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The importance of Bone Density

Bones | September 23, 2020 | Author: Naturopath

age related

The importance of Bone Density

Often the first indicator your bone density could be poor is when you suffer from a broken bone. Porous bones, with no internal strength, can easily snap and this may happen from a simple action such as a sneeze or coughing. Poor bone density can commonly be due to inadequate calcium intake, low vitamin D levels, insufficient exercise, certain medication, health disorders and genetics, but there is also a connection to the gut microbiome, the immune system and cellular senescence. 

Bone density evaluation

Bone density tests, as the name implies, tests for the density of bone. A bone density machine can scan the body, usually the hip and spine, and access how porous bone is. A scan takes around 10 -15 minutes and can be performed through clothing. The lower the bone density the greater the risk of breakage.

Bone density evaluationA bone density scan can indicate –

  • Normal bone density
  • Low bone density (osteopenia)  – fracture risk is low – medium. Bone density will need to be monitored
  • Osteoporosis is low bone density and poses a high risk of bone fracture. This condition needs to be monitored and usually requires medication

The word osteoporosis actually means porous bones and is a disease of reduced density and quality of bone.

Osteoporosis often has no symptoms until fractures occur - which can be as simple as a small bump or slight fall. Osteoporosis most often occurs in older people, but it can also happen to younger folk. People with risk factors who are over the age of 50 should be assessed for osteoporosis. The sooner the diagnosis the sooner bone management can be put in place to help prevent future fractures.

Risk Factors for osteoporosis

Osteoporosis is influenced by lifestyle factors often experienced in earlier life, with the resulting porous bone issues appearing in the later years. These include:

  • Smoking
  • Excess alcohol
  • Poor dietary choices

It is a multifactorial disease with a complex interplay of genetics, intrinsic, external and life style factors involved. These include:

  • Being Female -females are four times more likely than males to become osteoporotic. This is usually due to hormonal influences such as pregnancy, menopause and hormonal imbalances.
  • Aging - poor bone quality. The skeleton of the body is made of bone. It provides support, shape and protection for soft tissue and internal organs. Bone is continuously remodelling throughout life – old and damaged bone is reabsorbed and replaced by new bone. As we age this process of removal and rebuilding can become disturbed resulting in thinner and more fragile bones. Instability and balance in the elderly can also be a factor in more frequent in fracture occurances in the elderly.
  • Previous fracture
  • Family history - genetics
  • Low vitamin and mineral intake - vitamin D and calcium particulary, but other mineral can be involved such as magnesium.
  • Inactivity - sendentary lifestyle. Exercise strengthens bones and muscles.
  • Low body weight
  • Chronic illnesses - Rheumatoid arthritis, diabetes mellitus, hyperthyroidism, gastrointestinal disease, chronic liver or kidney disease, chronic obstructive pulmonary disease (COPD), epilepsy, systemic lupus erythematosus (SLE), HIV
  • Organ transplantation
  • Medication - steroid anti-inflammatory medication used for skin conditions, inflammatory bowel disease and musculoskeletal conditions, can result in secondary causes of osteoporosis.

​Bone and immune system interactionsBone and immune system interactions

A new field of study, osteoimmunology, has established a link between bone metabolism and the immune system. This involves cells responsible for bone reabsorption, osteoclasts, and immune cells. 

Osteclasts can be regarded as a prototype of an osteoimmune cell due to a shared common precursor cells with cells of the immune system - monocytes, macrophages, and (myeloid) dendritic cells. Inflammatory diseases such as rheumatoid arthritis, which result in bone destruction, are believed to be linked to this pathway.

Bone and the gut microbiome

Another new area of research connects the influence of the gut microflora and bone metabolism. It is recognised that the entire microorganisms living in the intestinal tract play a major role in the development and balance of the digestive system – this includes how nutrients are produced and absorbed; immunity and growth. Many diseases (diabetes, rheumatoid arthritis etc.) have been linked to changes in the gut microbiome and there is evidence which links the gut microbiome and bone homeostasis. Modulation of the gut microbiome can be achieved by the use of probiotics and antibiotics.

Cellular senescence

Cellular senescence is an essential mechanism by which cells remain metabolically active whist ceasing to divide. These cells have a series of features that characterize them. Whilst they are not able to divide anymore, they are larger than normal cells; they express and secrete certain molecules that normal cells only secrete in small amounts or not at all. Studies are focused on the mechanism of senescence and its relationship to age-related bone loss.

Treatment strategies

Goal of osteoporosis therapy is to reduce the risk of fractures and bone loss, pain reduction and the prevention of disability. Treatment strategies involve smoking and alcohol cessation, ensuring adequate vitamin D, and ensuring diet is rich in protein and calcium. In the elderly fall prevention is paramount – correcting vision and hearing issues, muscle and balance training and wearing supportive footwear.

Pharmaceutical medications have a variety of actions some of which includes:

  • Inhibiting bone reabsorption  by preventing osteoclast apoptosis (death of the cells involved in resorption of aged or damaged bone)
  • Stimulation of osteoblasts resulting in bone formation
  • Increasing oestrogen levels – inhibition of bone reabsorption
  • Antibody therapy – inhibit bone reabsorption

The role of Calcium

The role of calcium as a remedy or in preventing osteoporosis is to prevent bone reabsorption. Calcium has an endocrine feedback system with vitamin D and PTH (parathyroid hormone). When there is adequate calcium in the intestine, there is no need to draw it from the bone.
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Calcium​Hydroxyapatite is a naturally occurring form a calcium apatite consisting of calcium, phosphorus and oxygen and is the main structure of bone and tooth enamel. Hydroxyapatite may be obtained from marine algae, coral and bovine sources or be synthetically derived and is used for bone repair and regeneration. It is used as a coating on orthopedic or dental implants and in the efficient delivery of bone-specific drugs for the treatment of skeletal related disorders such as osteoarthritis, osteomyelitis and osteoporosis. Hydroxyapatite microcrystals can be found in supplement form to be taken orally as to accelerate fracture repair and prevent osteoporosis.

Vitamin D - modulates calcium metabolism with the effect of inhibiting bone reabsorption.
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Exercise – especially weight-bearing activity to improve muscle strength, balance and posture.

Diet should include calcium-rich foods, mineral-dense foods and foods high in protein. These include: soy, dairy, sardines and salmon with bones, leafy green vegetables, beans, almonds and seeds. 
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Digestion. Address any digestive health issues and support digestiion with plenty of fibre, fruit and vegetables and probiotic foods and/or supplements. 
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References

https://www.osteoporosis.org.au/diagnosis

https://www.sciencedirect.com/topics/chemical-engineering/hydroxyapatite

Nanohydroxyapatite Application to Osteoporosis Management https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3830883/

Development of Bone Targeting Drugs https://pubmed.ncbi.nlm.nih.gov/28644392/

https://www.garvan.org.au/research/diseases/osteoporosis/?gclid=EAIaIQobChMI6rXNs4Pv6wIVAVZgCh3c1gdsEAAYAyAAEgLJrfD_BwE

Osteoporosis: Pathophysiology and therapeutic options https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7415937/

https://biologydictionary.net/cellular-senescence/

The role of gut microbiota in bone homeostasis https://pubmed.ncbi.nlm.nih.gov/32169602/

Regulation of apoptosis in osteoclasts and osteoblastic cells https://www.sciencedirect.com/science/article/abs/pii/S0006291X04026464

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