Osteoporosis:

Marissa, Jeremy and Eleanor

Azrina, G. Felias, Kenneth, Levanya,
Nurulfitri, Siti Zulimas
 Overview
“ I've always been told that calcium is important for strong, healthy bones.
My mom says that as long as I drink milk, I won't develop osteoporosis. Is
this correct? Is there anything else I can do to protect myself? “
Section A - Marissa:
Bone physiology, risk factors, and
signs and symptoms
Marissa
A petite, Caucasian, 15-year-old, learned her 55-year-old grandmother, was
diagnosed with osteoporosis after visiting her doctor for chronic hip and wrist pain.

In the past year, Marisa's life has been a tragedy. Her parents were killed in a
car crash on the way home from their 16th anniversary surprise party. Her
boyfriend of two years moved to another state and ended the relationship.
She also failed algebra and didn’t make the soccer team in her freshmen.

Marisa's grandmother lives far from where she used to, and since she is an
only child, she often finds herself feeling lonely and near depression. She
can only count on her best friend, Tara, whom she told about her
grandmother's disease after she found out. Marisa doesn't know
osteoporosis or what it does to the body. All she knows is that her
grandmother is the only close living relative she has and she can't fathom
losing another loved one.
 Bone Physiology
Describe bone physiology and the bone remodeling cycle. Be sure to emphasize the
two types of bone tissue and the roles of osteoblasts and osteoclasts.
 Light and
porous
Found in
epiphysis
Made of
trabeculae

Dense bone

Form diaphysis

Made of osteon
 Bone Remodeling

Osteoclast Osteoblast
Secrete acid and Synthesis of
enzymes for uncalcified matrix
dissolution of mineral (osteoid) & deposition
and matrix release of hydroxyapatite
crystal
 Bone Physiology
Explain the relationship between calcium and bones

Explain how the body controls calcium levels in the bones and blood. Be sure to
describe the roles of parathyroid hormone (PTH) and calcitonin in detail.
 Bone Physiology
Explain specifically how osteoporosis affects the bone matrix and the normal bone
remodeling cycle
 OSTEOPOROSIS

The risk of osteoporosis increases when the rate of bone

resorption exceeds the rate of formation during the
process of bone remodelling.
Age-related alteration in bone mass.
Age-related alteration in bone mass.
 HOW OSTEOPOROSIS AFFECT BONE MATRIX

1. Osteoporosis is the effect of osteoclasts breaking down bones faster

than the osteoblasts can make them.
2. In the normal bone remodeling cycle, osteoblasts form new bone by
secreting collagen matrix and calcium salts.
3. Then the osteoblasts calcify, change structures and become osteocytes.
4. Osteocytes maintain the level of calcium in the bones until they are
broken down by osteoclasts to be reabsorbed.
5. The constant breaking down and rebuilding of the osteoblasts and
osteoclasts are responsible for the maintenance of healthy bones.
6. An imbalance in this process will lead to brittle bones or osteoporosis
 Risk Factors
Discuss what scientists know about the genetics behind osteoporosis

Genetic Predisposition plays a major role in Osteoporosis:

● Bone mass
● Bone turnover rate
○ Total volume of bone that is both resorbed and formed over a period of
time
Bone turnover occurs mainly through bone remodelling
○ Bone remodeling:
Active process throughout the skeleton, essential for calcium homeostasis and preserving
the integrity of the skeleton, through the coupled activity of osteoclasts and osteoblasts
 Risk Factors
List as many risk factors for this disease as you can, both controllable and
uncontrollable
 Sign and Symptom
What are the symptoms or telltale signs of osteoporosis?

Early signs : presence of osteopenia

Osteoporosis Diagnostic Signs:
Osteoporosis Symptoms: -> High levels of serum calcium
-> High levels of alkaline phosphatase
-> Fragility fracture (most common)
-> Bone Density test showing T =-2.5
-> Loss of height -> Vitamin D deficiency

-> Posture change

-> Joint pains

Recommendation for
Marissa’s Grandmother
● Fulfill the recommended daily intake of Calcium (1200
mg/day) and Vit D (600 IU/day)
● Low phosphorus diet
● Moderate intensity exercise (walking, gardening, golf)
● Muscle strength training (stairs, dancing, groceries)
● Do balance training with physical therapist, Tai Chi or Yoga
classes
● Use hip protectors to reduce risk of fracture
● Bend knees while lifting & avoid awkward bending
 Pharmacological therapy

Targets Targets
preosteoblasts, osteoclasts or
osteoblasts and osteoclast
lining cells precursor
Section B - Jeremy:
Nutrition, exercises, and drugs
A lanky, 19-year-old college sophomore, recently become interested in Jeremy
weightlifting. He wants to improve his physique, strength, self-esteem, and
impress his girlfriend. He has been taking asthma medication since 7 and
hopes the exercise will improve his condition that slightly worsened over the
years.

In high school, Jeremy was teased for being scrawny. And in college, he
wanted to put the past behind him. He discovered alcohol and drank heavily
to have a belly to show for it.

In summer, he met Sebastian at his job where he noticed Sebastian’s muscle

and asked if he lifted weights. The two became friends and gym buddies, and
Sebastian recommended a PT for Jeremy.

Jeremy returned in fall in better shape and promised to cut down drinking. His
PT told him that he had small bones for a guy and alcohol would aggravate
the problem. He suggested to follow his lead and start taking steroids to bulk
up. Jeremy wondered what he meant and intended to ask his biology
professor
 Nutrition and Osteoporosis
Why calcium is vital to bone health?
Calcium is an essential substance to the body which composed the bone and teeth.
99% of calcium amount are used to keep the bone and teeth, and the rest of it are
used for cell signalling, blood clotting, muscle contraction, and nerve function.
 Asthma Medication, Steroid, and Calcium
● Anti -inflammatory medication (i.e. glucocorticoids) will decrease the calcium
absorption rate in the body. Thus, increase the calcium uptake from bone and
decrease the bone density
○ Eat high vitamin D and calcium amount diets
○ Exercise
○ life-style → drink less alcohol, less caffeine and less sodium
 Nutrition and Osteoporosis
What foods are good sources of calcium?
 Nutrition and Osteoporosis
The importance of Vitamin D to calcium absorption
Vitamin D deficiency

Calcitriol deficiency

Inhibit the calcium absorption from foods in intestines

The body will take the calcium from bone which lead to bone weakening
 Nutrition and Osteoporosis
Calcium supplementation and recommended daily dosage
Types of Calcium Supplementation
● Calcium carbonate (40 percent
elemental calcium)
● Calcium citrate (21 percent elemental
calcium)
● Calcium gluconate (9 percent elemental
calcium)
● Calcium lactate (13 percent elemental
calcium)
 Calcium Dosage
Men (year old) Daily RDA Daily Upper Limit

19-50 1000 mg 2500 mg

50-71 1000 mg 2000 mg

71 and older 1200 mg 2000 mg

Women (year old) Daily RDA Daily Upper Limit

19-50 1000 mg 2500 mg

50 and older 1200 mg 2000 mg

 Excessive Calcium Consumption
1. Constipation
2. Inhibit zinc and iron absorption
3. Lead to kidney stone formation
 Nutrition and Osteoporosis
Effects of sodium, caffeine, and alcohol on calcium levels in the
body
● Sodium
○ The increase of sodium consumption will result in the increasing of calcium
excretion
○ It affects the reabsorption process in kidney
○ Can be compensated by PTH
● Caffeine
○ Interfering with calcium absorption
○ Can be prevented by consuming coffee-milk
● Alcohol
○ It prevents the calcium absorption by affecting pancreas and liver
○ Activates bone-damaging hormone → cortisol and parathyroid hormone
 Exercise, Drugs, and Osteoporosis
Explain what peak bone mass is and its relationship to osteoporosis
If you have more peak bone mass, you will have higher starting t-score before your hormonal balance starts to decline with age.
Because of that, your t-score has more leeway i.e has to lower more before you will reach the osteoporotic levels
 Exercise, Drugs, and Osteoporosis
Describe the types of exercise that help prevent osteoporosis, why?
Any and all exercise should help prevent osteoporosis; but exercises that strains the legs, hips, arms, and waists especially helps. This
is because most fragility fractures tend to occur at those bones. Walking, running, weightlifting, swimming
 Exercise, Drugs, and Osteoporosis
What are steroids? What are they use for?
Steroids are hormonal drugs used to reduce inflammations
https://patient.info/health/preventing-steroid-induced-osteoporosis
 Exercise, Drugs, and Osteoporosis
Explain how long-term use of steroids may increase risk for osteoporosis
Corticosteroid tend to reduce the actions of bone forming cells (osteoblasts) and increase the activity of bone destroying cells
(osteoclasts)
https://www.ncbi.nlm.nih.gov/pubmed/8941496
Section C - Eleanor:
Estrogen, HRT and other treatments
Eleanor
45-year-old perimenopausal woman, considering hormone replacement therapy (HRT)
to prevent osteoporosis. Lately experienced severe hot flashes, nausea, on and off sore
back. Had smoked for the past 20 years and has a family history of breast cancer and
heart disease.

Two years ago, her mother underwent double mastectomy for breast cancer. The
experience stops her from smoking, drinking, and to start living healthier. Every
morning she walks around the park with her dog and her husband.

Considering HRT as she doesn't want to risk her bone health like her 58-year-old
neighbor, Janice, who refused her doctor's advice to take HRT and now walks with a
cane. She wants to stay healthy for her husband and 25-year-old son, Chad, but is
unsure of the consequences of HRT. She's heard that it might have some bad effects.
 Estrogen
Define "perimenopausal”
-answer-

per·i·men·o·pau·sal
/ˌperəˌmenəˈpôzəl/
“Time around menopause, when the body undergo natural
transition to menopause.”
Also known as: menopausal transition
 Estrogen
Explain how menopause affects a woman's hormonal levels.
-answer-

Estrogen Progesterone

Stimulates growth of breast Prepares lining of the uterus

tissue, Maintains vaginal for a fertilized egg and helps
blood flow and lubrication, maintain early pregnancy
Causes lining of the uterus
Normal Function to thicken during the
menstrual cycle, Keeps
vaginal lining elastic,
preserving bone

Low production of Production of

Effect of Menopause estrogen progesterone are
stopped
 Estrogen
Explain how estrogen affects calcium levels in bones.
-answer-

● Cause closure of epiphyseal plate → blocking further long bone growth

● protect adult skeleton from resorption
● enhance the reabsorption of Ca2+ by kidney and increase the production of 1,25-DHC

● may reduce PTH release and prevent hypercalcemia

 Estrogen
Explain how smoking affects estrogen levels. How does this in turn affect
calcium levels?
-answer-

Toxin from cigarette disturb the hormone imbalance by stimulating the production of
estrogen-destroying enzyme

Estrogen level decreased

Calcium level decreased

What is HRT?

Usually intended for those who...

the Pro:

the Con:
 Medicines that helps to treat and prevent
osteoporosis...
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