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Osteoporosis: Prevention
and Treatment Mechanisms
Salima Hassam
April 4th 2015

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Osteoporosis

Osteoporosis is a disease characterized by low bone

mass and deterioration of bone tissue.

Decrease in bone stress and density, bones become

porous

Leads to increased bone fragility and risk of fracture,

The most common sites of osteoporotic fracture are the

wrist, spine, shoulder and hip.

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Characteristics of Bone

Collagen

Calcium-phosphate mineral complexes

protein that gives bones a flexible framework

make bones hard and strong

Bone Cells

Osteoblasts: produce collagen fibers on which calcium salts

are deposited

Osteoclasts: break down bone, convert calcium salts to

soluble form

Osteocytes: maintains bone

cortical bone = more dense, less porous

Trabecular bone = less dense, more porous

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Remodelling Cycle

(1) bone resorption (breakdown or removal)

During resorption osteoclasts on the bone's surface dissolve bone tissue and
create small cavities

(2) bone formation.

During formation, other cells (osteoblasts) fill the cavities with new bone
tissue.

bone resorption and bone formation take place in close sequence and
remain balanced.

imbalance in the bone remodeling cycle occurs with menopause and

with aging in both genders, and it can occur with other conditions.

imbalance can result in bone loss that eventually leads to osteoporosis

(Francis, 2002)

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Porosity and Bone Strength

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Bone density testing:
A

DXA test measures bone mineral density and compares it to

that of an established norm or standard to give a score (T score)

+1

and 1 is considered normal or healthy.

and 2.5 indicates low bone mass

2.5 or lower indicates osteoporosis.

score :

BMD

is compared to that of a typical individual with a matched

age
.

Not used as often to diagnose

Useful

in indicating if there is an underlying disease or

condition

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Bone Development and
Maturation

Peak bone mass developed during childhood and

adolescence and rate at which bone is lost during aging
process are major contributing factors to risk of OP

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Skeletal Physiology Utah (1995)

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Loss of bone mass over age

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Bone Adaptation: Disuse

Bone resorption increases dramtically with disuse (loitzramage & zernicke 1996)

Remodelling of bone post immobilization is not as rapid or

complete as amount of bone loss

Animal studies show after 3 weeks of immobilization,

bones lost 12% of bone mass, but only regained between
38-62% of that back with exercise

space flight demonstrates significant loss of trabecular

bone in weight bearing joints. (doty2004; oganov, 2004).

Degree of recovery is related to duration of immobilization

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Bones and Physical Activity

Bones require mechanical stress to grow and

strengthen
Loading increased Deposition Increased Density
Loading is both external loads (gravity)and muscle
forces
Physical activity helps maintain bone health

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Wolfs Law

Governs bone re-modeling (growth and breakdown)

Changes in the function of a bone will result in changes in

architecture

Bone gets stronger in the direction of loading

Bone will breakdown (re-sorb) when loading is too low

Bones are both

Anisotropic Response depends on direction of load application

Viscoelastic Response depends on rate and duration of loading

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Quantity vs Quality of Bone
(Biewener, 1986)

Weight bearing exercise increases bone mass

Is more better?

Animal study

Exercised on treadmill

Bone mass and length increased

Strains remained the same

Adaptation of bone: Optimal

Mechanical Stress

cortical bone responses shown to be

highest when:

strain rate and magnitude are high

but within tolerance limits

loads are cyclic, and temporally

separated

gender and genetic influence

(Schoenau,2002)

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Strenuous Exercise - Human

relationship between running volume and bone mineral

mass in runners

15-20 miles > BMC than the controls (5-10 miles

p/week)

>20 miles per week showed no change in BMC

60-75 miles per week had lower BMC than controls

(MacDougall, 1985)

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Strenuous Exercise Animal

Young (3 week) roosters exposed to moderately intense

treadmill running

5-9 weeks

compared to sedentary age matched controls

Compared structural and mechanical properties of

tarsometatarsus bones

Significant decrease in bending stiffness and energy to

fracture with treatment group

(Matsuda, 1986)

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Gravitational Forces or muscle
Loading

What Impacts Bone Adaptation Better?

computer model has shown introducing muscle loading

forces during gait have been shown to positively
influence bone growth (Beck,2009)

Muscle (concentric, eccentric contraction) and Forces

from gravity are dynamically changing during exercise

Separating the contributions of both forces not possible

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Whole body vibration and Bone
Loss Prevention Strategy?

Effects of whole body vibration or vibration plus

resistance exercise on BMD in young women

16 weeks (Control, V, V +R)

-V + V+R significant increase in BMD at the femoral

neck

Strategy to achieve peak bone mass and stave off

osteoporosis later in life

(Humphries,2009)

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Vibration treatment and Post
menopausal bone loss

Low intensity vibration in ovariectomized rats

50Hz, 2G, 30 min/day, 5days/week

Vibration prevented bone loss, but did not build bone

(Flieger, 1997)

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Calcium and Vitamin D

calcium supplements are unnecessary unless it is not consumed enough

from dietary sources (dairy, fruits vegetables)

Excess calcium will not be absorbed.

Calcium is absorbed best when taken in amounts of 500 600 mg or less.

Vitamin D is necessary to absorb calcium

Vitamin D sources include sunlight and some fish sources

Vitamin D supplements are taken more commonly than vitamin C

Prolonged supplementation of Ca and vitamin D in elderly has been

shown to prevent bone loss, and in some intervention studies to prevent
fragility fractures.

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Dietary Patterns and BMD

Cross sectional study in post menopausal women with

osteoporosis

sweet foods, coffee and tea was inversely correlated with

BMD (femur and TB) for the overall sample. (7% diet sugar)

Excessive consumption of sweet foods and caffeine exerts a

negative effect on BMD.

These Foods > inflammation, negative impact on bone

quality

high amounts of fruit and vegetables have shown a positive

relationship with skeletal health.

(Franca, 2015)

Possible Mechanism Negative effect of

Glucose Intake on BMD
high sucrose diet
hyperinsulinemia
can lead to the inhibit of renal tubular resorption of
calcium
affect bone quality mineralization

(Franca,2015)

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Biophosphates

class of drugs reduce bone loss

enhance bone density (QUANTITY)

reduce fracture incidence in post menopausal women

(Wells,2008)

prolonged use (>4 years)

> risk of atypical fracture

-subtrochanteric
-transverse
-proximal 1/3

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Biophosphates - Mechanism

Bisphosphonates inhibit osteoclastic bone

resorption

act on mature osteoclasts by inhibiting their

attachment to the bone surface

inhibit growth of osteoclast precursor cells

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Weight Bearing Exercises

weight bearing activity is working against the force of gravity

low levels of impact associated with non-weight-bearing activities appear to

negatively influence bone formation and thus bone density.

high strain rates are more effective at inducing new bone formation and
enhancing BMD at weight-bearing sites.

athletes involved in weight bearing activities have an increased bone mineral

density compared to general population and swimmers who train in non weight
bearing environment (Layne, 1999)

repetitive stress applied to weight bearing sites act as a strengthening agent for
bones. Findings suggest that weight bearing exercises may be more beneficial
than swimming. (Layne, 1999)

High-impact exercises that load improve skeletal integrity, muscular

performance, and dynamic balance in premenopausal women. If done regularly,
this type of exercise may help decrease the risk of osteoporotic fractures in later
life. (MacKelvie, 2002)

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Overall Conclusions

Focus should be on building bone mass at a young age

via proper calcium and vitamin D intake, weight
bearing exercise, a healthy diet (< sugar) and possible
vibration methods

Focus should be on decreasing the rate of bone loss,

post menopause for women, and post 35 -45 for men.

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References
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postmenopausal bone loss in ovariectomized rats. Calcif Tissue Inc. 1998 Dec;63(6):510-4.
Francis RM, Tuck SP. Osteoperosis. Post Graduate Medical Journal. (2002): 526-532
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effect of high-impact exercise on selected risk factors for osteoporotic fractures. The Lancet. Volume 348, p1343
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