Osteoporosis: A Case Study
Osteoporosis is a major cause for concern for many older aged women and is gaining prevalence as our population ages (Ong, Sahota, Tan & Marshall, 2014). Identifiable by a lower than healthy bone mass and bone tissue deterioration (Ong et al., 2014; Mehler, Cleary & Gaudiani, 2011), osteoporosis leads to an increased risk of fracture in those with the disease, which in turn leads to pain, fragile bones, high medical bills, a loss of independence, and potentially, a shortened life span (Aungst & Rainer, 2014). Thus, reducing the risk factors associated with osteoporosis is an important field of research. This being said, numerous studies are being conducted into the causes of osteoporosis and possible methods of prevention. Three promising areas of research
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involve the connection between osteoporosis and body mass index (BMI), the effects of the eating disorder Anorexia Nervosa on bone health, and vitamin D levels as they relate to osteoporosis. The studies indicate that both a high and low BMI (Compston et al., 2014; Johansson et al., 2014; Ong et al., 2014), Anorexia Nervosa (Mehler, Cleary & Gaudiani, 2011; Lucas, Melton, Crowson & O’Fallon, 1999) and low levels of vitamin D (Buchebner et al., 2014; Feskanich, Willet & Colditz, 2003) all lead to an increased risk of osteoporotic fracture. Thus, altering these risk factors can lower a woman’s risk of osteoporotic fracture. On the whole, body mass index is one of the key areas related to bone health and osteoporotic risk in women. Body mass index is an important area of consideration when it comes to osteoporotic fracture. The calculation used to determine BMI is weight (kg) divided by height (m) squared (kg/m2) (Compston et al., 2014).
Typically, a healthy BMI is considered to be between 18.5 and 24.9 (kg/m2), underweight people have a BMI under 18.5 (kg/m2), an overweight BMI is between 25 and 29.9 (kg/m2), and obesity is above 30 (kg/m2) (Johansson et al., 2014; Ong et al., 2014). Extensive research is being conducted to determine the effect that a high or low BMI has in regard to risk of fracture. Several studies are in agreement that both a low BMI and a high BMI are detrimental to bone health in women (Compston et al., 2014; Johansson et al., 2014; Ong et al., 2014). In regards to a high BMI in women, specifically within the range of obesity, increased osteoporotic fracture of the ankle, leg, and arm are seen more frequently (Compston et al., 2014; Johansson et al., 2014; Ong et al., 2014). In addition, risk of hip fracture, which is common in women with osteoporosis and a normal BMI, is seen to be of a lower risk to women with a BMI above the normal range (Compston et al., 2014). This being said, women with a low BMI are at a much higher risk of nearly all osteoporotic fracture than are women with a high BMI (Compston et al., 2014, Johansson et al., 2014; Korpelainen, Korpelainen, Heikkinen, Väänänen, &
Keinänen-Kiukaanniemi, 2006). The only exception for women with a low BMI is a lower risk of fracture of the lower leg (Johansson et al., 2014). These findings are significant in many ways. First and foremost, with the rising levels of obesity across the globe, this research can help to bring awareness to the immensely broad scope of the harms of obesity. This knowledge may convince overweight and obese women to make important changes to their body mass index. However, Ong et al. (2014) suggests that women with a high BMI may be treated for osteoporosis less often because many health care practitioners may believe that obesity prevents osteoporotic fracture. This is certainly an area that requires increased awareness among health care practitioners as well as the general population. On the other hand, Korpelainen et al. (2006), focus on the benefits of physical activity for older women with a low BMI. Although the researchers in this study are unable to prove whether or not physical activity preserves bone mass or simply improves the “motor performance, reaction time, balance, muscle strength and coordination” (p. 389) of physically active women, physical activity is proven to reduce the risk of osteoporotic fracture in women with a low BMI (Korpelainen et al., 2006). Beyond what is considered a low BMI, women with the eating disorder Anorexia Nervosa have a BMI so deficient it threatens all aspects of their health, including bone health. Eating disorders such as Anorexia Nervosa have been found to have a profound effect on risk of osteoporotic fracture among women diagnosed with the disease. Anorexia Nervosa is a psychiatric disease most often seen in young women and is distinguished by a body mass index below 17.5 (kg/m2), a lack of regular menstruation, and a distorted view of one’s body (Wong et al., 2004). In addition to previous studies into how a low BMI affects bone health in older women, researchers also study how an extremely insufficient BMI affects young women with Anorexia Nervosa as they age (Mehler, Cleary & Gaudiani, 2011; Wong et al., 2004; Lucas, Melton, Crowson & O’Fallon, 1999). According to Mehler, Cleary and Gaudiani (2011), osteoporosis is identified in nearly 40% of women with Anorexia Nervosa, and osteopenia, a less severe loss of bone mass is present in 92% of patients with Anorexia Nervosa. Consequently, Anorexia Nervosa is a crucial area of research when it comes to risk factors for osteoporosis. Studies show that individuals diagnosed with Anorexia Nervosa have 2.9-times the risk of osteoporotic bone fracture compared to people without the eating disorder, and an even greater risk of hip, spine and forearm fracture as opposed to other fracture sites (Lucas, Melton, Crowson & O’Fallon, 1999). Overall, women with Anorexia Nervosa have a 57% chance of an osteoporotic fracture at some point in their lives (Lucas, Melton, Crowson & O’Fallon, 1999). Another significant finding is that the length of time that women are considered anorexic has a serious effect on bone health; with women ill for a longer period of time showing a greater risk of osteoporotic fracture (Wong et al., 2004). Overall, the best predictor of bone mineral density loss, and therefore an increased risk of fracture, is a BMI under 15 (kg/m2) and six consecutive months of amenorrhea (Mehler, Cleary & Gaudiani, 2011). Such studies have far-reaching implications when it comes to a greater awareness of osteoporosis. Primarily, immediate diagnosis and treatment of Anorexia Nervosa will be important in the future to prevent as much bone mineral density loss as possible. However, researchers are not in agreement about what treatment options are best. Specifically, estrogen replacement therapy is under controversy. In the past, this treatment was used to slow down or prevent osteoporosis in women with Anorexia Nervosa, but researchers are in debate whether or not this treatment actually yields results (Mehler, Cleary & Gaudiani, 2011; Lucas, Melton, Crowson & O’Fallon, 1999). Therefore, more research needs to be done to determine the effectiveness of treatments for Anorexia Nervosa as it pertains to bone mineral density loss and eventual osteoporosis. In addition to the effects of Anorexia Nervosa on bone health, there is also research into the use of vitamin D to prevent osteoporosis. Intake of vitamin D is still surrounded by controversy in terms of its influence on bone health, but continues to be an important area of osteoporosis research. This vitamin is one of several necessary for ample bone development and re-growth (Buchebner et al., 2014). Measured by calcifediol serum levels (25(OH)D) in the blood, vitamin D helps to maintain calcium homeostasis which is widely known to be an important aspect of bone health (Buchebner et al., 2014; Feskanich, Willet & Colditz, 2003). However, although there is extensive research into how calcium levels affect bone health, there is little knowledge about how vitamin D levels alone impact the risk of osteoporosis in women. Therefore, this is a crucial area of research for developing awareness of potential causes of osteoporosis. So far, the evidence suggests that vitamin D is indeed significant in preventing osteoporotic fracture. Buchebner et al. (2014) found that women with a 25(OH)D level above 50 nanomoles per litre (nmol/L) between the ages of 75 and 80 have a 2-fold decrease in their risk of osteoporotic hip fracture in the next five years. The greatest reduction of hip fracture risk caused by osteoporosis was seen in women aged 80 to 90 with a 25(OH)D level above 75 (nmol/). However, a 25(OH)D level above 75 (nmol/L) also increased the level of other, non-hip, osteoporotic fracture. It is important to note that research suggests women see the same bone health benefits when vitamin D is a natural part of their diet or added in supplemental form (Feskanich, Willet & Colditz, 2003). Another important finding is that the consumption of dark fish decreased women’s risk of hip fracture by 33% (Feskanich, Willet & Colditz, 2003). In addition, women with a daily vitamin D intake of 12.5 micrograms (µg) have a considerable increase in spinal bone density after one year (Feskanich, Willet & Colditz, 2003). Research into the affects of vitamin D levels on bone health is significant in several ways. Above all, the research shows that high vitamin D levels are critical to bone health and therefore hypovitaminosis D should be diagnosed and treated as soon as possible to prevent undue osteoporotic damage (Buchebner et al., 2014). In addition, adequate intake of vitamin D should be stressed by health care practitioners, especially to menopausal and postmenopausal women (Aungst & Rainer, 2014). There is certainly an opportunity for more research into vitamins in minerals that are crucial to bone health as more studies continue. Overall, vitamin D levels are an important aspect of bone health for women. As Canada’s population ages, osteoporosis will become a greater concern, especially for women. This will lead to a strain on the medical system and unnecessary pain and suffering for many women. As illustrated, body mass index, Anorexia Nervosa, and vitamin D levels all play a significant role when it comes to bone health in women. Research shows that both a high and low BMI (Compston et al., 2014; Johansson et al., 2014; Ong et al., 2014), Anorexia Nervosa (Mehler, Cleary & Gaudiani, 2011; Lucas, Melton, Crowson & O’Fallon, 1999) and low levels of vitamin D (Buchebner et al., 2014; Feskanich, Willet & Colditz, 2003) all lead to an increased risk of osteoporotic fracture. Reducing the risk of osteoporotic fracture can be accomplished by maintaining a healthy BMI, receiving treatment for eating disorders such as Anorexia Nervosa and increasing one’s vitamin D intake. In terms of future research, there is much to be done. In regards to body mass index, further studies into how physical activity helps to reduce osteoporotic fracture risk in women is necessary. Because of the rising obesity levels in Canada, it will also be imperative to gain a greater understanding of a high BMI on bone health. As previously mentioned, it will be crucial for researchers to come to an agreement on the best treatment options for women with Anorexia Nervosa and how best to prevent osteoporosis for them in the future. Furthermore, there needs to be investigation into the extent of the damage done to the bones of patients with Anorexia Nervosa for an extended period of time. In addition, more research about vitamins and minerals required for good bone health, such as vitamin D, will help to better educate health care practitioners and the general public on ways to prevent osteoporosis. As demonstrated, osteoporosis is a serious health concern facing many women in Canada. This being said, there are several mentioned methods to reducing the risk factors for an osteoporotic fracture. One of the best methods of reduction is education and prevention. Ensuring that young females have adequate nutrition and physical activity may help to cut down on the number of women diagnosed with osteoporosis in the future. While researchers still have a long way to go in discovering alternate ways to reduce the risk factors, there are currently many options for women to lessen their chances of a painful and expensive osteoporotic fracture.
involve the connection between osteoporosis and body mass index (BMI), the effects of the eating disorder Anorexia Nervosa on bone health, and vitamin D levels as they relate to osteoporosis. The studies indicate that both a high and low BMI (Compston et al., 2014; Johansson et al., 2014; Ong et al., 2014), Anorexia Nervosa (Mehler, Cleary & Gaudiani, 2011; Lucas, Melton, Crowson & O’Fallon, 1999) and low levels of vitamin D (Buchebner et al., 2014; Feskanich, Willet & Colditz, 2003) all lead to an increased risk of osteoporotic fracture. Thus, altering these risk factors can lower a woman’s risk of osteoporotic fracture. On the whole, body mass index is one of the key areas related to bone health and osteoporotic risk in women. Body mass index is an important area of consideration when it comes to osteoporotic fracture. The calculation used to determine BMI is weight (kg) divided by height (m) squared (kg/m2) (Compston et al., 2014).
Typically, a healthy BMI is considered to be between 18.5 and 24.9 (kg/m2), underweight people have a BMI under 18.5 (kg/m2), an overweight BMI is between 25 and 29.9 (kg/m2), and obesity is above 30 (kg/m2) (Johansson et al., 2014; Ong et al., 2014). Extensive research is being conducted to determine the effect that a high or low BMI has in regard to risk of fracture. Several studies are in agreement that both a low BMI and a high BMI are detrimental to bone health in women (Compston et al., 2014; Johansson et al., 2014; Ong et al., 2014). In regards to a high BMI in women, specifically within the range of obesity, increased osteoporotic fracture of the ankle, leg, and arm are seen more frequently (Compston et al., 2014; Johansson et al., 2014; Ong et al., 2014). In addition, risk of hip fracture, which is common in women with osteoporosis and a normal BMI, is seen to be of a lower risk to women with a BMI above the normal range (Compston et al., 2014). This being said, women with a low BMI are at a much higher risk of nearly all osteoporotic fracture than are women with a high BMI (Compston et al., 2014, Johansson et al., 2014; Korpelainen, Korpelainen, Heikkinen, Väänänen, &
Keinänen-Kiukaanniemi, 2006). The only exception for women with a low BMI is a lower risk of fracture of the lower leg (Johansson et al., 2014). These findings are significant in many ways. First and foremost, with the rising levels of obesity across the globe, this research can help to bring awareness to the immensely broad scope of the harms of obesity. This knowledge may convince overweight and obese women to make important changes to their body mass index. However, Ong et al. (2014) suggests that women with a high BMI may be treated for osteoporosis less often because many health care practitioners may believe that obesity prevents osteoporotic fracture. This is certainly an area that requires increased awareness among health care practitioners as well as the general population. On the other hand, Korpelainen et al. (2006), focus on the benefits of physical activity for older women with a low BMI. Although the researchers in this study are unable to prove whether or not physical activity preserves bone mass or simply improves the “motor performance, reaction time, balance, muscle strength and coordination” (p. 389) of physically active women, physical activity is proven to reduce the risk of osteoporotic fracture in women with a low BMI (Korpelainen et al., 2006). Beyond what is considered a low BMI, women with the eating disorder Anorexia Nervosa have a BMI so deficient it threatens all aspects of their health, including bone health. Eating disorders such as Anorexia Nervosa have been found to have a profound effect on risk of osteoporotic fracture among women diagnosed with the disease. Anorexia Nervosa is a psychiatric disease most often seen in young women and is distinguished by a body mass index below 17.5 (kg/m2), a lack of regular menstruation, and a distorted view of one’s body (Wong et al., 2004). In addition to previous studies into how a low BMI affects bone health in older women, researchers also study how an extremely insufficient BMI affects young women with Anorexia Nervosa as they age (Mehler, Cleary & Gaudiani, 2011; Wong et al., 2004; Lucas, Melton, Crowson & O’Fallon, 1999). According to Mehler, Cleary and Gaudiani (2011), osteoporosis is identified in nearly 40% of women with Anorexia Nervosa, and osteopenia, a less severe loss of bone mass is present in 92% of patients with Anorexia Nervosa. Consequently, Anorexia Nervosa is a crucial area of research when it comes to risk factors for osteoporosis. Studies show that individuals diagnosed with Anorexia Nervosa have 2.9-times the risk of osteoporotic bone fracture compared to people without the eating disorder, and an even greater risk of hip, spine and forearm fracture as opposed to other fracture sites (Lucas, Melton, Crowson & O’Fallon, 1999). Overall, women with Anorexia Nervosa have a 57% chance of an osteoporotic fracture at some point in their lives (Lucas, Melton, Crowson & O’Fallon, 1999). Another significant finding is that the length of time that women are considered anorexic has a serious effect on bone health; with women ill for a longer period of time showing a greater risk of osteoporotic fracture (Wong et al., 2004). Overall, the best predictor of bone mineral density loss, and therefore an increased risk of fracture, is a BMI under 15 (kg/m2) and six consecutive months of amenorrhea (Mehler, Cleary & Gaudiani, 2011). Such studies have far-reaching implications when it comes to a greater awareness of osteoporosis. Primarily, immediate diagnosis and treatment of Anorexia Nervosa will be important in the future to prevent as much bone mineral density loss as possible. However, researchers are not in agreement about what treatment options are best. Specifically, estrogen replacement therapy is under controversy. In the past, this treatment was used to slow down or prevent osteoporosis in women with Anorexia Nervosa, but researchers are in debate whether or not this treatment actually yields results (Mehler, Cleary & Gaudiani, 2011; Lucas, Melton, Crowson & O’Fallon, 1999). Therefore, more research needs to be done to determine the effectiveness of treatments for Anorexia Nervosa as it pertains to bone mineral density loss and eventual osteoporosis. In addition to the effects of Anorexia Nervosa on bone health, there is also research into the use of vitamin D to prevent osteoporosis. Intake of vitamin D is still surrounded by controversy in terms of its influence on bone health, but continues to be an important area of osteoporosis research. This vitamin is one of several necessary for ample bone development and re-growth (Buchebner et al., 2014). Measured by calcifediol serum levels (25(OH)D) in the blood, vitamin D helps to maintain calcium homeostasis which is widely known to be an important aspect of bone health (Buchebner et al., 2014; Feskanich, Willet & Colditz, 2003). However, although there is extensive research into how calcium levels affect bone health, there is little knowledge about how vitamin D levels alone impact the risk of osteoporosis in women. Therefore, this is a crucial area of research for developing awareness of potential causes of osteoporosis. So far, the evidence suggests that vitamin D is indeed significant in preventing osteoporotic fracture. Buchebner et al. (2014) found that women with a 25(OH)D level above 50 nanomoles per litre (nmol/L) between the ages of 75 and 80 have a 2-fold decrease in their risk of osteoporotic hip fracture in the next five years. The greatest reduction of hip fracture risk caused by osteoporosis was seen in women aged 80 to 90 with a 25(OH)D level above 75 (nmol/). However, a 25(OH)D level above 75 (nmol/L) also increased the level of other, non-hip, osteoporotic fracture. It is important to note that research suggests women see the same bone health benefits when vitamin D is a natural part of their diet or added in supplemental form (Feskanich, Willet & Colditz, 2003). Another important finding is that the consumption of dark fish decreased women’s risk of hip fracture by 33% (Feskanich, Willet & Colditz, 2003). In addition, women with a daily vitamin D intake of 12.5 micrograms (µg) have a considerable increase in spinal bone density after one year (Feskanich, Willet & Colditz, 2003). Research into the affects of vitamin D levels on bone health is significant in several ways. Above all, the research shows that high vitamin D levels are critical to bone health and therefore hypovitaminosis D should be diagnosed and treated as soon as possible to prevent undue osteoporotic damage (Buchebner et al., 2014). In addition, adequate intake of vitamin D should be stressed by health care practitioners, especially to menopausal and postmenopausal women (Aungst & Rainer, 2014). There is certainly an opportunity for more research into vitamins in minerals that are crucial to bone health as more studies continue. Overall, vitamin D levels are an important aspect of bone health for women. As Canada’s population ages, osteoporosis will become a greater concern, especially for women. This will lead to a strain on the medical system and unnecessary pain and suffering for many women. As illustrated, body mass index, Anorexia Nervosa, and vitamin D levels all play a significant role when it comes to bone health in women. Research shows that both a high and low BMI (Compston et al., 2014; Johansson et al., 2014; Ong et al., 2014), Anorexia Nervosa (Mehler, Cleary & Gaudiani, 2011; Lucas, Melton, Crowson & O’Fallon, 1999) and low levels of vitamin D (Buchebner et al., 2014; Feskanich, Willet & Colditz, 2003) all lead to an increased risk of osteoporotic fracture. Reducing the risk of osteoporotic fracture can be accomplished by maintaining a healthy BMI, receiving treatment for eating disorders such as Anorexia Nervosa and increasing one’s vitamin D intake. In terms of future research, there is much to be done. In regards to body mass index, further studies into how physical activity helps to reduce osteoporotic fracture risk in women is necessary. Because of the rising obesity levels in Canada, it will also be imperative to gain a greater understanding of a high BMI on bone health. As previously mentioned, it will be crucial for researchers to come to an agreement on the best treatment options for women with Anorexia Nervosa and how best to prevent osteoporosis for them in the future. Furthermore, there needs to be investigation into the extent of the damage done to the bones of patients with Anorexia Nervosa for an extended period of time. In addition, more research about vitamins and minerals required for good bone health, such as vitamin D, will help to better educate health care practitioners and the general public on ways to prevent osteoporosis. As demonstrated, osteoporosis is a serious health concern facing many women in Canada. This being said, there are several mentioned methods to reducing the risk factors for an osteoporotic fracture. One of the best methods of reduction is education and prevention. Ensuring that young females have adequate nutrition and physical activity may help to cut down on the number of women diagnosed with osteoporosis in the future. While researchers still have a long way to go in discovering alternate ways to reduce the risk factors, there are currently many options for women to lessen their chances of a painful and expensive osteoporotic fracture.