Wednesday 2 December 2015

Most Common Diseases of elder: The Clinical Trials and Studies of Musculo-Skeletal disorders: Osteoporosis - The diseases associated to Osteoporosis

Kyle J. Norton (Scholar)

Health article writer and researcher; Over 10.000 articles and research papers have been written and published on line, including world wide health, ezine articles, article base, healthblogs, selfgrowth, best before it's news, the karate GB daily, etc.,.
Named TOP 50 MEDICAL ESSAYS FOR ARTISTS & AUTHORS TO READ by Disilgold.com Named 50 of the best health Tweeters Canada - Huffington Post
Nominated for shorty award over last 4 years
Some articles have been used as references in medical research, such as international journal Pharma and Bio science, ISSN 0975-6299.

Musculoskeletal disorders (MSDs) are  medical condition mostly caused by work related occupations and working environment, affecting patients’ muscles, joints, tendons, ligaments and nerves and developing over time. According to a community sample of 73 females and 32 males aged 85 and over underwent a standardised examination at home, musculoskeletal pain was reported by 57% of those interviewed(1).

      Types of Musculo-Skeletal disorders in elder(2)

1. Osteoarthritis
2. Gout
3. Rheumatoid Arthritis
4. Polymalagia Arthritis
5. Cervical myleopathy and spinal canal stenosis
6. Osteoporosis
7. Low back pain
8. Fibromyalgia

                                Osteoporosis

Osteoporosis is defined as a condition of thinning of bone and bone tissues as a result of the loss of bone density over a long period of time. It is a widespread degenerative disease of skeletal joints and often associated with senescence in vertebrates due to excessive or abnormal mechanical loading of weight-bearing joints, arising from heavy long-term use or specific injuries(6).

The diseases associated to Osteoporosis

Misdiagnosis of osteoporosis is rare, but it can happen in comprised with misdiagnosis with diseases.

1. Haemochromatosis
Hemochromatosis is a genetic defect of gene (C282YY) and a compound heterozygous mutation (C282Y/H63D)(143). Patient with the disease is associated to risk of 25% of osteoporosis and 41% of osteopenia(144). Patient with osteoporosis-hemochromatosis with misdiagnosis(146) and delay diagnosis(147) of hemochromatosis can induce complications of liver cirrhosis and carcinoma, diabetes or heart failure(145).

2. Myeloma
Multiple myeloma (Myeloma) is a type of cancer originated from plasma cells in the bone marrow induced symptoms of bone pain, infection, anemia, bleeding, back pain certain neurological symptoms, etc.,..(148). 
In the United States, each year approximately 700,000 vertebral body compression fractures due to osteoporosis and bone metastasis
with approximately 70,000 of these resulting in hospitalization(151). Clinical manifestations of multiple myeloma may be derived directly from the malignant infiltration of bone marrow associated to osteoporosis(149), through alter the functions of bone-resorbing (osteoclasts) and bone-forming (osteoblasts) cells, inducing skeletal destruction(150).
According to the Homerton University Hospital, the coexistent osteoporosis and multiple myeloma can induce multiple vertebral fractures in the context of severe osteoporosis causes of vertebral collapse fracture(152).

3. Wilson's Disease 
Wilson's Disease is a genetic disease causes of disorder of copper metabolism(excessive amounts of copper accumulate in the body, especially in the liver and central nervous system). The high prevalence of the osteoporosis in patient with Wilson's diseases(154) may lead to fractures(155) and lower bone mineral density (BMD)(155) due to bone loss,...Patient with WD comprised of severe neurological involvement, low BMI, and/or amenorrhea ate found to associate to risk of fracture, probably due to lower bone mineral density(153)

4. Crohn's disease 
Crohn's disease  is a chronic inflammatory bowel diseases associated to the intestine(156). Patients with inflammatory bowel disease(IBD) are found to associate to metabolic bone diseases such as osteopenia and osteoporosis, a study in Japan insisted(157). In a cross-sectional study of 388 patients with IBD aged 20-50 years, lower bone mineral density, including  mineral density of the femoral neck, total femur and lumbar spine is coexiated in patient with Crohn's disease(158). The study of Iranian patient, risk of developing osteopenia and osteoporosis increase in patient of Crohn's diseases with smoking, corticosteroid use, age, and BMI(159).

5. Kidney disease
Kidney disease is a chronic disease with gradual loss of renal function over a prolonged period of time. Lifestyle-related diseases, including chronic kidney disease have been shown to have a possible effect on bone metabolism of which can lead to decrease in bone mineral density and an increase risk of fracture(160)(161). According to Capital Medical University Beijing, osteoporosis biomarkers in some case can act as predictors for diagnosis of chronic renal insufficiency in elder patients(162). Patient with pyperparathyroidism due to renal insufficiency may lead to turbulence of bone metabolism and unbalance between serum calcium and phosphorus(162). Renal osteodystrophy damage of bone morphology and abnormal bone metabolism by CKD due to P and Ca abnormalization of mineral metabolism(163).

6. Lupus
 Lupus, is an immune disorder disease causes of chronic inflammation associated to the attack of immune system against its won tissues(164). Osteoporosis is considered as a long term complication of patient with lupus due to its effect in reduced quality of life, increased mortality rates and increased risk of new vertebral and non-vertebral fractures(165). According to the University of Birmingham, in a cross sectional study of a large cohort of patients with systemic lupus erythematosus (SLE), the prevalence of reduced bone mineral density (BMD) and fractures, and risk factors for fractures were significantly high(166). According to Medicines that May Cause Bone Loss, patient with lupus may need to take medicines, including steroids, to control their symptoms of which can cause bone loss and osteoporosis(167).

7. Multiple sclerosis(MS)
Multiple sclerosis, is an immune disorder associated to demyelinating disease of the central nervous system due to the production of high-affinity anti-myelin immunoglobulin (Ig)G antibodies by the immune system(168). Patient with MS have found to at risk of low bone mineral density and fracture(170). According to Kings College London, used of glucocorticoid for treatment of MS although reduced mobility but increased risk for osteoporosis(169). The University Hospital of North Norway study suggested that due to high prevalence of osteoporosis in patients with multiple sclerosis and the share of aetiological risk factors such as smoking and hypovitaminosis D, as well as pathogenetic players such as osteopontin and osteoprotegerin, BMD should be measured shortly after diagnosis(171).

8. Ankylosing spondylitis(AS)
Ankylosing spondylitis, a type of spinal arthritis, is an inflammatory disease affected your spine. According to the study of 204 patients with AS by University of Gothenburg and 55 AS patients and 33 healthy controls by Izmir Tepecik Training and Research Hospital elevated serum levels of Wingless protein(Wnt-3a) and low levels of osteoprotegerin (OPG) may be used as biomarkers of bone metabolism in relation to osteoproliferation and osteoporosis(172)(173) respectively.
The Cochin Hospital study insisted that both AS and osteoporosis related to both systemic inflammation and decreased mobility and vertebral fracture risk(174), but so far there are no effective treatment in decreased risk of fractures(174)

9. Celiac Disease(CD)
Celiac Disease, is an multisystem autoimmune disorder in which such the disgestive system is highly sensitive to gluten Celiac disease. Patient with CD may experience secondary osteoporosis of that can lead metabolic osteopathy and joint and muscle problems and risk fracture(176),due to abnormal bone mineral metabolism (total calcium/albumin, 25-OH vitamin D3 and parathormone levels in serum) and bone mineral density (densitometry)(175).
According to the Hacettepe University, in the study of 34 children with untreated celiac disease at diagnosis and in 28 patients on a gluten-free diet, suggested that early diagnosis and treatment of celiac disease during childhood with a strict gluten-free diet improves bone mineralization and against the devopment of osteoporosis(177).

10. Diabetes
Patient with diabetes have a higher risk of developing osteoporosis. Indeed, osteoporosis and its related fractures, are clinically significant and commonly problem in diabetes type I and II patients(181). An India study of a prospective cross-sectional study on 150 patients with T2DM showed that patient with type 2 diabetes have significantly lower BMD at both femoral neck and lumbar spine compared to age and sex matched healthy controls(178). Postmenopausal women with non-insulin dependent type 2 diabetes mellitus (T2DM) also have an increased risk of osteoporosis(180) and vitamin D deficiency(179).

11. Hyperparathyroidism
Hyperparathyroidism is a medical condition of excessive serum of thyroid hormones in the blood stream induced a variable degree of osteopenia(184). Patient with the disease is at the greater risk of in developed osteoporosis and and fractures, especially in the population of in the young and in the early postmenopausal period, according to the La Sapienza University, but have a protective effect on trabecular bone in elderly postmenopausal women(182).
The study by Queen's University, Kingston, found that the alternation of vitamin D in these patient may lead to the development of secondary hyperparathyroidism in primary osteoporosis and osteopenia(183)

12. Hyperthyroidism

Hyperthyroidism is a medical condition of over production of thyroid hormone by the thyroid glands. Patient with hyperthyroidism, including subclinical hyperthyroid is at increased rate to risk of osteoporosis(185)(188) of which can lead to reduce in bone resorption and in ossified bone mineral deposition(185). In thyrotoxicosis patients with Graves' disease, according to the Yokohama Rosai Hospital, the resorption and formation was imbalance may result of decreased bone mineral density (BMD) and increased risk for osteoporotic fracture(186). Dr. Sato K. said" ...the gradual decrease in bone mineral density (BMD),..... In young patients, the decreased BMD is reversible, but not in post-menopausal women"(187)

13. Cushing’s syndrome
Cushing’s syndrome is a medical condition of over production of corticosteroid hormones (hypercortisolism) by the adrenal cortex of that can lead to higher risk of osteoporosis of that can induce further fractures and bone loss(189). Glucocorticoid therapy used mostly for treatment of the disease may elaborate the impaired the replication, differentiation and function of osteoblasts and induce the apoptosis of mature osteoblasts and osteocytes(190)(191). Dr. Suzuki Y. said" for management of GC-induced osteoporosis,....alendronate and risedronate are recommended as first-line treatment. Ibandronate, teriparatide, and active vitamin D3 derivatives are recommended as alternative option...."(192).

14. Leukemia and Lymphoma
Leukemia is defined as condition of abnormal increase of white blood cells produced by the bone marrow and/or the lymphatic system(193). According to the study by the University of Ottawa, increased odds for fracture, reduced lumbar spine (LS) and bone mineral density(BMD) as a result of vertebral compression, a serious complication of childhood acute lymphoblastic leukemia (ALL)(195).
Lymphoma is defined as a condition of cancer in the lymphatic cells (lymphocytes) of the immune system originated in lymph nodes. It represents a group of over 20 types of cancers(194).
According to the John Radcliffe Hospital, lymphomas share some common pathological and clinical features with multiple myeloma (MM), including the association with osteoporosis(198), such as correlating serum levels of osteoclast activating cytokine(198)
Chemotherapy used for treatment of leukemia and lymphoma is associated to high rate of osteoporosis and osteopenia(196)(197).

15. Sickle Cell Disease(SCD)

Sickle Cell Disease is a severe case genetic disorder of anemia caused by mutation of hemoglobin in the red blood cells, afflicting the oxygen absorption. Children with sickle cell anemia is associated to risk of lower bone mineral density(199). In adult with with SCD, the prevalence of abnormal bone mass density (BMD) is high (60%) with a significant low serum level of vitamin D3 and low testosterone hormone in those with very low bone mass density (BMD)(200). Dr,.Patil PL and Dr. Rao BV. said" Early diagnosis of this disease by family physicians will enable initiation of therapy..........patients education regarding management of modifiable risk factors linked with osteoporosis"(201).

15. Thalassemia
Thalassemia, also known as Mediterranean anemia, is a mild form of genetic blood disorder affecting the formation of hemoglobin. 
 There are strong evidence and indication of the association among children, adolescents and young adults with thalassaemia major (TM) in the development of the osteopenia/osteoporosis of that can induce the skeletal abnormalities, fractures, spinal deformities, nerve compression and growth failure, if the diagnosis is delay(202). The diseases is found to contribute to seriously diminished bone mineral density (BMD) as a result of an unbalanced bone turnover with an increased resorptive phase(203).
In fact, Osteopenia-osteoporosis syndrome (OOS) have shown to affect over 60-80% β-thalassemia major (β-TM) patients(204), according to the University College London Hospitals. 




References
(1) Prevalence of rheumatic symptoms, rheumatoid arthritis, ankylosing spondylitis, and gout in Shanghai, China: a COPCORD study by Dai SM1, Han XH, Zhao DB, Shi YQ, Liu Y, Meng JM.(PubMed
(2) Musculoskeletal Disorders in the Elderly by Ramon Gheno, Juan M. Cepparo, Cristina E. Rosca,1 and Anne Cotten(PMC)
(3) Osteoporosis(Life extension)
(4) Hormone and bone by Francisco Bandeira1, Marise Lazaretti-Castro2, John P. Bilezikian3
(5) Growth hormone and bone by Ohlsson C1, Bengtsson BA, Isaksson OG, Andreassen TT, Slootweg MC.(PubMed)
(6) GH and bone--experimental and clinical studies by Isaksson OG1, Ohlsson C, Bengtsson BA, Johannsson G.(PubMed)
(143) [Molecular genetic analysis and clinical aspects of patients with hereditary hemochromatosis].[Article in German] by Lange U1, Teichmann J, Dischereit G.(PubMed)
(144) Association between iron overload and osteoporosis in patients with hereditary hemochromatosis by Valenti L1, Varenna M, Fracanzani AL, Rossi V, Fargion S, Sinigaglia L.(PubMed)
(145) Miscellaneous non-inflammatory musculoskeletal conditions. Haemochromatosis: the bone and the joint of  Guggenbuhl P1, Brissot P, Loréal O(PubMed)
(146) Hereditary hemochromatosis: missed diagnosis or misdiagnosis? by Cherfane CE1, Hollenbeck RD, Go J, Brown KE.(PubMed)
(147) [Hereditary hemochromatosis: presenting manifestations and diagnostic delay].[Article in French] by Gasser B1, Courtois F2, Hojjat-Assari S3, Sauleau EA4, Buffet C5, Brissot P6.(PubMed)
(148) Multiple Myeloma (Myeloma) by Kyle J. Norton
(149) Multiple myeloma and bone disease: pathogenesis and current therapeutic approaches
E C Papadopoulou, S P Batzios, M Dimitriadou, V Perifanis, and V Garipidou(PMC)
(150) Bone antiresorptive agents in the treatment of bone metastases associated with solid tumours or multiple myeloma by Terpos E1, Confavreux CB2, Clézardin P3.(PubMed)
(151) Vertebral augmentation in osteoporosis and bone metastasis by Siemionow K1, Lieberman IH.(PubMed)
(152) Coexistent osteoporosis and multiple myeloma: when to investigate further in osteoporosis.
Mumford ER1, Raffles S1, Reynolds P2.(PubMed)
(153) Bone status and fractures in 85 adults with Wilson's disease by Quemeneur AS1, Trocello JM, Ea HK, Ostertag A, Leyendecker A, Duclos-Vallée JC, de Vernejoul MC, Woimant F, Lioté F.(PubMed)
(154) Bone mineral density of children with Wilson disease: efficacy of penicillamine and zinc therapy by Selimoglu MA1, Ertekin V, Doneray H, Yildirim M.(PubMed)
(155) Fracture in a Young Male Patient Leading to the Diagnosis of Wilson's Disease: A Case Report. by Shin JJ1, Lee JP1, Rah JH1.(PubMed)
(156) Crohn's Disease". National Digestive Diseases Information Clearinghouse (NDDIC). July 10, 2013. Retrieved 12 June 2014.
(157) [Inflammatory bowel disease and bone decreased bone mineral density].[Article in Japanese] by Hisamatsu T1, Wada Y2, Kanai T3.(PubMed)
(158) Risk factors for decreased bone mineral density in inflammatory bowel disease: A cross-sectional study by Wada Y1, Hisamatsu T2, Naganuma M3, Matsuoka K4, Okamoto S4, Inoue N3, Yajima T4, Kouyama K5, Iwao Y6, Ogata H3, Hibi T7, Abe T5, Kanai T4(PubMed)
(159) Bone mineral density in Iranian patients with inflammatory bowel disease by Zali M1, Bahari A, Firouzi F, Daryani NE, Aghazadeh R, Emam MM, Rezaie A, Shalmani HM, Naderi N, Maleki B, Sayyah A, Bashashati M, Jazayeri H, Zand S.(PubMed)
(160) [On "2015 Guidelines for Prevention and Treatment of Osteoporosis". Osteoporosis associated with lifestyle-related diseases: other lifestyle-related diseases].[Article in Japanese] by Yamauchi M1.(PubMed)
(161) Premature aging in chronic kidney disease and chronic obstructive pulmonary disease: similarities and differences by Kooman JP1, Shiels PG, Stenvinkel P.(PubMed)
(162) Osteoporosis biomarkers act as predictors for diagnosis of chronic renal insufficiency in elder patients by Li ZX1, Xu C1, Li YC1, Sun QM2.(PubMed)
(163) [Bone and Nutrition. Nutrition care of renal osteodystrophy].[Article in Japanese] by Tanaka S1, Ito M.(PubMed)
(164) Cerebritis, Lupus, and Lupus Cerebritis by Kyle J. Norton
(165) Osteoporosis in patients with systemic lupus erythematosus by García-Carrasco M1, Mendoza-Pinto C, Escárcega RO, Jiménez-Hernández M, Etchegaray Morales I, Munguía Realpozo P, Rebollo-Vázquez J, Soto-Vega E,Delezé M, Cervera R.(PubMed)
(166) Prevalence and predictors of fragility fractures in systemic lupus erythematosus by Yee CS1, Crabtree N, Skan J, Amft N, Bowman S, Situnayake D, Gordon C.(PubMed)
(167) Medicines that May Cause Bone Loss(National Osteoporosis foundation)
(168) Anti-myelin antibodies play an important role in the susceptibility to develop proteolipid protein-induced experimental autoimmune encephalomyelitis by Marín N1, Eixarch H, Mansilla MJ, Rodríguez-Martín E, Mecha M, Guaza C, Álvarez-Cermeño JC, Montalban X, Villar LM, Espejo C.(PubMed)
(169) Osteoporosis in multiple sclerosis by Hearn AP1, Silber E.(PubMed)
(170) Bone health and multiple sclerosis by Dobson R1, Ramagopalan S, Giovannoni G.(PubMed)
(171) Multiple sclerosis, a cause of secondary osteoporosis? What is the evidence and what are the clinical implications?by Kampman MT1, Eriksen EF, Holmøy T.(PubMed)
(172) Biomarkers of bone metabolism in ankylosing spondylitis in relation to osteoproliferation and osteoporosis by Klingberg E1, Nurkkala M2, Carlsten H2, Forsblad-d'Elia H2.(PubMed)
(173) Biomarkers and cytokines of bone turnover: extensive evaluation in a cohort of patients with ankylosing spondylitis by Taylan A1, Sari I, Akinci B, Bilge S, Kozaci D, Akar S, Colak A, Yalcin H, Gunay N, Akkoc N.(PubMed)
(174) Inflammation, bone loss and fracture risk in spondyloarthritis by Briot K1, Roux C1.(PubMed)
(175) [Osteoporosis and bone alterations in celiac disease in adults].[Article in Czech] by Hoffmanová I, Anděl M.(PubMed)
(176) Pathologic bone alterations in celiac disease: etiology, epidemiology, and treatment by Krupa-Kozak U1.(PubMed)
(177) Bone mineral density in children with untreated and treated celiac disease by Kavak US1, Yüce A, Koçak N, Demir H, Saltik IN, Gürakan F, Ozen H.(PubMed)
(178) Decreased Bone Mineral Density at the Femoral Neck and Lumbar Spine in South Indian Patients with Type 2 Diabetes by Mathen PG1, Thabah MM2, Zachariah B3, Das AK4.(PubMed)
(179) Prevalence of osteoporosis among postmenopausal females with diabetes mellitus by Al-Maatouq MA1, El-Desouki MI, Othman SA, Mattar EH, Babay ZA, Addar M.(PubMed)
(180) Increased risk of osteoporosis in postmenopausal women with type 2 diabetes mellitus: a three-year longitudinal study with phalangeal QUS measurements by Neglia C1, Agnello N1, Argentiero A1, Chitano G1, Quarta G1, Bortone I1, Della Rosa G1, Caretto A2, Distante A1, Colao A3, Di Somma C4, Migliore A5,Auriemma RS6, Piscitelli P6.(PubMed)
(181) Prevalence and determinants of osteoporosis in patients with type 1 and type 2 diabetes mellitus by Leidig-Bruckner G1, Grobholz S, Bruckner T, Scheidt-Nave C, Nawroth P, Schneider JG.(PubMed)
(182) Primary hyperparathyroidism and osteoporosis by Mazzuoli GF1, D'Erasmo E, Pisani D(PubMed)
(183) Secondary hyperparathyroidism in primary osteoporosis and osteopenia: optimizing calcium and vitamin D intakes to levels recommended by expert panels may not be sufficient for correction by Yendt ER1, Kovacs KA, Jones G.(PubMed)
(184) Effects of oral alendronate in elderly patients with osteoporosis and mild primary hyperparathyroidism by Rossini M1, Gatti D, Isaia G, Sartori L, Braga V, Adami S.(PubMed)
(185) Thyroid hormone excess rather than thyrotropin deficiency induces osteoporosis in hyperthyroidism by Bassett JH1, O'Shea PJ, Sriskantharajah S, Rabier B, Boyde A, Howell PG, Weiss RE, Roux JP, Malaval L, Clement-Lacroix P, Samarut J, Chassande O,Williams GR.(PubMed)
(186) [Osteoporosis treatment in patients with hyperthyroidism].[Article in Japanese] by Saito J1, Nishikawa T.(PubMed)
(187) [Graves' disease and bone metabolism].[Article in Japanese] by Sato K1.(PubMed)
(188) Bone mineral density in patients with endogenous subclinical hyperthyroidism: is this thyroid status a risk factor for osteoporosis? by Földes J1, Tarján G, Szathmari M, Varga F, Krasznai I, Horvath C.(PubMed)
(189) Skeletal diseases in Cushing's syndrome: osteoporosis versus arthropathy by Kaltsas G1, Makras P.(PubMed)
(190) Glucocorticoid-induced osteoporosis: pathophysiology and therapy by Canalis E1, Mazziotti G, Giustina A, Bilezikian JP.(PubMed)
(191) [Glucocorticoid-induced osteoporosis].[Article in Japanese] by Suzuki Y.(PubMed)
(192) [On "2015 Guidelines for Prevention and Treatment of Osteoporosis". Drug-induced osteoporosis:glucocorticoid-induced osteoporosis].[Article in Japanese]by Suzuki Y1.(PubMed)
(193) Most common Types of Cancer - Leukemia by Kyle J. Norton
(194) Lymphoma (Non Hodgkin's Lymphoma) by Kyle J. Norton
(195) Advanced vertebral fracture among newly diagnosed children with acute lymphoblastic leukemia: results of the Canadian Steroid-Associated Osteoporosis in the Pediatric Population (STOPP) research program by Halton J1, Gaboury I, Grant R, Alos N, Cummings EA, Matzinger M, Shenouda N, Lentle B, Abish S, Atkinson S, Cairney E, Dix D, Israels S, Stephure D, Wilson B, Hay J, Moher D, Rauch F, Siminoski K, Ward LM; Canadian STOPP Consortium(PubMed)
(196) Bone mineralization defects after treatment of acute lymphoblastic leukemia ın children.Guren by Dolu M1, Canbolat Ayhan A, Erguven M, Timur C, Yoruk A, Ozdemir S.(PubMed)
(197) Treatment of osteoporosis/osteopenia in pediatric leukemia and lymphoma.Bryant ML1, Worthington MA, Parsons K(PubMed)
(198) Lymphoplasmacytoid lymphoma presenting as severe osteoporosis.
Atoyebi W1, Brown M, Wass J, Littlewood TJ, Hatton C.(PubMed)(201) Sickle cell disease with osteogenesis imperfecta by Patil PL, Rao BV.(PubMed)
(199) [Evaluation of bone mineral density in children with sickle cell disease].[Article in Spanish] by Garrido Colino C1, Beléndez Bieler C2, Pérez Díaz M3, Cela de Julián E2.(PubMed)
(200) Predictors of abnormal bone mass density in adult patients with homozygous sickle-cell disease by Garadah TS1, Hassan AB1, Jaradat AA2, Diab DE2, Kalafalla HO2, Kalifa AK3, Sequeira RP2, Alawadi AH1(PubMed)
(201) Sickle cell disease with osteogenesis imperfecta by Patil PL, Rao BV.(PubMed)

Tuesday 1 December 2015

Most Common Diseases of elder: The Clinical Trials and Studies of Musculo-Skeletal disorders: Osteoporosis - The Diagnosis

Kyle J. Norton (Scholar)

Health article writer and researcher; Over 10.000 articles and research papers have been written and published on line, including world wide health, ezine articles, article base, healthblogs, selfgrowth, best before it's news, the karate GB daily, etc.,.
Named TOP 50 MEDICAL ESSAYS FOR ARTISTS & AUTHORS TO READ by Disilgold.com Named 50 of the best health Tweeters Canada - Huffington Post
Nominated for shorty award over last 4 years
Some articles have been used as references in medical research, such as international journal Pharma and Bio science, ISSN 0975-6299.

Musculoskeletal disorders (MSDs) are  medical condition mostly caused by work related occupations and working environment, affecting patients’ muscles, joints, tendons, ligaments and nerves and developing over time. According to a community sample of 73 females and 32 males aged 85 and over underwent a standardised examination at home, musculoskeletal pain was reported by 57% of those interviewed(1).

      Types of Musculo-Skeletal disorders in elder(2)

1. Osteoarthritis
2. Gout
3. Rheumatoid Arthritis
4. Polymalagia Arthritis
5. Cervical myleopathy and spinal canal stenosis
6. Osteoporosis
7. Low back pain
8. Fibromyalgia

                                Osteoporosis

Osteoporosis is defined as a condition of thinning of bone and bone tissues as a result of the loss of bone density over a long period of time. It is a widespread degenerative disease of skeletal joints and often associated with senescence in vertebrates due to excessive or abnormal mechanical loading of weight-bearing joints, arising from heavy long-term use or specific injuries(6).


                               The Diagnosis 

According to the Clinical practice guidelines, the diagnosis and management of osteoporosis include screening and diagnostic methods: risk-factor assessment, clinical evaluation, measurement of bone mineral density, laboratory investigations(131)

If you are experience certain symptom of osteoporosis, the tests which your doctor order include
1. Laboratory testsThe aim of the tests is to check for serum calcium, phosphate, creatinine, alkaline phosphatase and 25-hydroxyvitamin D and, additionally in men, testosterone(132), according to The Catholic University of Korea.

2. Dual energy X-ray absorptiometry (DXA)
Dual energy X-ray absorptiometry (DXA) is one most common test to measure the total bone density of including spine, hip, wrist etc... The test forms an important role in the evaluation of individuals at risk of osteoporosis,(133)(134).

3. Quantitative Ultrasound and computed tomography (QCT)
Quantitative ultrasound (QUS) is a portable and accurate technology used to evaluate skeletal status including bone density at the lumbar spine and hip without the use of ionizing radiation(137). In compared to the conventional dual energy x-ray absorptiometry (DEXA), quantitative ultrasound yielded results comparable to DEXA and may therefore be used for screening patients osteoporosis(135) and can be a helpful tool for assessing pathological fractures(136), especially for those with CRD(135)

Computed Tomography (CT) scanner.a technology for measuring properties of bone at peripheral skeletal sites for noninvasive bone mineral measurement(138) with greatest advantages of high precision and sensitivity of the vertebral spongiosa site(139) and the latter region of the skeleton, correlates well with the spinal fracture index(140)

Dual-energy x-ray absorptiometry (DXA) and quantitative computed tomography (QCT), which are now the standard methods for assessing osteoporosis severity and treatment efficacy(141). But according to the Universitätsklinikum Schleswig-Holstein, in cross-sectional study of males with glucocorticoid-induced osteoporosis (GIO, quantitative computed tomography (QCT), High-resolution quantitative computed tomography (HRQCT)-based were more superior to DXA in diferentiating between patients with vertebral fracture status(142).

4. Etc.


References
Prevalence of rheumatic symptoms, rheumatoid arthritis, ankylosing spondylitis, and gout in Shanghai, China: a COPCORD study by Dai SM1, Han XH, Zhao DB, Shi YQ, Liu Y, Meng JM.(PubMed)
(131) Clinical practice guidelines for the diagnosis and management of osteoporosis. Scientific Advisory Board, Osteoporosis Society of Canada(CMAJ)
(132) Current Recommendations for Laboratory Testing and Use of Bone Turnover Markers in Management of Osteoporosis by Jehoon Lee, M.D.1 and Samuel Vasikaran, M.D.(PMC)
(133) The role of DXA bone density scans in the diagnosis and treatment of osteoporosis by Glen M Blake and Ignac Fogelman(PMC)
(134) The clinical role of dual energy X-ray absorptiometry by Blake GM1, Fogelman I.(PubMed)
(135) Assessment of osteoporosis by quantitative ultrasound versus dual energy X-ray absorptiometry in children with chronic rheumatic diseases by Hartman C1, Shamir R, Eshach-Adiv O, Iosilevsky G, Brik R.(PubMed)
(136) Review of comparative studies between bone densitometry and quantitative ultrasound of the calcaneus in osteoporosis by Flöter M1, Bittar CK, Zabeu JL, Carneiro AC.(PubMed)
(137) Quantitative ultrasound techniques for the assessment of osteoporosis: expert agreement on current status. The International Quantitative Ultrasound Consensus Group by Glüer CC.(PubMed)
(138) Quantitative computed tomography in assessment of osteoporosis by Genant HK1, Block JE, Steiger P, Glueer CC, Smith R.(PubMed)+
(139) Osteoporosis: assessment by quantitative computed tomography by Genant HK, Ettinger B, Cann CE, Reiser U, Gordan GS, Kolb FO.(PubMed)
(140) Assessment of metabolic bone diseases by quantitative computed tomography by Richardson ML, Genant HK, Cann CE, Ettinger B, Gordan GS, Kolb FO, Reiser UJ.(PubMed)

Monday 30 November 2015

Most Common Diseases of elder: The Clinical Trials and Studies of Musculo-Skeletal disorders: Osteoporosis - The Risk Factors

Kyle J. Norton (Scholar)

Health article writer and researcher; Over 10.000 articles and research papers have been written and published on line, including world wide health, ezine articles, article base, healthblogs, selfgrowth, best before it's news, the karate GB daily, etc.,.
Named TOP 50 MEDICAL ESSAYS FOR ARTISTS & AUTHORS TO READ by Disilgold.com Named 50 of the best health Tweeters Canada - Huffington Post
Nominated for shorty award over last 4 years
Some articles have been used as references in medical research, such as international journal Pharma and Bio science, ISSN 0975-6299.

Musculoskeletal disorders (MSDs) are  medical condition mostly caused by work related occupations and working environment, affecting patients’ muscles, joints, tendons, ligaments and nerves and developing over time. According to a community sample of 73 females and 32 males aged 85 and over underwent a standardised examination at home, musculoskeletal pain was reported by 57% of those interviewed(1).

      Types of Musculo-Skeletal disorders in elder(2)

1. Osteoarthritis
2. Gout
3. Rheumatoid Arthritis
4. Polymalagia Arthritis
5. Cervical myleopathy and spinal canal stenosis
6. Osteoporosis
7. Low back pain
8. Fibromyalgia

                                Osteoporosis

Osteoporosis is defined as a condition of thinning of bone and bone tissues as a result of the loss of bone density over a long period of time. It is a widespread degenerative disease of skeletal joints and often associated with senescence in vertebrates due to excessive or abnormal mechanical loading of weight-bearing joints, arising from heavy long-term use or specific injuries(6).

                           The Risk factors

1. Young Age at Diagnosis, Decreased Lean Mass
In the study to investigate the prevalence and identify the risk factors of osteoporosis, researchers at the Korea Cancer Center Hospital, Seoul, showed that young age at diagnosis(55), and low lean mass(55)(56) are found to be risk factors of the development of osteopenia and osteoporosis(55) 

2. Male sex(55)(56) and adult (GH) growth hormone deficiency or excess
There was the high prevalence of osteoporosis and osteopenia in male sex, a low lean mass, and adult growth hormone replacement(58). Patient with  either GH deficiency (GHD) or GH excess are found to have bone, metabolic, and somatic impairments(57). 

3. Chlamydia pneumoniae
Chlamydia pneumoniae is an bacterial infection causes of pneumoniae. According to the "Sapienza" University, there is an association between the presence of Chlamydia pneumoniae DNA both in osteoporotic bone tissue and peripheral blood mononuclear cells (PBMCs) and the increase in circulating resorptive cytokines(63), probably due to induced of bone loss(64).

5. Race
Race with limit intake of lactos, the lactose a disaccharide sugar found in milk may be associate to risk of osteoporosis(104). According to the joint study lead by Université Libre de Bruxelle, intake of dairy can confer a favourable benefit with regard to bone health(104).
Low calcium intakes(106), and Lactose intolerance(107) also has an impact on low bone density(105)(106) among Hispanic-American and Asian-American populations may create an elevated risk for osteoporosis(105)(107).

6. Family history
The family history is found positively in related to a significant, independent risk factor for osteoporosis in U.S. women aged of 35 and over, according to the the National Center on Birth Defects and Developmental Disabilities(108). 
According to the, risk of  osteoporosis in women was 8.3%. Patient with  positive family history of the diseases have a increased risk of 19.8%  of which is considered as a independent risk of osteoporosis(109). Dr. Betancourt Ortiz SL said "Family history of bone fractures might serve for identifying post-menopausal women at increased risk of loss of BMD", according to his study at the at the "San Juan" Specialities Hospital in Riobamba (Province of Chimborazo, Republic of Ecuado(110)
7. Skin color and body size
Skin color, body size and bone mineral density (BMD) may also be an independent  risk of  osteoporosis among three groups of postmenopausal women: 104 healthy black women, 45 healthy white women, and 52 osteoporotic white women with vertebral fractures(111), especially on large body size on bone mineral density effects in black and white(111)(112). In fact, family history, use of contraceptive device and postnatal environmental factors, are found to associate to infant bone size and bone mass of which may induce long-term consequences in the increased risk of osteoporosis in later life(113).

8. Diet and lifestyle
Certain diet, including typical American diet with high intake of salt, soda, caffeine, process foods, such as can foods, etc,... have been found to induce risk of osteoporosis, according to Elizabeth Ward, MS, RD. In deed, high salt intake was found to associated with osteoporosis and an increased calcium excretion in urine(114) of which induced loss of calcium and risk of osteoporosis.
Negative lifestyle such as smoking(116), heavy alcohol consumption(117)  may reduce bone mineral density and increase the incidence of fragility fracture,
Positive lifestyle such as  green tea drinking(118), dairy products(119) and physical activity(120) improved bone minerals density of which reduced risk of osteoporosis(115).

9. Heavy alcohol intake or alcoholism
Moderate intake of alcohol use may have beneficial effects on bone mineral density of that reduced risk of osteoporosis. Oppositely, Heavy alcohol intake or alcoholism disrupts calcium and bone homeostasis(121) of which leads to reduce bone mineral density and increase the incidence of fragility fracture, according to the study by Albert Einstein College of Medicine and Montefiore Medical Center(122).

10. Smoking and lower serum IGF-I and IGF-binding protein (IGFBP)-3
 levels
The study of middle-aged Korean men, conduced by the Sungkyunkwan University School of Medicine,   suggest that current smoking history, and history of smoking and lower serum IGF-I levels are risk factors for lower BMD  of which can induce risk of osteoporosis(123). In deed, insulin-like growth factor I (IGF-I) and IGF-binding protein (IGFBP)-3 showed to have a significant relation to relationship to osteoporotic spinal fracture and bone mass distribution(124)(125) of that can be used as a predictor for the severity of osteoporosis, and risk of bone fracture associated with osteoporosis(124).

11. Other risk factors
Patient suffered from chronic illness, such as chronic kidney disease(126), chronic inflammatory rheumatic Disease(127, chronic obstructive pulmonary disease(129),cancers(130), etc.... are found to associate to risk of osteopenia and osteoporosis(128) due to slowly decreased bone mineral density, vitamin and calcium diet content, etc...



References
(1) Prevalence of rheumatic symptoms, rheumatoid arthritis, ankylosing spondylitis, and gout in Shanghai, China: a COPCORD study by Dai SM1, Han XH, Zhao DB, Shi YQ, Liu Y, Meng JM.(PubMed
(2) Musculoskeletal Disorders in the Elderly by Ramon Gheno, Juan M. Cepparo, Cristina E. Rosca,1 and Anne Cotten(PMC)
(3) Osteoporosis(Life extension)
(4) Hormone and bone by Francisco Bandeira1, Marise Lazaretti-Castro2, John P. Bilezikian3
(5) Growth hormone and bone by Ohlsson C1, Bengtsson BA, Isaksson OG, Andreassen TT, Slootweg MC.(PubMed)
(6) GH and bone--experimental and clinical studies by Isaksson OG1, Ohlsson C, Bengtsson BA, Johannsson G.(PubMed)
(55) Young age at diagnosis, male sex, and decreased lean mass are risk factors of osteoporosis in long-term survivors of osteosarcoma by Lim JS1, Kim DH, Lee JA, Kim DH, Cho J, Cho WH, Lee SY, Jeon DG.(PubMed)
(56) Body fat is associated with increased and lean mass with decreased knee cartilage loss in older adults: a prospective cohort study. by Ding C1, Stannus O, Cicuttini F, Antony B, Jones G.(PubMed)
(57) The role for growth hormone in linking arthritis, osteoporosis, and body composition by Tauchmanova L1, Di Somma C, Rusciano A, Lombardi G, Colao A.(PubMed)
(58) Risk factors for osteoporosis in long-term survivors of intracranial germ cell tumors by Kang MJ1, Kim SM, Lee YA, Shin CH, Yang SW, Lim JS.(PubMed)
(59) Treatment of primary osteoporosis in men by Giusti A1, Bianchi G2.(PubMed)
(60) Age- and menopause-related bone loss compromise cortical and trabecular microstructure by Seeman E1.(PubMed)
(61) Bone loss and bone size after menopause by Ahlborg HG1, Johnell O, Turner CH, Rannevik G, Karlsson MK.(PubMed)
(62) Secondary osteoporosis by Stein E1, Shane E.(PubMed)
(63) Chlamydia pneumoniae and osteoporosis-associated bone loss: a new risk factor by Di Pietro M1, Schiavoni G, Sessa V, Pallotta F, Costanzo G, Sessa R.(PubMed)
(64) Chlamydia pneumoniae infection results in generalized bone loss in mice by Bailey L1, Engström P, Nordström A, Bergström S, Waldenström A, Nordström P.(PubMed)
(105) Hip osteoarthritis: influence of work with heavy lifting, climbing stairs or ladders, or combining kneeling/squatting with heavy lifting by Jensen LK1.(PubMed)
(106) Consumption of calcium-fortified cereal bars to improve dietary calcium intake of healthy women: randomized controlled feasibility study by Lee JT1, Moore CE2, Radcliffe JD2.(PubMed)
(107) Lactose intolerance and health disparities among African Americans and Hispanic Americans: an updated consensus statement by Bailey RK1, Fileti CP, Keith J, Tropez-Sims S, Price W, Allison-Ottey SD.(PubMed)
(108) Prevalence, family history, and prevention of reported osteoporosis in U.S. women by Robitaille J1, Yoon PW, Moore CA, Liu T, Irizarry-Delacruz M, Looker AC, Khoury MJ.(PubMed)
(109) Is family history of osteoporosis associated with osteoporosis preventive behavior in US women? A population-based study by Julie Robitaille, Paula W. Yoon, Margarita Irizarry-De La Cruz, Tiebin Liu, Cynthia A. Moore, Muin J. Khoury(CDC.GOV)
(110) [Bone mineral density, dietary calcium and risk factor for presumptive osteoporosis in Ecuadorian aged women].[Article in Spanish] by Betancourt Ortiz SL1.(PubMed)
(111) Skin color and body size as risk factors for osteoporosis by Nelson DA1, Kleerekoper M, Peterson E, Parfitt AM.(PubMed)
(112) Bone mass, skin color and body size among black and white women by Nelson DA1, Kleerekoper M, Parfitt AM.(PubMed)
(113) Infant programming of bone size and bone mass in 10-year-old black and white South African children by Vidulich L1, Norris SA, Cameron N, Pettifor JM.(PubMed)
(114) Salt intake, hypertension, and osteoporosis by Caudarella R1, Vescini F, Rizzoli E, Francucci CM.(PubMed)
(115) Osteoarthritis of the knee and hip. Part I: aetiology and pathogenesis as a basis for pharmacotherapy. by Adatia A1, Rainsford KD, Kean WF.(PubMed)
(116) Smoking, radiotherapy, diabetes and osteoporosis as risk factors for dental implant failure: a meta-analysis by Chen H1, Liu N, Xu X, Qu X, Lu E.(PubMed)
(117) Alcohol and bone by Mikosch P1.(PubMed)
(118) Catechin-rich oil palm leaf extract enhances bone calcium content of estrogen-deficient rats by Bakhsh A1, Mustapha NM, Mohamed S.(PubMed)
(119) Dairy products consumption and serum 25-hydroxyvitamin D level in Saudi children and adults by Al-Daghri NM1, Aljohani N2, Al-Attas OS1, Krishnaswamy S3, Alfawaz H4, Al-Ajlan A5, Alokail MS1.(PubMed)
(120) Physical activity in the prevention and amelioration of osteoporosis in women : interaction of mechanical, hormonal and dietary factors by Borer KT1.(PubMed)
(121) [Osteoporosis and alcohol intake].[Article in Japanese] by Kogawa M1, Wada S.
(122) Association between alcohol consumption and both osteoporotic fracture and bone density by Berg KM1, Kunins HV, Jackson JL, Nahvi S, Chaudhry A, Harris KA Jr, Malik R, Arnsten JH.(PMC)
(123) Age, body mass index, current smoking history, and serum insulin-like growth factor-I levels associated with bone mineral density in middle-aged Korean men by Rhee EJ1, Oh KW, Lee WY, Kim SW, Oh ES, Baek KH, Kang MI, Park CY, Choi MG, Yoo HJ, Park SW.(PubMed)
(124) Serum levels of insulin-like growth factor (IGF) I, IGF-binding protein (IGFBP)-2, and IGFBP-3 in osteoporotic patients with and without spinal fractures by Sugimoto T1, Nishiyama K, Kuribayashi F, Chihara K.(PubMed)
(125) Serum levels of insulin-like growth factor (IGF); IGF-binding proteins-3, -4, and -5; and their relationships to bone mineral density and the risk of vertebral fractures in postmenopausal women by Yamaguchi T1, Kanatani M, Yamauchi M, Kaji H, Sugishita T, Baylink DJ, Mohan S, Chihara K, Sugimoto T.(PubMed)
(126) [Osteoporosis treatment for patients with chronic kidney disease].[Article in Japanese] by Konishi Y.(PubMed)
(127) Identification of Osteoporosis & Chronic Inflammatory Rheumatic Disease In French Claims Data. by Belhassen M1, Levy-Bachelot L2, Laforest L1, Ginoux M1, van Ganse E1.(PubMed)
(128) Aging, chronic illness and self-concept: a study of women with osteoporosis by Wilkins S1.(PubMed)
(129) The chronic obstructive pulmonary disease comorbidity spectrum in Japan differs from that in western countries by Takahashi S1, Betsuyaku T2.(PubMed)
(130) Osteopenia and osteoporosis in women with breast cancer by Ramaswamy B1, Shapiro CL(PubMed)

Sunday 29 November 2015

Most Common Diseases of elder: The Clinical Trials and Studies of Musculo-Skeletal disorders: Osteoporosis - The Causes

Kyle J. Norton (Scholar)

Health article writer and researcher; Over 10.000 articles and research papers have been written and published on line, including world wide health, ezine articles, article base, healthblogs, selfgrowth, best before it's news, the karate GB daily, etc.,.
Named TOP 50 MEDICAL ESSAYS FOR ARTISTS & AUTHORS TO READ by Disilgold.com Named 50 of the best health Tweeters Canada - Huffington Post
Nominated for shorty award over last 4 years
Some articles have been used as references in medical research, such as international journal Pharma and Bio science, ISSN 0975-6299.

Musculoskeletal disorders (MSDs) are  medical condition mostly caused by work related occupations and working environment, affecting patients’ muscles, joints, tendons, ligaments and nerves and developing over time. According to a community sample of 73 females and 32 males aged 85 and over underwent a standardised examination at home, musculoskeletal pain was reported by 57% of those interviewed(1).

      Types of Musculo-Skeletal disorders in elder(2)

1. Osteoarthritis
2. Gout
3. Rheumatoid Arthritis
4. Polymalagia Arthritis
5. Cervical myleopathy and spinal canal stenosis
6. Osteoporosis
7. Low back pain
8. Fibromyalgia

                                Osteoporosis

Osteoporosis is defined as a condition of thinning of bone and bone tissues as a result of the loss of bone density over a long period of time. It is a widespread degenerative disease of skeletal joints and often associated with senescence in vertebrates due to excessive or abnormal mechanical loading of weight-bearing joints, arising from heavy long-term use or specific injuries(6).


                                The Causes 
A. Primary causes
Bone loss is a natural aging process occurs during the normal aging process. Primary osteoporosis is a type of  osteoporosis due to involutional losses(65) causes by hormone imbalance associated with aging(59), In men, it is the result of low testosterone(59) and, in women, additional losses related to natural menopause(60)(61). The abnormal secretion(deficiency) of  GH due to the effects of age, sex, diet, exercise, stress, and other hormones may also induce the loss of bone density(4)(5) as a result of reduced interaction with GH receptors on osteoblasts(6)(7). Sleep deprivation generally suppresses GH release, also can contribute to the onset of bone loss(8).


2. Secondary causes
 According to the study by Department of Medicine, College of Physicians and Surgeons, Columbia University, other disorders or medication exposures causes of osteoporosis are referred as "secondary" osteoporosis(62) also include
1. Other hormone imbalance
Thyroid dysfunction such as hyperthyroidism and hypothyroidism can interfere with the secretion of thyroid hormone of which can have a direct impart on the bone mineral density(11)(10). Bone mineral density deficiency has been found to associate to patient with parathyroid hormone excess(12)(13), especially at the lumbar spine, total hip, and femoral neck in postmenopausal women with osteoporosis(13).
Massachusetts General Hospital, insisted that patient with a higher-than-normal levels of the hormone prolactin in the blood are at higher risk for the development of osteoporosis(14).
Hypogonadism is a condition in which the body doesn't produce enough testosterone due to decrease on alkaline phosphatase (AP), can have a direct influence to the deficiency of bone mineral density, according to Weill Cornell Medical College(16). 
"Pituitary disorders, can also influence bone metabolism and cause secondary osteoporosis, induced a significant increase of fracture risk", the Wroclaw Medical University said(17). 

2. Calcium deficiency
Calcium, one the mineral has a significant effect on bone turn over in patient with osteoporosis(19), Patient with parathyroid hormone (PTH), the disease with removed calcium from the bone(22) has a progressive link to the early onset of osteoporosis(23). Calcium at dosage of at least 1200 mg has been suggested by researchers in reducing the incidence of non-vertebral and hip fracture(18). Deficiency of vitamin D and calcium in patient with osteoporosis has shown to induced risk of post fracture in associated to the rate of mortality in elder, according to the prospective analysis, conducted by University of Helsinki, Helsinki(20).  But the University of Auckland in searching of meta-analyses with data for > 50 000 older adults suggested that calcium with or without vitamin D has only weak, inconsistent effects on fracture, and should not be recommended for fracture prevention in adults with no diagnosed osteoporosis(21).

3. Low serum of Vitamin D
Vitamin D found in a number of food such as liver,  and fish oil but abundantly under sunlight has a direct effect for the body in absorb calcium and and phosphate(28) for prevention the onset of osteoporosis(24), through its effect on the control of osteoblast(26) function and bone extracellular matrix  mineralization(25), according to the Erasmus Medical Center Rotterdam. In deed, according to the VU University Medical Center, Vitamin D used for stimulate the absorption of calcium may have a direct influence on bone mineral density and bone turnover as vitamin D deficiency is associate to patient with osteoporosis and fracture bone(27). Dr. Yoshida T and Dr. Stern PH. said" Vitamin D analogues has provided new therapeutic options for increasing bone mineral density and reducing fractures"(28)

Adding to secondary causes of osteoporosis, according to Clarke 2010, Confavreux 2009, Lieben 2009; Zhou 2011 include
4. Oxidative stress
Oxidative stress is an imbalance between production of free radicals and the ability of the body antioxidants in neutralizing its harmful effects. Oxidative stress has shown to damage the cellular components of osteoblasts, causing osteoporosis(29), according to the Shanghai Jiaotong University School of Medicine. In aging population, with estrogen deficiency and increased in reactive oxygen species (ROS) production(31), risk of osteoporosis is in the increase, Dr. Manolagas SC said" (there is) an emerging evidence provides a paradigm shift from the "estrogen-centric" account of the pathogenesis of involutional osteoporosis"(30)

5. Hyperglycemia
Hyperglycemia is a medical condition of elevated blood sugar, often associated to diabetes(32).
Insulin dependent diabetes mellitus is shown to associate with osteoporosis and increased fracture rate as a result of modulate osteoblast gene expression(66), function and bone formation(33).
In deed,  Individuals with type 2 diabetes has found to associate to increased fracture risk(68), despite normal bone mineral density (BMD) and high BMI-factors, the joint study said(67).
Interestingly, "Although type 1 diabetes is associated with lower bone density, those with type 2 diabetes usually have elevated bone density. Yet for both types of diabetes, bone appears to be more fragile for a given density" said Dr. Schwartz AV1,Dr. Sellmeyer DE.(69).

6. Inflammation
Would there be an association between osteoporosis and inflammation? According to the study in
patients with chronic pancreatitis, bone bone turnover and highest systematic inflammation was shown to be associated patients with osteoporosis(70). In post-menopausal women, withdrawal of estrogen exhibited the production of pro-inflammatory cytokines, the primary mediators in accelerated bone loss(71), reduced osteoclastic bone resorption(71) of that induced risk of osteoporosis(71). According to the Medical University Innsbruck, chronic inflammatory diseases such as inflammatory bowel diseases (IBD) not only affect bone metabolism but also are frequently associated with the presence of osteoporosis(72)..

7. Metabolic syndrome(3)
Metabolic syndrome is the collection of symptoms of which can lead to cardiovascular disease and diabetes(73)(74). According to the study by Tongji University School of Medicine, metabolic syndrome has a negative effect on bone mineral density in men but positive effect in women(75).
In support to above claim, the Military Hospital Mohammed V, Morocco showed that menopause  women with MS have a protective effect of osteoporosis due to higher BMD at the hip and spine(76).

[In adolescent, low bone mineral density or secondary osteoporosis is more frequent in young people and is generally due to an underlying cause(9) 
8. Nutritional deficiencie 
Calcium and vitamin D in many research are best known for theirs effectiveness in managed osteoporosis(77). Children and adult with long term deficiency of vitamin D  have found to associate with low mineralization in theskeleton, leading to rickets(78). According to study, Poor nutritional conditions in early life are linked to greater prevalence of OA due the gradual deterioration of function(9).
(see calcium and Vitamin D for more information)]

9. Long-term Glucocorticoid therapy
Glucocorticoid is chemical used to relieve pain caused by inflammation as a result of the over active immune system in induced certain diseases, such as allergies, asthma, autoimmune diseases, and sepsis. The chemical is found to associate to the development of osteoporosis due to its adverse effect in induced apoptosis of steoblasts(79). According to the Chiba University study, glucocorticoid-induced osteoporosis (GIOP) in children with autoimmune diseases by inflating the a high level of bone turnover markers, interferring with femoral neck bone mineral density (BMD), serum bone alkaline phosphatase, and urinary deoxypyridinolin(80)

10. Immunosuppressive therapy
Medication used to suppress the immune system to prevent rejection of transplanted organs and tissues may also induced osteoporosis(83). Patient with solid organ transplant (SOT) patient often are found to have low levels of calcium and vitamin D due to the effects of the medication induced malnutrition(81) In fact, reduced exposure of glucocorticoid and appropriate physical activity before and after transplant has shown to aid the future management of osteoporosis in these patient(81)(82).
Dr. Bia M said" Pretransplant period or early post transplant and should include assessment of fracture risk as well as metabolic factors. Bone mineral density measurement is recommended in all patients even if its predictive value for fracture risk in the transplant population..... Management of bone disease should be directed toward decreasing fracture risk as well as improving bone density"(84)

12. Medication
Medication used for treatment of chronic diseases such as cancers and diabetes have found to associate to the development of osteoporosis, according to The University of Texas MD Anderson Cancer Center(85) and joint study(86) respectively. In patient with schizophrenia, the use of antipsychotic drugs have shown to induce hyperprolactinemia through inhibited hypothalamo-pituitary-gonadal axis and reduced bone mineral density(15)
Other medication may induce osteoporosis include, aromatase inhibitors, gonadotropin-releasing hormone agonists, thyroid replacement therapy, antiepileptics, antidepressants, antipsychotics, lithium, gastric acid lowering agents, thiazolidinediones, loop diuretics, heparins and warfarin, vitamin A and cyclosporine, according to the study of Drug-induced Osteoporosis in the Older Adult led posted in Medscape(87).

13. Medical conditions
13. HIV infected patient
Menopausal women with HIV-infected Postmenopausal Women is found to associated to an additional risk of predictor for osteoporosis and fractures. According to the study, the prevalence of osteoporosis in patient with HIV infected is much higher in uninfected postmenopausal women(89),

13.2. Spinal cord injuriesPatient with spinal cord injuries are associate to bone resorption rate is hypercalciuria, low PTH, and 1,25 (OH)2 vitamin D of that exhibit the risk of decreased bone density and increased risk of fracture,  such as lower extremity fractures, according to DR. Ott SM(92). The injures can also can lead to abnormal calcium and phosphate metabolism and the parathyroid hormone (PTH)-vitamin D axis of that increse risk of osteoporosis(93).
In deed, according to the Swiss Paraplegic Center, spinal core injures can cause long-term changes in bone metabolism, bone mineral density, quantitative ultrasound parameters, and fracture incidence(94).

13.3. Weight loss surgery
Weight loss surgery such as gastric bypass is found to increased risk of lower bone mineral density, especially in the femoral neck and among patients who had greater baseline BMD and greater reduction in ghrelin concentrations(95). The American University of Beirut-Medical Center study also concerned of the decreased mechanical loading, calcium, metabolic acidosis, and elevated peptide YY(97) and vitamin D malabsorption(97) with secondary hyperparathyroidism(97), deficiency in other nutrients in patient with weight loss surgery(96).

13.4. Premature ovarian failure
 Premature ovarian failure is an early onset of menopause in  women younger than age of 40 with the medical occurrence of amenorrhea, hypergonadotropinemia and estrogen deficiency(98) of which can lead to bone loss and increased risk psychological stress and mortility(99).
In a retrospective analysis of 223 consecutive new referrals conducted by King's College Hospital NHS Foundation, women with premature ovarian insufficiency are associated to the risk of low bone minerals density(100).
14. Eating disorder
Anorexia nervosa (AN), type of eating disorder can induce loss of bone mineral density(91), impaired bone quality(91) and increased fracture risk(91) as a result of abnormal production of estrogen(91) in influence to weight loss(91) and menstrual disorder(90).

15. Menstrual disorder
Menstrual disorder is a result of the abnormal production of hormones in  women menstrual cycle.
15.1. Abnormal production of prolactin is produced by the anterior lobe of the pituitar can lead to menstrual disorder. Hyperprolactinaemia cause higher serum prolactin levels of that increase of the risk of osteopenia or/and osteoporosis, according to Medical University of Poznań(101).
15.2. Amenorrhea
Young women with an age when bone formation should still be occurring may put themselves at risk of osteoporosis if amenorrhea is untreated(102).
Dr. Golden NH said" Female athlete triad is a condition ....... characterized by the triad of amenorrhea, disordered eating and osteoporosis"(103).


References
(1) Prevalence of rheumatic symptoms, rheumatoid arthritis, ankylosing spondylitis, and gout in Shanghai, China: a COPCORD study by Dai SM1, Han XH, Zhao DB, Shi YQ, Liu Y, Meng JM.(PubMed
(2) Musculoskeletal Disorders in the Elderly by Ramon Gheno, Juan M. Cepparo, Cristina E. Rosca,1 and Anne Cotten(PMC)
(3) Osteoporosis(Life extension)
(4) Hormone and bone by Francisco Bandeira1, Marise Lazaretti-Castro2, John P. Bilezikian3
(5) Growth hormone and bone by Ohlsson C1, Bengtsson BA, Isaksson OG, Andreassen TT, Slootweg MC.(PubMed)
(6) GH and bone--experimental and clinical studies by Isaksson OG1, Ohlsson C, Bengtsson BA, Johannsson G.(PubMed)
(7) Regulation of bone mass by growth hormone by Olney RC1.(PubMed)
(8) Role of Sleep and Sleep Loss in Hormonal Release and Metabolism by Rachel Leproult and Eve Van Cauter(PMC)
(9) Low bone mineral density in a growth hormone deficient (GHD) adolescent by Anna Capozzi, Silvia Della Casa, Barbara Altieri, and Alfredo Pontecorvi(PMC)
(10) [Osteoporosis in thyroid diseases].[Article in Polish] by Kosińska A1, Syrenicz A, Kosiński B, Garanty-Bogacka B, Syrenicz M, Gromniak E.(PubMed)
(11) [Bone metabolism and thyroid disease. Normalized bone metabolism prevents osteoporosis].[Article in Swedish] by Tørring O1.(PubMed)
(12) Enhancing Effect of Intermittent Parathyroid Hormone Administration on Bone Formation After Titanium Implant Placement in an Ovariectomized Rat Maxilla by Heo HA1, Park SH, Jeon YS, Pyo SW.(PubMed)
(13) Effects of abaloparatide, a human parathyroid hormone-related peptide analog, on bone mineral density inpostmenopausal women with osteoporosis by Leder BZ1, O'Dea LS, Zanchetta JR, Kumar P, Banks K, McKay K, Lyttle CR, Hattersley G.(PubMed)
(14) Hyperprolactinemia and bone mineral density: the potential impact of antipsychotic agents by Naidoo U1, Goff DC, Klibanski A.(PubMed)
(15) Antipsychotic-induced hyperprolactinemia inhibits the hypothalamo-pituitary-gonadal axis and reduces bone mineral density in male patients with schizophrenia by Kishimoto T1, Watanabe K, Shimada N, Makita K, Yagi G, Kashima H.(PubMed)
(16) The effect of hypogonadism and testosterone-enhancing therapy on alkaline phosphatase and bone mineral density by Dabaja AA1, Bryson CF, Schlegel PN, Paduch DA.(PubMed)
(17) Pituitary disorders and osteoporosis by Bolanowski M1, Halupczok J1, Jawiarczyk-Przybyłowska A1.(PubMed)
(18) Calcium citrate and vitamin D in the treatment of osteoporosis by Quesada Gómez JM1, Blanch Rubió J, Díaz Curiel M, Díez Pérez A.(PubMed)
(19) Alfacalcidol reduces accelerated bone turnover in elderly women with osteoporosis by Shiraki M1, Fukuchi M, Kiriyama T, Okamoto S, Ueno T, Sakamoto H, Nagai T.(PubMed)
(20) Post-fracture prescribed calcium and vitamin D supplements alone or, in females, with concomitant anti-osteoporotic drugs is associated with lower mortality in elderly hip fracture patients: a prospective analysis by Nurmi-Lüthje I1, Lüthje P, Kaukonen JP, Kataja M, Kuurne S, Naboulsi H, Karjalainen K.(PubMed)
(21) Should we prescribe calcium or vitamin D supplements to treat or prevent osteoporosis? by Bolland MJ1, Grey A1, Reid IR1.(PubMed)
(22) The actions of parathyroid hormone on bone: relation to bone remodeling and turnover, calcium homeostasis, and metabolic bone diseases. II. PTH and bone cells: bone turnover and plasma calcium regulation by Parfitt AM.(PubMed)
(23) Osteoporosis and Parathyroid Disease (Hyperparathyroidism)
(24) Dietary Reference Intakes for Calcium and Vitamin D by Institute of Medicine (US) Committee to Review Dietary Reference Intakes for Vitamin D and Calcium; Ross AC, Taylor CL, Yaktine AL, et al., editors.Washington (DC): National Academies Press (US); 2011.(NCBI)
(25) Vitamin D control of osteoblast function and bone extracellular matrix mineralization by van Leeuwen JP1, van Driel M, van den Bemd GJ, Pols HA.(PubMed)(26) Skeletal characterization of an osteoblast-specific vitamin D receptor transgenic (ObVDR-B6) mouse model by Triliana R1, Lam NN2, Sawyer RK3, Atkins GJ4, Morris HA5, Anderson PH6.(PubMed)
(27) The effect of vitamin D on bone and osteoporosis by Lips P1, van Schoor NM.(PubMed)
(28) How vitamin D works on bone by Yoshida T1, Stern PH.(PubMed)
(29) Oxidative damage to osteoblasts can be alleviated by early autophagy through the endoplasmic reticulum stresspathway--implications for the treatment of osteoporosis by Yang YH1, Li B1, Zheng XF1, Chen JW1, Chen K1, Jiang(PubMed)
(30) From estrogen-centric to aging and oxidative stress: a revised perspective of the pathogenesis of osteoporosis by Manolagas SC1.(PubMed)
(31) Practicality of intermittent fasting in humans and its effect on oxidative stress and genes related to aging and metabolism by Wegman MP1, Guo MH, Bennion DM, Shankar MN, Chrzanowski SM, Goldberg LA, Xu J, Williams TA, Lu X, Hsu SI, Anton SD, Leeuwenburgh C, Brantly ML.(PubMed)
(32) Diabetic hyperglycemic hyperosmolar syndrome(Medline Plus)
(66) Extracellular glucose influences osteoblast differentiation and c-Jun expression by Zayzafoon M1, Stell C, Irwin R, McCabe LR.(PubMed)
(67) Type 2 diabetes and the skeleton: new insights into sweet bones by Shanbhogue VV1, Mitchell DM2, Rosen CJ3, Bouxsein ML4.(PubMed)
(68) Type 2 diabetes mellitus and fracture risk by Dede AD1, Tournis S2, Dontas I2, Trovas G2.(PubMed)
(69) Diabetes, fracture, and bone fragility by Schwartz AV1, Sellmeyer DE.(PubMed)
(70) An association between abnormal bone turnover, systemic inflammation, and osteoporosis in patients with chronic pancreatitis: a case-matched study by Duggan SN1, Purcell C1, Kilbane M2, O'Keane M2, McKenna M2, Gaffney P3, Ridgway PF1, Boran G3, Conlon KC4.(PubMed)
(71) Osteoporosis and inflammation by Mundy GR1.(PubMed)
(72) Gut, inflammation and osteoporosis: basic and clinical concepts by Tilg H1, Moschen AR, Kaser A, Pines A, Dotan I.(PubMed)
(73) Epidemiology of paediatric metabolic syndrome and type 2 diabetes mellitus by De Ferranti SD1, Osganian SK.(PubMed)
(74) Association between salivary pH and metabolic syndrome in women: a cross-sectional study by Tremblay M1, Brisson D, Gaudet D.(PubMed)
(75) Association between metabolic syndrome and osteoporosis: a meta-analysis by Zhou J1, Zhang Q, Yuan X, Wang J, Li C, Sheng H, Qu S, Li H.(PubMed)
(76) Osteoporosis, vertebral fractures and metabolic syndrome in postmenopausal women by El Maghraoui A1, Rezqi A, El Mrahi S, Sadni S, Ghozlani I, Mounach A.(PubMed)
(77) The use of calcium and vitamin D in the management of osteoporosis by John A Sunyecz(PubMed)
(78) Bone Health and Osteoporosis: A Report of the Surgeon General.
(79) Curcumin alleviates glucocorticoid-induced osteoporosis by protecting osteoblasts from apoptosis in vivo and in vitro by Chen Z1, Xue J2, Shen T1, Ba G1, Yu D1, Fu Q1.(PubMed)
(80) Efficacy of intravenous alendronate for the treatment of glucocorticoid-induced osteoporosis in children with autoimmune diseases by Inoue Y1, Shimojo N, Suzuki S, Arima T, Tomiita M, Minagawa M, Kohno Y.(PubMed)
(81) Osteoporosis in the adult solid organ transplant population: underlying mechanisms and available treatment options by Early C1, Stuckey L1, Tischer S2.(PubMed)
(82) [Glucocorticoid induced osteoporosis].[Article in Croatian] by Anić B, Mayer M.(PubMed)
(83) Bone disease after transplantation: osteoporosis and fractures risk by Kulak CA1, Borba VZ1, Kulak Júnior J2, Custódio MR3.(PubMed)
(84) Evaluation and management of bone disease and fractures post transplant by Bia M1.(PubMed)
(85) National comprehensive cancer network(NCCN research)
(86) Osteoporosis Risk in Type 2 Diabetes Patients by Mishaela R Rubin; Ann V Schwartz; John A Kanis; William D Leslie(Medscape)
(87) Drug-induced Osteoporosis in the Older Adult by Mary Beth O'Connell; Laura M Borgelt; Susan K Bowles; Sheryl F Vondracek(Medscape)
(88) [Bone and Joint Involvement in Celiac Disease].[Article in Czech] by Hoffmanová I1, Sánchez D, Džupa V.(PubMed)
(89) Bone Density and Fractures in HIV-infected Postmenopausal Women: A Systematic Review by Cortés YI, Yin MT, Reame NK.(PubMed)
(90) State of the art systematic review of bone disease in anorexia nervosa by Misra M1, Golden NH2, Katzman DK3(PubMed)
(91) Bone health in anorexia nervosa by Misra M1, Klibanski A.(PubMed)
(92) Osteoporosis in women with spinal cord injuries by Ott SM1.(PubMed)
(93)Osteoporosis after spinal cord injury by Jiang SD1, Dai LY, Jiang LS.(PubMed)
(94) Long-term changes in bone metabolism, bone mineral density, quantitative ultrasound parameters, and fracture incidence after spinal cord injury: a cross-sectional observational study in 100 paraplegic men by Zehnder Y1, Lüthi M, Michel D, Knecht H, Perrelet R, Neto I, Kraenzlin M, Zäch G, Lippuner K.(PubMed)
(95) Changes in bone mineral density after sleeve gastrectomy or gastric bypass: relationships with variations in vitamin D, ghrelin, and adiponectin levels by Carrasco F1, Basfi-Fer K, Rojas P, Valencia A, Csendes A, Codoceo J, Inostroza J, Ruz M.(PubMed)
(96) Bone and mineral metabolism in patients undergoing Roux-en-Y gastric bypass. by Hage MP1, El-Hajj Fuleihan G.(PubMed)
(97) Gastric bypass in obese rats causes bone loss, vitamin D deficiency, metabolic acidosis, and elevated peptide YY by Canales BK1, Schafer AL2, Shoback DM2, Carpenter TO3.(PubMed)
(98) Premature ovarian failure: a review by Nippita TA1, Baber RJ.(PubMed)
(99) Premature ovarian failure: clinical presentation and treatment by Kovanci E1, Schutt AK2.(PubMed)
(100) Fertility desires, choice of hormone replacement and the effect of length of time since menopause on bone density in women with premature ovarian insufficiency: a review of 223 consecutive new referrals to a tertiary centre by Mittal M1, Kreatsa M2, Narvekar N2, Savvas M2, Hamoda H2.(PubMed)
(101) [Hyperprolactinaemia and bone mineral density].[Article in Polish] by Kostrzak A1, Męczekalski B1.(PubMed)
(102) Secondary amenorrhea leading to osteoporosis: incidence and prevention by McGee C1.(PubMed)
(103) A review of the female athlete triad (amenorrhea, osteoporosis and disordered eating). by Golden NH1.(PubMed)