Understanding Osteoporosis

Osteoporosis affects the bones, causing them to become weak and fragile and more likely to break (fracture). These fractures most commonly occur in the spine, wrist and hips but can affect other bones such as the arm or pelvis.

In childhood, bones grow and repair very quickly, but this process slows as we get older. Bones stop growing in length between the ages of 16 and 18, but continue to increase in density until you are in your late 20s. From about the age of 35, we gradually lose bone density. This is a normal part of ageing, but for some people it can lead to osteoporosis and an increased risk of fractures. Bones inside our body are being constantly remodeled & renewed. This is the natural, healthy state of continuous uptake of old bone (resorption) followed by the deposit of new bone. This turnover is important in keeping bones healthy and in repairing any minor damage that may occur with wear and tear.

The cells that lay new bone down are called osteoblasts, and the cells responsible for resorption of old bone are called osteoclasts. Osteoporosis occurs as a result of a mismatch between osteoclast and osteoblast activity. This mismatch can be caused by many different disease states or hormonal changes. It is also commonly a result of aging, the change in normal hormones that occurs after menopause, and from diets low in calcium and vitamin D.

In osteoporosis, osteoclasts outperform osteoblasts so that more bone is taken up than is laid down. The result is a thinning of the bone with an accompanying loss in bone strength and a greater risk of fracture. A thinning bone results in a lower bone density or bone mass.

The role of bone:

Although calcium flow to and from the bone is neutral, about 5 mmol is turned over a day. Bone serves as an important storage point for calcium, as it contains 99% of the total body calcium. Calcium release from bone is regulated by parathyroid hormone. Calcitonin stimulates incorporation of calcium in bone, although this process is largely independent of calcitonin.

Low calcium intake may also be a risk factor in the development of osteoporosis. In one meta analysis, the authors found that fifty out of the fifty-two studies that they reviewed showed that calcium intake promoted better bone balance. With a better bone balance, the risk of osteoporosis is lowered.

Osteoporosis is called the ‘silent epidemic’ because of its symptom-less development and the lack of public awareness.
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