risk for osteoporosis increases with an increase in age, while dietary deficiency, especially in calcium and protein also impacts on the disease, as does inactivity (National Institute of Arthritis and Musculoskeletal and Skin Diseases. (2012). Meanwhile, the issue of calcium replacement, as it relates to osteoporosis, is still riddled with controversy. However, studies on osteoporosis shows that patient education on the disease helps to increase awareness, adoption of health behavior, and increased adherence to treatment.

Introduction

Osteoporosis remains by far the most common type of bone disease. It is characterized by bone tissues’ deterioration, low bone mass, and bone strength losses ( ‘Consensus development conference: prophylaxis and treatment of osteoporosis” 1991). This results in fractures due to increased bone fragility. Excess bone loss can lead to osteoporosis, as does too little bone formation. The following research paper shall endeavor to provide an overview of osteoporosis, including its causes. In addition, its pathophysiology shall be explored, along with the impact of race, age, diet, and exercise on the disease. The research paper will also attempt to assess the current controversies on calcium replacement as it relates to osteoporosis, and the implication for patient teaching and prevention of the disease.

Overview of cause

Even though we have witnessed great strides in our understanding of the causes, epidemiology, diagnosis, pathophysiology and treatment of osteoporosis, the disease is still an issue of great health concern. While there are various forms of bone disease, osteoporosis is by far the most common. Genetics play a key role in the causation of osteoporosis. Various studies have revealed the polygenic nature of the genetics of osteoporosis, including an interaction of its polymorphic alleles with environment-related and other factors (Ongphiphadhanakul, 2007).  At the same time, a number of studies (for example, Karasik et al., 2010) have relied on genome-wide scanning and gene approach in a bid to further analyze the genetic factors of osteoporosis. Nonetheless, the research findings of such studies in diverse populations remain largely inconsistent, and this is indicative of the genetic heterogeneity that characterizes osteoporosis.

Age and gender are the other risk factors for osteoporosis. As one ages, so does the risk of osteoporosis increase (Kanis et al., 2001). Moreover, osteoporosis is more prevalent in women than men, to a degree because women undergo menopause. This period is characterized by a sharp decline in the levels of the hormone estrogen that is directly involved in bone homeostasis.  Body size is yet another risk factor, with the risk being higher among small, thin women. In addition, the risk of osteoporosis is higher among Asians and white women, in comparison with their Hispanic and African-American counterparts.

Pathophysiology:

The essential mechanisms that cause osteoporosis concern the possession of deprived bone mass at the increase and development phase, coupled with accelerated bone loss once peak bone mass has been attained. In this case, genetic and environmental factors play a key role in modulating the two processes. Pre-menopausal peak bone mass accounts for nearly two-thirds of the risk of fractures among women who have reached menopause (Ongphiphadhanakul, 2007). Again, race plays a vital role here, with blacks experiencing a higher peak bone mass than Asians or whites. In terms of gender, women experience a lower peak bone mass than men. During pubertal development, an individual will have accumulated nearly 50 percent of his/her bone mass. This is often linked to increased levels of sex hormones during this period, with peak bone mass being attained at about 30 years of age. Studies done on mother-daughter pairs and twins propose that genetic factors are responsible for between 40 and 80 percent of the variability in bone mass (Cleveland Clinic, 2010).  Estrogen-based receptor genes, collagen, apolipoprotein E and the growth factor-β are some of the genes involved in osteoporosis.  On the other hand, environmental factors, including behavioral, medications, and nutritional, have been implicated with bone loss, although genetic factors are still important, especially in regards to an individual’s estrogen status.

What is the role of diagnostic testing in osteoporosis?

Diagnostic testing in osteoporosis is important for a number of reasons. To start with, it is vital in determining if an individual has osteoporosis, or not. In addition, it can also determine the level of bone mass. Individuals with low bone mass are at a higher risk of developing osteoporosis. Also, diagnostic testing helps to determine if the individual is hormone-deficient or menopausal, or whether they have an underlying condition likely to exacerbate or cause bone loss, thereby leading to osteoporosis. The primary test in the diagnosis of osteoporosis is the BMD (bone mineral density) test (National Osteoporosis Foundation, 2015). It helps to identify low bone mass and by extension, osteoporosis using the dual-energy X-ray absorptiometry.

Describe how race, age, diet and exercise impact the disease

Influence of race on the epidemiology of osteoporosis and fragility fractures has been documented. African Americans have a higher bone mineral density compared with their white and Asian counterparts. The prevalence of hip fracture among White omen is twice that of men, a trend that is also seen across the other races. The risk for fracture also increases with age in an exponential manner among men and women, with the highest incidences in women being recorded postmenopausal. Osteoporosis can also be caused by dietary deficiencies (NHS, 2013). There is evidence to show that protein under-nutrition actually contributes to the development of osteoporosis.  A number of randomized controlled studies have shown that high-impact exercises enhance muscular performance, dynamic balance, and skeletal integrity in pre-menopausal women (Aki, 2007). When done regularly, this kind of exercise has been shown to reduce the risk associated with osteoporotic fractures postmenopausal. Additionally, immobilization or inactivity has been linked with increased risk for osteoporotic fractures.

Describe the current controversies regarding calcium replacement  

The use of calcium supplementation in preventing osteoporosis during menopause has been riddled in controversy. While studies have shown the role of estrogen in reducing bone loss during menopause, an increasingly higher number of researchers have cast their doubt on whether calcium supplementation actually prevent the development of osteoporosis postmenopausal (Haas & Bellows, 2014).  At the same time, the primary role that calcium plays in regards to the etiology of osteoporosis is largely a controversial issue in spite of numerous investigations having documented its implication.

 What are the implications for patient teaching and prevention?

Health behaviors associated with osteoporosis have been linked with such factors as lack of beliefs among patients in practices linked to prevention and insufficient or total lack of knowledge on the diseases, lack of motivation to surmount challenges linked to osteoporosis prevention, insufficient access to behavior and care opportunities, lack of social support, and language barriers. To-date, most of the interventions that have been undertaken involve an integration of one form of intervention (for example, combining self-management with education), as well as employing strategies aimed at engaging patients in a bid to influence their attitudes and beliefs about the disease, in addition to the recommended medications.

A number of studies show that self-efficacy or health beliefs are vital in enabling individuals to both adopt and uphold healthy behaviors, in as far as the prevention and adherence to osteoporosis entreat is concerned (for example, Hendricks et al., 2013). Increased patient knowledge on osteoporosis will lead to more patients seeking additional information on the diseases. As a result, an increasingly higher number of individuals will change their lifestyles and reduce the environmental risk factors associated with the development of osteoporosis. Low knowledge level about osteoporosis is linked to increased prevalence for the diseases. Therefore, by increasing patient’s awareness of osteoporosis, we can hope to reduce its prevalence. For this reason, health care practitioners should be knowledgeable on the etiology, pathophysiology, prevention, and treatment of osteoporosis. This will ensure that patients have access to accurate information. In addition, health care practitioners should endeavor to promote behavioral changes among patients diagnosed with osteoporosis, in addition to enhancing their health beliefs.

Conclusion

In sum, osteoporosis still remains an issue of public health concern. While genetics play a key role in its causation, the interplay between environmental and genetic factors is also crucial in modulating the two processes involved in the pathophysiology of the disease. These are the acquisition of poor bone mass at the growth and development phase and increased bone loss upon the attainment of peak bone mass. Diagnostic testing helps to determine who has osteoporosis and the levels of bone mass. Race, age diet and exercise all impact on osteoporosis. Whites and Asians have a higher risk to osteoporosis compared with African-Americans due to their lower bone mineral density. The risk of osteoporosis also increases with increased age, while calcium and protein deficiencies and inactivity also increase the risk, although the mechanisms involved are not fully known. Teaching patients about osteoporosis and the risk involved would likely lead to increased prevention efficiency and enhanced adherence to treatments.

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