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Friday, 27 December 2013

Women and Osteoporosis

Osteoporosis is defined as a condition in which the bone minerals density including calcium, is deteriorate with the amounts of protein in the bone is alter,that lead to bone weakening, causing the increased risk of fracture. In women, osteoporosis happens in the stage of menopause, as the result of the reduction of hormones which protects the bones from calcium and are at increased risk bone fracture related to osteoporosis. In the US, more than 24 million women in the United States are affected by this disease.
Types of osteoporosis
Osteoporosis can be divided to 3 subtypes
1. Primary type 1
Postmenopausal osteoporosis occurs after the women enter the stage of menopause.
2. Primary type 2
Senile osteoporosis occurs after the age of 75, with the risk ratio of 2-1 in women and men.
3. Secondary osteoporosis
The disease can occurs to any age regardless of genders. Secondary osteoporosis mostly caused by prolonged use of certain medication, or results from chronic predisposing medical problems or disease.



Symptoms
In the beginning of the disease, there is no specific symptoms, but when the the disease progress due to the loss certain amount of minerals, some women might experience certain symptoms, including
1. Fragility Fracture
Fragility fractures occur in the vertebral column, rib, hip and wrist is very common for women with osteoporosis, as the result of the bone have become more fragile due to the loss of calcium and certain minerals.

2. Loss of height over time
As a result from the articular cartilage damage

3. Back pain
It may be result from the fracture of the vertebra, wrist, hip.

4. Stooped posture
Such as rounding of the upper back, caved shoulders and leaning forward while standing, etc. due to the bone no longer can support the body weight normally.

5. Etc.

Causes and risk factors
The causes of osteoporosis are unknown, but the process of osteoporosis are caused by remolding disruption.
1. Lack of calcium
Lack of calcium, in women is caused by levels of estrogen. Under normal circumstance, as the depletion of numbers of egg in the ovaries causes the ovaries not responding to the estrogen stimulating hormones as the women enter the stage of menopause.

2. Lack of exercise
According to the artcle of Exercise and Osteoporosis - How exercise helps maintain bone health By Elizabeth Quinn, the author wrote, a survey of 350 middle-aged women found that those who were most active in their daily lives had significantly greater bone density in their spines, femurs and forearms than less active women. Another study from found that running strengthens the leg bones of both older and younger women.
Exercise also enhances muscle power, synthesis, and balance and reduces the likelihood of falls in the elderly.

3. Age
In women, estrogen reduction increase with age, that can cause the loss of bone density, resulting of osteoporosis.
4. Smoking
smoking inhibits osteoblasts which are mononucleate cells that are responsible for bone formation, In an article of The effects of smoking on bone health by Peter K. K. WONG, Jemma J. CHRISTIE and John D. WARK, researchers indicated that Compared with non-smokers, smokers are weaker, have poorer balance and impaired neuromuscular performance. In the study by Nelson et al., smokers had a decrease in physical and neuromuscular function, compared with non-smokers, 50–100% as great as that associated with a 5 year increase in age

5. Hyperthyriodism
Hyperthyroidism can increase loss of calcium and phosphorous in the urine and stool excretion, that can lead to loss of bone mineral.

6. Medications
Certain medications such as Steroid-induced osteoporosis (SIOP), Barbiturates, phenytoin and some other enzyme-inducing antiepileptics, etc can cause the loss of bone minerals density.

7. Low levels of estrogen
Estrogen is best known for its protection against the loss of calcium of bone. The levels of estrogen is lower naturally with aging, that is the reason that osteoporosis happens most frequent in the women after entering stage of menopause. Excessive exercise can also disrupt the levels of estrogen, leading to abnormal menstrual cycle that can lead to increased risk of osteoporosis.

8. Alcohol
Excessive consumption of alcohol increases the risk of posteriors. In an article of Association Between Alcohol Consumption and Both Osteoporosis Fracture and Bone Density by Karina M. Berg, MD, MS, Hillary V. Kunins, MD, MS, MPH, Jeffrey L. Jackson, MD, MPH, Shadi Nahvi, MD, Amina Chaudhry, MD, MPH, Kenneth A. Harris Jr. MD, MPH, Rubina Malik, MD, MS, Julia H. Arnsten, MD, MPH., researchers found that compared with abstainers and heavier drinkers, persons who consume 0.5 to 1.0 drink per day have a lower risk of hip fracture. Although available evidence suggests a favorable effect of alcohol consumption on bone density, a precise range of beneficial alcohol consumption cannot be determined.

9. Medical conditions
Chronic predisposing medical problems or disease requires the use of certain medication can increase the risk of osteoporosis, such as Steroids and Corticosteroids used to treat inflammatory intestinal illness, asthma and rheumatoid arthritis; prescription drugs used to treat heartburn, acid reflux, indigestion, excess stomach acid and ulcers:, etc.

10. Gender
Women are at higher risk in developing osteoporosis than men.

11. Family history
Increased risk of osteoporosis if a woman has a history of bone fracture.

12. Gene
In a study of Pathogenesis of osteoporosis: concepts, conflicts, and prospects by Lawrence G. Raisz; University of Connecticut Health Center, Musculoskeletal Institute, Farmington, Connecticut, USA. researcher found that Gene deletion studies have shown that absence of runt-related transcription factor 2 (Runx2) or a downstream factor, osterix, are critical for osteoblast differentiation. Interestingly, overexpression of Runx2 leads to a decrease in bone mass....

13. Vitamin D deficiency
In an article of Osteoporosis: the role of micronutrients American Journal of Clinical Nutrition, Vol. 81, No. 5, 1232S-1239S, May 2005 © 2005 American Society for Clinical Nutrition indicated that Adults with vitamin D deficiency have muscle weakness and are more likely to fall. In a meta-analysis, vitamin D supplementation appeared to reduce falls by 20%, and furthermore if 15 patients were treated with vitamin D, fall could be prevented.

14. Etc.

Diagnosis and tests
1. Blood test
Blood test for calcium and vitamin D in the sample withdrawn from your vein will be helpful to determine the metabolic process of bone breakdown.

2. Bone mineral density (BMD)
Bone mineral density (BMD) is a test to measure the amount of matter per cubic centimeter of bones used as an indicator of osteoporosis and fracture risk with a special X ray or computed tomography (CT) scan.

3. Bone density scan
Bone density scan also known as dual-energy x-ray absorptiometry (DXA) or bone densitometry,
is test to measure amount of bone loss by exposing a part of the body to a small dose of ionizing radiation with the use of X ray to take image of the inside of the body.

4. Etc.

Preventions
No women can prevent the loss of calcium due to aging, but women always can reduce the loss of calcium to a minimum and prevent the onset of osteroporosis.
1. How to reduce the loss of calcium and minerals
a. Quit smoking
b. Reduce intake of alcohol
c. Moderate exercise
d. Eating healthy
e. Maintain a healthy style
f. Taking calcium, vitamin D, and C.
g. Etc.

2. Diet
A balance diet is always helpful in maintaining an optimal health, reduce the risk of diseases
a. Whole grains
b. Beans and legumes
c. Vegetables and fruits
d. Nuts and seeds
e. Lean meats and sea foods
For more information and details of above healthy foods, please visit http://healthy-foods-index.blogspot.com/

3. Nutritional supplements
a. Calcium
Calcium is important in maintaining the strong bond and reduce the risk of osteoporosis. unfortunately, the loss of calcium is inevitable as a result of reduced levels of estrogen due to aging, intake of calcium may be helpful to replace it.

b. Vitamin D
Vitamin D is important in enhancing the absorption of the calcium, thus taking vitamin D and calcium together will reduce the risk of the diseases.

c. Vitamin C
Vitamin C not only enhances the absorption of other vitamins and minerals but also promotes higher calcium uptakes. In an article of Vitamin C reverses osteoporosis in mice, published in the recent issue of the Journal of Clinical Investigation, experiments on mice showed that antioxidants, and the enzymes responsible for maintaining them in a reduced state, fell substantially in rodent bone marrow after ovariectomy. Bone loss was however entirely preventable by giving the mice 20mg of vitamin C per day.

d. Phosphate and Alendronate
In an article, Phosphate and Alendronate Helpful in Adult Growth Hormone Deficiency published in Reuters Health, New york, regarded to the study of studied 44 patients.
Those who were previously naive to GH were randomized to receive GH
replacement alone or with alendronate or phosphate. After a year, patients receiving phosphate had significantly greater increases in nephrogenous cAMP (a marker of renal PTH activity) than
those on GH alone. There was also a significantly greater increase in BMD.

e. Phytoestrogen from soy and wolfberry
Phytoestrogen contain plant base estrogen which can occupy the estrogen receptor site to replace the loss of estrogen produced by ovaries due to aging, thus reducing the risk of osteoporosis.

f. Vitamin K
vitamin K is important to prevent bone loss caused by estrogen deficiency.

g. Etc.

4. Herbs
a. Alfalfa
Alfalfa is a source of vitamins A, C, E, and K and of the minerals, calcium, potassium, phosphorus, and iron, which is important for osreroporosis caused lack of nutrients and nutrients deficiency.

b. Horny Goat Weed (Epimedium)
The flavonoids in Epimedium were shown to prevent bone loss in postmenopausal women, according to a study of Epimedium-derived phytoestrogen flavonoids exert beneficial effect on preventing bone loss in late postmenopausal women: a 24-month randomized, double-blind and placebo-controlled trial, by Zhang G, Qin L, Shi Y.

c. Black Cohosh
Black cohosh has beeen used in herbal medicine as a dietary supplement to relieve the symptoms of menopause caused by estrogen deficiency. It has antiosteoporotic effects, according to the study of Effects of black cohosh (Cimicifuga racemosa) on bone turnover, vaginal mucosa, and various blood parameters in postmenopausal women: a double-blind, placebo-controlled, and conjugated estrogens-controlled study by Wuttke W, Gorkow C, Seidlov√°-Wuttke D.
and has been shown to enhance bone formation in a study of Ethanolic extract of Actaea racemosa (black cohosh) potentiates bone nodule formation in MC3T3-E1 preosteoblast cells.
Chan BY, Lau KS, Jiang B, Kennelly EJ, Kronenberg F, Kung AW.

d. Red clover
Red clover contains compounds known as isoflavones that helps to replace lost estrogen in the female body. Also known for its uses before menopause as it can delay the natural progression. according to a study of Clinical effects of a proprietary combination isoflavone nutritional supplement in menopausal women: a pilot trial by Lukaczer D, Darland G, Tripp M, Liska D, Lerman RH, Schiltz B, Bland JS.

e. Etc

5. Chinese herbs
1. Chinese engleica roots (Dang Qui or dong quai)
Dang Qui is considered as a queen herb in traditional Chinese medicine to treat menstrual and menopausal symptoms. Dang Qui exhibits estrogenic activity in vitro, according to the study of Evaluation of estrogenic activity of plant extracts for the potential treatment of menopausal symptoms by Liu J, Burdette JE, Xu H, Gu C, van Breemen RB, Bhat KP, Booth N, Constantinou AI, Pezzuto JM, Fong HH, Farnsworth NR, Bolton JL.

2.Rehmannia glutinosa (Shu di huang)
It is one of the good herb for tonifying blood, nourishing yin and blood and enriching kidney essence.

3. Ligustrum lucidum (Nu zhen zi)
Nu zhen zi is good for liver and kidney tonification and clearing heat due to yin deficiency.

4. Morus Albus (Sang shen)
The herbs is most used in nourishing yin, tonifying blood and promoting the generation of body fluids.

5. Etc.

Treatments
The main objective of the treatments is to prevent or reduce bone fractures and maintain or increase bone density
1. Hormone-replacement therapies (HRTs)
a. Hormone-replacement therapies (HRTs) are used to prevent the symptoms caused by diminished circulating estrogen and progesterone hormones for women in the stage of menopause and peri-menopause and have an effect in reduce bone loss when are used.
b. Risks and side effects
b.1. Thrombophlebitis
b.2. Pulmonary embolism
b.3. Heart disease
b.4. Strokes
b.5. Breast cancer
b.6. Endometrial cancer
b.7. Etc

2. Bisphosphonates
a. Bisphosphonates are a group of drugs that are used to prevent the loss of bone mass and to treat osteoporosis by reducing the risk of osteoporotic fracture in those who have had previous fractures, but not those who have not previously had a fracture, including alendronate, etidronate, risedronate, zoledronic acid, etc. Avvording to the study of Risedronate for the primary and secondary prevention of osteoporotic fractures in postmenopausal women by
George A Wells, Ann Cranney, Joan Peterson, Michel Boucher, Beverley Shea, Vivian Welch, Doug Coyle, Peter Tugwell.
b. Risks and side effects
b.1. Upset Stomach
b.2. Esophogeal Inflammation
b.3. Unusual femur fractures
b.4. Bone, Joint, and Muscle Pain
b.5. Etc.

3. Calcitonin
a. Calcitonin, a hormone produced by the thyroid gland in our body belonging to belongs to the calcitonin-like protein family, can help to reduce blood calcium and strengthen bone by inhibiting umbilical absorption by the intestines and osteoclast activity in bones, according to the report of Sect. 5, Ch. 6: Effects of CT on the Small Intestine". Medical College of Georgia. Retrieved 2008-08-07.
b. Risks and side effects
b.1. Runny nose
b.2. Sores, or
b.3. Redness.
b.4. Nose bleeding
b.5. Swelling
b.6. Etc.

4. Selective estrogen receptor modulators (SERMs)
a. Selective estrogen receptor modulators are a group of compounds that act on the estrogen receptor, including lasofoxifene, femarelle, raloxifene, etc.. Most SERMs used to treat postmenopausal osteoporosis with a favorably respond and may be used as replacements for hormone replacement therapy (HRT).
b. Risks and side effects
1. Uterine cancer
2. Blood clots
3. Endometrial cancer and
4. Stroke
5. Dizziness
6. Severe headaches
7. Hot flashes
8. Fatigue
9. Mood swings
10. Etc.

5. Denosumab
a. Denosumab, a medicine manufactured by Amgen is given as an injection and used to treat osteoporosis to induce bone loss, bone metastases, rheumatoid arthritis, etc. according to the study of Denosumab in Postmenopausal Women with Low Bone Mineral Density by
Michael R. McClung, M.D., E. Michael Lewiecki, M.D., Stanley B. Cohen, M.D.,Michael A. Bolognese, M.D., Grattan C. Woodson, M.D., Alfred H. Moffett, M.D.,Munro Peacock, M.D., Paul D. Miller, M.D., Samuel N. Lederman, M.D.,Charles H. Chesnut, M.D., Douglas Lain, M.D., Alan J. Kivitz, M.D.,Donna L. Holloway, Ph.D., Charlie Zhang, Ph.D., Mark C. Peterson, Ph.D.,and Pirow J. Bekker, M.D., Ph.D., for the AMG 162 Bone Loss Study Group.
b. Risks and side effects
b.1. Persistent, or severe infection
b.2. Spasms
b.3. Nervous tension such as depression, confusion and irritability
b.4. Arrhythmia
b.5. Unexplained swelling
b.6. Difficult breathing
b.7. Etc.
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