Osteoporosis

Osteoporosis is a disease of bone that leads to an increased risk of fracture. In osteoporosis the bone mineral density (BMD) is reduced, bone microarchitecture is disrupted, and the amount and variety of non-collagenous proteins in bone is altered. Osteoporosis is defined by the World Health Organization (WHO) in women as a bone mineral density 2.5 standard deviations below peak bone mass (20-year-old healthy female average).

Osteoporosis is most common in women after the menopause, when it is called postmenopausal osteoporosis, but may also develop in elderly men, and may occur in anyone in the presence of particular hormonal disorders and other chronic diseases or as a result of medications, specifically glucocorticoids, when the disease is called steroid- or glucocorticoid-induced osteoporosis (SIOP or GIOP).

Osteoporosis itself has no specific symptoms; its main consequence is the increased risk of bone fractures. Osteoporotic fractures are those that occur in situations where healthy people would not normally break a bone; they are therefore regarded as fragility fractures. Typical fragility fractures occur in the vertebral column, hip and wrist.

The underlying mechanism in all cases of osteoporosis is an imbalance between bone resorption and bone formation. In normal bone, there is constant matrix remodeling of bone; up to 10% of all bone mass may be undergoing remodeling at any point in time.

Three main mechanisms are involved in osteoporosis development, that is:

• an inadequate peak bone mass
• excesive bone resorption
• inadequate formation of new bone during remodeling.

Additionally, hormonal deficiencies strongly determine the rate of bone resorption, and so deficiency of calcium and vitamin D can lead to impaired bone deposition.

There are several causes/risk factors that can lead to osteoporosis. The risk factors can chiefly be splitted between modifiable and non-modifiable.

The nonmodifiable risk factors are the followings:

• advanced age (in both men and women)
• female sex
• hormones deficiency following menopause
• in men a decrease in testosterone levels
• ethnicity (European or Asian ancestry predisposes for osteoporosis)
• family history
• those who have already had a fracture.

Additionaly, serveral other factors like life style, diet, etc. that can cause osteoporosis; yet, as such they can be modified or avoided. They do include:

• tobacco smoking - tobacco smoking inhibits the activity of osteoblasts, and is an independent risk factor for osteoporosis
• malnutrition
• excess alcohol
  
• insufficient physical activity - bone performs remodeling in response to physical stress. People who remain physically active throughout life have a lower risk of osteoporosis.
• excess physical activity - excessive exercise can lead to constant damages to the bones which can cause exhaustion of the structures as described above
• heavy metal - a strong association between cadmium, lead and bone disease has been established. Low level exposure to cadmium is associated with an increased loss of bone mineral density readily in both genders, leading to pain and increased risk of fractures, especially in elderly and in females. Higher cadmium exposure results in osteomalacia (softening of the bone)
• soft drinks - some studies indicate that soft drinks (many of which contain phosphoric acid) may increase risk of osteoporosis;others suggest soft drinks may displace calcium-containing drinks from the diet rather than directly causing osteoporosis

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