Bibliography
Osteoporosis
Osteoporosis is a disease which can affect both men and postmenopausal women. The characteristic deleterious aspect of osteoporosis is a decrease in the quantity (mass) of bone mineral. That is to say that the bone present is of good quality, there just is not enough of it present.
There are two types of osteoporosis. Type I osteoporosis affects women about 10-20 years after menopause (ages 50 - 70 years). Type II osteoporosis can affect both men and women and starts at about the end of the seventh decade.
Current treatments for this condition can include calcium and vitamin D supplementation, hormone replacement therapy (HRT), and salmon calcitonin nasal spray. These treatments , however, are geared more toward slowing down the disease than early prevention.
Early prevention of this disease must be attacked in the adolescent years before peak bone mineral density (BMD) is reached (between the ages of 18-25 years). True prevention of this disease must begin with proper diet and exercise early on that must be maintained throughout life. The bad news is, if you are old enough to read this and haven't already started your prevention regimen it is getting too late. The good news is that this disease may be preventable, especially for our daughters and grand daughters.
In childhood primary prevention of osteoporosis is based on exercise and adequate intake of calcium. Osteoporosis has long been considered a disease of the elderly, however, there is now a general agreement that predisposition begins in childhood and adolescence. Thus rational approaches to prevention of this disease should be started during childhood and adolescence.(1) Efforts to prevent osteoporosis in later life by maximizing peak BMD during adolescence and young adulthood must be directed at identifying young people who are at risk...pediatricians must keep in mind the axion: osteoporosis...the only cure is prevention.(2) If BMD is found to be low, efforts to enhance bone formation must be encouraged. In women undergoing menopause, HRT administered for at least ten years remains the preventive treatment of choice.(3)
Of primary importance in prevention of the fractures associated with osteoporosis is increasing the skeletal mass and size. Peak bone mass is a major determinant of the risk of osteoporosis, and the second decade is the critical period of peak BMD acquisition: thus providers of health care for adolescents need to understand the factors that affect bone mineralization during this period and advise patients accordingly.(4) Optimum skeletal mass can be attained if the nutrient supply of calcium is ample, but the age-dependent decrease in skeletal mass that begins in the third decade can not be arrested by adequate calcium intake alone.(5)
Another factor that must also be considered is exercise. As we exercise the stresses the muscle places on the bone help to remodel the bone in order to support the added stresses placed on it. High intensity strength training exercises are an effective and feasible means of improving muscle mass, strength, balance and BMD.(6)
It is of utmost importance that this exercise be continued throughout ones life time. That is to say that adequate life long exercise is of great importance. In athletes who have retired from competitional training the bone formation does not differ from that of the more sedentary populations.(7) It is of further importance that the exercise attempted be of weight bearing nature. While aerobic exercise does wonders for our cardiovascular and respiratory systems, it is of little real benefit to the skeletal muscles which will help to remodel the bones of the legs and arms to increase their BMD. In one study it was found that "the absolute value of muscle strength training correlates significantly with BMD, muscle strength of the upper limb appeared to be more closely correlated with bone mass while muscle strength in the lower limb was more specific for femoral (hip) BMD. The most important finding that these results demonstrated was a concomitant decline in muscle strength of the upper limb and BMD between the fifth and sixth decades". In contrast, they also showed "a decline in muscle strength of the lower limbs after the sixth decade, occurring before the decline in BMD observed between the seventh and eighth decades".(8) Although loss of bone and of muscle strength develop together overtime, remodeling imbalance appears to emerge much earlier than loss of muscle strength.(9)
As stated earlier, the main treatment for osteoporosis consists of HRT, calcium supplementation and calcitonin nasal spray, but this appears to be mostly too little too late for the osteoporosis patient. Some evidence currently suggests that "lumbar spine and proximal femur BMD were significantly increased in response to exercise and HRT... The combination of exercise plus HRT resulted in increased BMD at all sites except the wrist, with effects being additive for the lumbar spine and Ward's triangle and suggestive for the total body".(10) Therefore one must conclude that the best treatment to prevent deleterious effects of osteoporosis must consist of multiple therapies aimed at slowing down the progress as well as early prevention (prior to the age of twenty years). Early prevention must include proper nutrition, supplementation and weight bearing exercise that last a lifetime.
So how can Chiropractic help you? Your Chiropractor can help you
and your daughter by helping you with a diet plan; nutrition;
supplementation of calcium and vitamin D and recommendation of other
essential vitamins and minerals. Your Chiropractor can also recommend
and encourage beneficial exercise programs that will help in increasing
your BMD at an age early enough to offset the negative aspects of aging.
Your Chiropractor will also be able to monitor your's and your child's
general physical conditioning throughout your lives.
*NOTE*
Excess calcium intake can cause soft tissue calcification, depressed reflexes, anorexia, memory impairment, muscle weakness, headache, hypertension, cardiac and respiratory failure.
Excess intake of vitamin D can cause anorexia, diarrhea, increased serum (blood) calcium, renal failure, headaches, and constipation.
Excess intake of either calcium and/or vitamin D can cause polydipsia
(excess thirst) and polyuria (excess urination), both conditions which
may mimmic diabetes mellitus.
It is NOT recommended that you take any supplementation without being monitored by your physician for toxic side effects.
Bibliography
1. Osteoporosis as a Pediatric Problem; Carrie Fassler AL;
Bonjour JP; Pediatr Clin North Am, 42:4, 1995 Aug,811-24.
2. Bone Mineral Density in Adolescence; Kreepe RE; Pediatr Ann,
24:6, 1995 Jun, 308-15.
3. Prevention and Treatment of Osteoporosis; Chaupy MC; Meunier PJ;
Aging (Milano), 7:4, 1995 Aug, 164-73.
4. Bone Mineralization, Hypothalamic Amenorrhea, and Sex Steroid Therapy in Women Adolescents and Young Adults; Hergenroeder
AC; J Pediatr, 126: 5 Pt 1, 1995 May, 683-9.
5. Calcium and Osteoporosis; Bronner F; Am J Clin Nutr, 60:6, 1994 Dec, 831-6.
6. Effects of High-Intensity Strength Training on Multiple Risk
Factors for Osteoporotic Fractures. A Randomized Controlled Trial;
Nelson ME: Fiatarone MA; Morganti CM; Trice J; Greenburg RA; Evans
WJ; JAMA, 272-24, 1994 Dec 28; 1909-14.
7. Indications of Bone Formation in Weight Lifters; Karlson MK; Vergnaud P; Delmas PD; Obrant KJ; Calcif Tissue Int, 56:3, 1995 Mar, 177-80.
8. Cross-sectional Study of Muscle Strength and Bone Mineral
Density in a Population of 106 women between the Ages of 44 and 87
Years: Relationship with Age and Menopause; Calnels P; Vico L;
Alexander C; Minaire P; Eur J Appl Physiol, 70-2, 1995, 180-6.
9. The Relationship of Age-Related Decreases in Muscle Mass and
Strength in Skeletal Status; Marcus R; J Gerontal A Biol Sci Med Sci,
50 Spec No: 1995 Nov, 86-7.
10. Additive Effects of Weight-Bearing Exercise and Estrogen on
Bone Mineral Density in Older Women; Kohrt WM; Snead DB;
Slatopolsky E; Birge SJ Jr; J Bone Miner Res, 10:9, 1995 Sep, 1303-11.
Other suggested reading
Osteoporosis: Making the Diagnosis in Patients at Risk for Fracture;
Gamble CL; Geriatrics, 50:7,1995 Jul, 24-6, 29-30, 33.
Osteoporosis. Clinical Features, Prevention and Treatment; Gambert SR;
Schultz BM; Hamdy RC; Endocrinol Metab Clin North Am, 24:2, 1995 Jun, 317-71.
Menopause and Hormone Replacement Therapy; An Overview; Hammond CB;
Obstet Gynecol, 87:2, Suppl, 1996 Feb, 2S-15S.
Osteoporosis and the Role of Diet; Eaton-Evans J; Br J Biomed Sci, 51:4,
1994 Dec, 358-70.
Exercise Considerations for Postmenopausal Women With Osteoporosis;
Allen SH; Arthritis Care Res, 7:4, 1994 Dec, 205-14.
Management and Prevention of Osteoporosis; Williams P; Fletcher C; Prof Nurse, 10:4, 1995 Jan 233-6.
Age-Related Osteoporosis; Edwards BJ; Perry HM 3rd; Clin Geriatr Med,
10:4, 1994 Nov, 575-88.
Older Women's Health: Clinical Care in the Postmenopausal Years. A
Roundtable Discussion Part 2 [Clinical Conference]; Butler RN; Collins
KS; Meier DS; Muller CT; Pinn VW; Geriatrics, 50:6, 1995 Jun, 33-6, 39-41.
Treatment Options for Osteoporosis; Khosla S; Riggs BL; Mayo Clin Proc,
70:10, 1995 Oct, 978-82.
Primary Care for Women. Comprehensive Assessment of Common
Musculoskeletal Disorders; Maldonado A; Barger M; J Nurse Midwifery,
40:2, 1995 Mar-Apr, 202-15.
* Note: this list represents only a few of the journal articles that can be found concerning osteoporosis on Health Gate-Free-Medline.
