The Pathology of Osteoporosis

Osteoporosis Scenario Mrs. Bones is sixty-five years old and seeing patients expeditiously in her clinic. She turns a corner and runs straight into a desk which knocks her to the ground. She fractures her hip, requires surgery, and is later informed she has osteoporosis. Mrs. Bones is perplexed as she never experienced symptoms that would cause her concern over bone health. This was a real-life scenario that occurred within my clinical practice environment. Bone Health Information Mrs. Bones should be informed that osteoporosis is a skeletal disorder characterized by the reduction of bone mass or tissue which weakens the integrity of the bone. This loss of bone strength and integrity increases her potential for broken or fractured bones (Domino, Baldor, Golding, & Stephens, 2017). Osteoporosis is not typically identified by symptoms and may go undetected (American College of Rheumatology, 2017). However, back pain is a usual complaint for patients living with osteoporosis; this results from fractures and/or compensatory changes in body mechanics (Catalano et al., 2017). The Impact of Aging Mrs. Bones should be informed that age is a factor that has increased her risk for bone mass loss. Her body cells ability to communicate and regenerate have changed over time. Mrs. Bones should be educated as cells age the function of her osteoblasts and osteoclasts can become impaired. Osteoblasts are responsible for generating new bone and osteoclasts secrete enzymes that aid in the degradation of bone (International Osteoporosis Foundation, 2017). In normal healthy cells, cytokines support equilibrium between the relationship of osteoblasts and osteoclasts. Cytokine functions include regulating relationships amongst hormones like estrogen and prostaglandins (Catalano et al., 2017). “Factors that may be most important for aging include increased damage to the cell, reduced capacity to divide (replicative senescence), reduced ability to repair damaged DNA, and increased likelihood of defective protein balance or homeostasis” (Huether & McCance, 2017). Mrs. Bones’ age at sixty-five leads us to believe she is past menopause. Estrogen is decreased in post-menopausal women and is identified as a hormone essential to balancing musculoskeletal health. Osteoblasts have estrogen receptors on their cell bodies; and a decrease in estrogen limits the stimulation of hormone access into the cells that support bone health and replication (International Osteoporosis Foundation, 2017). As a result, women greater than sixty years of age are more vulnerable than men to be diagnosed with Osteoporosis (Domino et al., 2017). Mrs. Bones will require evaluation and intervention of her diagnosis of Osteoporosis to prevent future fractures and prevent further bone mass loss (American College of Rheumatology, 2017). The Pathology of Osteoporosis The pathology of bone mirrors a cyclical process in which homeostasis is present. This balance occurs through the process of breaking down aged bone, as previously described, by the osteoclasts. Healthy bone replaces the dissolved bone by way of osteoblasts. Also, osteocytes are observed cells that exist to repair injured bone. In youthful cells, a patient should have this homeostasis present within their bones. However, as cells age dysfunction can exist where the osteoclasts continue to resorb bone and osteoblasts are unable to keep up. The osteoblasts’ signals may be inhibited for various reasons limiting bone replication. Osteocytes which help in bone repair and mineral production tend to die off and decline with age. Research suggests that mitochondrial and DNA alterations may influence the development of osteoporosis as patients age (Manolagas, Rosen, & Mulder, 2018). Cellular influences related to osteoporosis are still being investigated. These include considerations for (receptor activation of NFkB) RANK and RANK ligand and how messages develop and exist between bone cells to produce action. It is hypothesized that RANKL alters the behaviors between the osteoclast and osteoblast during the aging process (International Osteoporosis Foundation, 2017). Finally, calcium shares a relationship with bone health. Calcium is released into the body as osteoclasts adhere themselves to bone. The aging patient will require good supplementation of calcium along with vitamin D to support adequate bone health and compensate for such loss. The risks for developing osteoporosis should be assessed in all patients age sixty-five years or older (American College of Rheumatology, 2017).

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