Free Report On Osteoporosis

Report/ Case Study

Osteoporosis is the gradual loss of bone mineral mass that occurs due to various factors. In post-menopausal women, the cause is the decrease in the production of sex steroids, mainly the hormone oestrogen. The condition is long-term problem and can only be managed conservatively. Other factors that may cause osteoporosis include a decrease in calcium intake, lack of vitamin D or some medications. The paper tries to scrutinize the osteoporosis in post-menopausal women and compare the efficacies of the intervention therapy choices available (Ganong and Kim 35).

Hormone Replacement Therapy

Hormone Replacement Therapy is a medical intervention mechanism intended to replace any deficiencies in hormone levels in a person due to a pathological condition. Oestrogen (a sex steroid) is a hormone in women that is crucial to bone growth that is essential in preventing osteoclastic activity (bone loss) in the body. Osteoblasts are cells that lay down new bone, and they destroy old bone. Oestrogen promotes bone growth by preventing the release of substances called cytokines and growth factors (IL-1, IL-6, and Tnf-alpha) into the blood stream. These substances mediate bone resorption and hence encourages loss of bone mineral mass and density. Oestrogen also promotes the secretion of Transforming Growth Factor-Beta (TGF-Beta) that also decreases bone resorption by causing the destruction of osteoblast. The hormone is available in physiologically adequate amounts in pre-menopausal women but starts to decline after menopause. This is because of a decrease in the functions of the ovary that produces it (Hall 21).

Consequences and Benefits of Oestrogen Therapy

Oestrogen therapy is beneficial to an individual but deserves weighing on a risk-benefit scale. Long-term therapy with oestrogen predisposes females to acquisition of cancers. These include uterine and breast cancers. Ovarian cancer is also rising as an effect of oestrogen therapy in post-menopausal women. Also, oestrogen therapy increases the risk of cardiovascular diseases. For instance, there is also increased risk of development of blood clots that may cause heart attacks and stroke. Also, a woman on HRT is likely to develop gallstones and increase in blood pressure. The clinician probably recognised that the oestrogen was causing more harm to the woman than benefits in light of the above reasons and decided to discontinue the therapy (van Schoor 35).

Vitamin D

Vitamin D is critical in bone development throughout life. Its primary role is to increase the absorption of dietary calcium from the intestine into the body. The vitamin is provided naturally via sunlight exposure and gets absorbed through the skin into the blood. Body systems convert it to its active metabolite, called 25-hydroxycholecalciferol that is the active ingredient in aiding the calcium absorption into the body (Hall 23). Calcium makes up the mineral component of bone that increases its tensile strength and mineral mass.Osteoporosis is the process of gradual loss of bone mineral mass and density causing weakening of bones. Thus, vitamin D is essential for increasing bone mineral mass by facilitating calcium absorptions that delay the osteoporotic process. The Vitamin D metabolite also facilitates Calcium reabsorption, increases the synthetic activity of osteoblast and is necessary for the normal calcification of bone matrix (Hall 24).
Boniva is the trade name of a drug whose chemical name is Ibandronic acid and belongs to a group of drugs called bisphosphonates. It functions by altering the cycle of bone formation and breakdown in the human body. Thus, it slows bone loss while increasing its mass that prevents bone fractures. It isan alternative option for the treatment of osteoporosis in women after menopause. Its mechanism of action lies in the fact that it has a high affinity for hydroxyapatite that is a component of the mineral matrix of the bone. Boniva inhibits osteoplastic activity and reduces bone resorption and turnover. In women past menopause, it helps reduce the rate of bone turnover causing an average net gain in bone mass.

Treatment of Osteoporosis

Protests is also a recent modern option of treatment of osteoporosis in postmenopausal women. It is indicated especially in reducing the risk of vertebrae and hip fractures. Protelos is a better option for treatment of osteoporosis than Boniva owing to several factors. Protelos is the only one of all antiosteoporotic agents that has a proven long-term efficacy against hip, vertebral and non-vertebral fractures (Ganong and Kim 41). Additionally, Protelos is effective for a wider patient profile than Boniva.Protelos action is rapid commencing as soon as one year and can go on for three years at both vertebral and non-vertebral site. Since osteoporosis is a chronic disease, treatments need to maintain a long-term efficacy and safety. There is no evidence currently showing that Boniva can decrease fracture after three years of treatment (van Schoor 34). Other controversial data suggests a possible association between prolonged bisphosphonate uses with atypical femoral fractures. On the other hand, data from TROPOS and SOTI studies on protests prove its efficacy and safety at vertebral and other sites over a ten-year follow-up period. The reason for the long-term efficacy lies in its mechanism of action. Boniva decreases not only bone resorption but also affects bone formation in the process. Consequently, bone remodelling stops leading to an increased risk of atypical fractures.Protelos act by increasing osteoblast replication, differentiation and activity. It also reduces osteoclastic differentiation and activity. The result is that the bone grows stronger able to withstand stronger impacts.

Treating Osteoporotic Postmenopausal

Clinicians need to decide on the treatment of osteoporotic postmenopausal women only after an analysis of the benefits and risks. The treatment needs to stop immediately in case of any negative effects on the patients. As stated above, currently Protelos provides the most efficient medical intervention therapy among other anti-osteoporotic medicines. A recent study from Range and Doherty compared the different treatments needed to treat (NNT) in order to avoid one fracture. The results showed that protests have a low NNT with only 9 patients requiring treatment over 3 years to avoid 1 vertebral fracture while it was 21 for Boniva. For Protelos, 48 patients needed treatment for hip fracture in comparison with 91 for Boniva, risedronate or zoledronate. The data affirm protelos position as the first-line treatment. However, since Protelos is relatively new, the data may be erroneous as it only takes into account a ten years duration. There is a need to get data over a longer period to ascertain its efficacy (Cairoli, E., et al. 1408). To guard against the probability of these errors, there is a need for more scientific research in medical laboratories. 

Works Cited

Cairoli, E., et al. "Factors associated with bisphosphonate treatment failure in postmenopausal women with primary osteoporosis." Osteoporosis International 25.4 (2014): 1401-1410.
Ganong, William F., and Kim E. Barrett. Review of medical physiology. Vol. 21. ^ eNew York New York: McGraw-Hill Medical, 2012.
Hall, John E. Guyton and Hall textbook of medical physiology. Elsevier Health Sciences, 2010.
van Schoor, Jacky. "Boniva®: the new quarterly intravenous osteoporosis treatment." SA Pharmaceutical Journal 81.9 (2014): 34-35.