Clinical Challenges in Managing Osteoporosis - Essay Example

Clinical challenges in managing Osteoporosis Background and significance Overview of the Osteoporosis Osteoporosis is a metabolic multifactorial bone disorder that causes a decrease and deterioration of bone mass in men and women (Lau & Gau, 2011). According to the National Osteoporosis Society, low bone mass (osteopenia) and osteoporosis are among the major health problems among women at lower incidence above the age of 50 in the United States. It is similarly reported in men, though at lower incidence and level of severity. Specifically, the US National Osteoporosis Foundation (NOF) reports that 10 million people could be suffering from osteoporosis in the US, and 5.3 million of these are women who are aged over 50 years Overview of the natural progression of Osteoporosis Osteogenesis refers to the formation of bones and it begins during the prenatal stage and continues into adulthood. It, in women as well as in men, identifies with Osteoporosis that is a factors of both bone formation and none loss as it reduces the net loss. Notably, osteogenesis occurs through endochondrial and intramembranous ossifications. In both cases, existing cartilages are replaced and the two cells which play a crucial role during osteogenesis are osteoblasts and osteoclasts. Osteoblasts are found in the bone tissue where they help to deposit calcium into collagen. Osteoclasts dissolve calcium previously deposited in the women’s bones and carry it away into other tissues. Fractures, followed by bone fracture, are the primary clinical manifestation of Osteoporosis. Osteoporosis is identified with a density loss that is “higher than 2.5 standard deviations” (O’Connor and Perkins, 2011, p. 18). According to Ringe (2006), the disease consists of weakening of the vertebrae of the spine and can cause them to collapse. Osteopenia/osteoporosis generally occurs in women who are aged 50 or more (Kanis et al., 2005). Osteoporosis can be diagnosed by a bone density test before a bone breaks. On the other hand, osteopenia refers to bone density that is lower than the required peak bone mass density. Peak bone mass density is a bone condition of maximum density and strength. Osteoporosis is diagnosed using dual energy x-ray absorption scan that entails passing of low energy x-ray through bone, and the values obtained are compared to existing recommended values. Osteopenia is diagnosed using x-ray absorptiometry that detects very low bone loss, as low as 2 percent loss per year (Kanis et al., 2005). Hip fracture occurs when the upper segment of the femur bone breaks. The key risk factors for the disease in women include old age, body size (small and thin women), family history, consumption of excessive alcohol and smoking. Other key risk factors include lack of exercises, lack of calcium and vitamin D and sex hormone deficiencies (Lau & Gau, 2011). For instance, when women reach menopause, their ovaries stop secreting estrogen, therefore the rate of bone resorption increases. This increase in resorption also increases the risk of bones to fracture, even with minimal trauma. Osteopenia, also a condition of bone loss, is less severe than osteoporosis and its density loss ranges from “1 to 2.5 standard deviations” (O’Connor and Perkins, 2011, p. 18). Initial onset of osteopenia is reported between women’s 60th to 65th years (2004). Osteoporosis occurs when there is an inequality between bone development and bone resorption (Magaziner, 2007). Thus, osteoporosis occurs when osteoclasts carry away calcium found in bone into other tissues. Loss of calcium in bones leads to imbalance between the growth of new bone and the failure of old bone resulting to osteoporosis. The disease therefore, develops when there is a superior weakening of bone tissue and a substantial reduction in bone mineral density, resulting to more delicateness and amplified chances of fractures (Gruntmanis, 2007). Prevention and treatment of osteoporosis has been identified as a genuine concern with the aging society. Even though there have been widespread bone density screening and efficacious therapies for patients, still, there are numerous challenges that occur in clinical practice. Specifically, there is lack of guidance on appropriate management of low bone density. Therefore, the most important gap that has been identified is lack of knowledge on when to initiate pharmacologic therapy in the management of osteoporosis. Even though a number of studies have been conducted to determine the appropriate time to initiate osteoporotic therapy, these studies have not provided conclusive results (Kanis et al., 2005). It has been suggested that absolute factors such as family history, prior fracture, age, bone mass density values derived from bone mass density procedures could be used to decide on the treatment that should be offered to Osteoporosis patients (Kanis et al., 2005). Bone mineral density is just one of the factors that independently determine fracture risk. According to Sornay-Rendu et al (2005), history of fracture and age also predisposes an individual to the disease. Kanis et al (2002) report that fracture risk is seven times higher in older postmenopausal women suffering from osteoporosis. Even though osteoporotic therapies have increased considerably, cases of osteoporosis continue to be reported in the US because the society lacks the capacity to treat all cases of postmenopausal osteoporosis in Women (Kanis et al., 2005). There is need to use treatments which are target specific in order to minimize unnecessary treatments, side effects, and increased costs in high risk individuals. World Health Organization recommends the use of X-ray absorptiometry (DXA) in diagnosing osteoporosis (Kanis et al., 2005). DXA measures bone mineral density using the T-scores2 which are the standard deviations recorded below or above the recommended bone density. Stuart (n.d) records that T-scores between -1 to -2.5 could be considered low BMD while T-scores of -2.5 or lower are considered osteoporosis. The high prevalence rate of Osteoporosis therefore identifies it as a significant problem in the society. Its scope that involves bone fracture and the subsequent adverse effects therefore calls for adequate management approach. While its diagnosis criteria and technologies, as well as treatment exist, the best time for initiating a pharmacologic therapy has not been empirically determined. This identifies the problem of time to begin therapy that this research seeks to explore. Research Question When is the best time to initiate pharmacologic therapy in the management of low bone density in women? Objectives The objectives of this study will be: To determine when to initiate pharmacologic therapy in order to enhance the management of low bone density. To explain how to manage a patient receiving low bone density therapy. To highlight the causes of treatment failure, and the management during osteoporosis management. Reasons for conducting the research The research is significant because its results will offers a basis, through accurate timing of initiating treatment, for managing the problem of Osteoporosis among both men and women in the society. Its results that will identify the appropriate time for initiating therapy will therefore facilitate wellbeing, especially among older women who are more susceptible to the complication. Importance of the research The research is important because its findings promise solution to the problem of managing Osteoporosis. Identification of the right time for initiating treatment will for example facilitate effective management of the disease by preventing adverse cases. It will also facilitate economic application of available resources by offering the resources to those whose conditions need attention. Study Design This randomized controlled design study will be conducted to determine when osteoporitic therapy should be initiated. Hypotheses Null Hypotheses Osteopenia therapy should be initiated when the test scores of BMD X-ray absorptiometry reading is between -1 to -2.5 and Osteoporosis therapy should be initiated when the test scores of BMD X-ray absorptiometry reading is -2.5 or lower in the elderly women. Alternative Hypotheses Osteopenia therapy should not be initiated when the test scores of BMD X-ray absorptiometry reading is between -1 to -2.5 and Osteoporosis therapy should not be initiated when the test scores of BMD X-ray absorptiometry reading is -2.5 or lower in the elderly women. Variables of Interest Readings of the BMD X-ray absorptiometry machines will be the dependent variable while the independent variable will be considered in research family history including age, alcohol use, smoking history, secondary osteoporosis, femoral neck bone mass index, and history of hip fracture from parents. References Bouxsein, M., L. (2005). Determinants of skeletal fragility. Best Pract Res Clin Rheumatol., 19:897–911. Felsenberg, D. & Boonen, S. (2005). The bone quality framework: determinants of bone strength and their interrelationships, and implications for osteoporosis management. Clin Ther., 27:1–11. Hulley, (2007), The Anatomy and Physiology of Clinical Research. Designing Clinical Research. 3rd ed. Lippincott Williams & Wilkins, Philadelphia PA. Kanis, J., A, et al. (2002). A new approach to the development of assessment guidelines for osteoporosis. Osteoporos Int., 13:527–36 Kanis J., A, et al. (2005). Assessment of fracture risk. Osteoporosis Int., 16:581–9 Lau, R. & Guo, X. (2011). A Review on Current Osteoporosis Research: With Special Focus on Disuse Bone Loss. Journal of Osteoporosis, doi:10.4061/2011/293808. O’Connor, C. and Perkins, S. (2011). Osteoporosis for dummies. Hoboken, NJ: John Wiley & Sons. Sornay-Rendu, E. et al. (2005). Identification of osteopenic women at high risk of fracture: the OFELY study. J Bone Miner Res., 20:1813–19. Stuart, L., S. (n.d). Identifying Patients at Risk for Osteoporotic Fracture: FRAX and the New NOF Guidelines. Retrieved on February 15, 2013< http://www.menopausemgmt.com/issues/18-03/mman_coverStory_042309.pdf Vondracek, S., F. et al. (2008). Clinical Challenges in the Management of Osteoporosis. 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