INTRO: Brittle Bones

Lena T -

Hello! Welcome to my first blog post!

I’m Lena, a first-generation student, from BASIS Prescott currently working on a research survey on Osteoporosis. I plan to become a Nurse Practitioner and open my own practice in the future. My curiosity for Osteoporosis stems from my internship at AZ Neurosurgery and Spine. I have been interning at the clinic since June of 2023 and have been entrusted to send referrals for Osteoporosis patients.

You may ask what is Osteoporosis? It is when the bones become weak and brittle that even mild stresses such as bending over, or sneezing can cause life-threatening fractures. The condition affects elderly patients and there are no symptoms that come with the disease which in turn gives it its nickname the ‘silent-disease.’ Osteoporosis occurs when the creation of new bone does not keep up with the loss of the old bone.

Is the disease curable? Unfortunately, the answer is no. There are treatments for the condition to maintain bone density and even bone growth but it comes with side effects.

My research survey will look at lifestyle factors that lead to the risk of decreasing bone density. Osteoporosis is most common in women and found to occur in areas like the cervical, lumbar, and wrists. The problem is that 80% of patients are not diagnosed with this condition and go untreated until a fracture happens. This is a threat to Prescott as the majority of the population are elderly adults. In addition, I hope I will be able to shadow providers to observe the treatment process for patients with the condition to deep dive into what elderly patients have to go through for bone growth and the social side of the medication process.

Senior Project Proposal

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    Toby Chang
    Interested to see what correlations you find between lifestyle habits and osteoporosis. What aspects of the "social side" of osteoporosis medication do you hope to touch on? Excited to see where your project goes!
    Are you going to look into how this disease is more prevalent in women? What about looking at care gaps and previous medical history of a patient? Are they part of an underrepresented community?
    Hey Toby! I love this question!! Many patients are afraid of the side effects that comes with Osteoporosis treatments such as increased risk of cancer, infections in the inner lining of the heart, kidney complications, and much more. They would much rather live at the risk of another life-threatening fracture. Treatment for the condition is expensive, especially if the patient is retired and may not have the budget to afford thousand-dollar injections. Without the treatment, there is a great risk for fractures to occur that can reduce one's mobility which leads to a limitation to everyday activities. Surgeries to repair fractures are also expensive. I plan to touch on about how patients weigh the pros and cons of receiving treatment and how I can play a role on educating patients on the condition. In addition, I also would like to understand how Osteoporosis may have impacted one's life/ family members/ close friends.
    Hello Sofia! Yes Yes Yes, breastfeeding and menopause contribute to major bone density loss in women. I will be surveying female patients to investigate if they had breastfed in the past and the frequency. I will also be asking for consent to collect past bone density reports so I can analyze them as well! I do not quite understand your last question, but I will try my best to answer it. Osteoporosis is underrepresented in public health. This condition occurs in both men and women, however, there are no symptoms leading up until a fracture pops up. As for race, I believe Asians and Whites have a higher risk compared to African Americans. However, I will be surveying the local Northern Arizona area which narrows my demographics, and I may not be able to reach a desired number of surveyees as I would like to represent each race. I plan to research during my college career, and I hope to expand my research beyond the local Northern Arizona area.
    This sounds great. I'm really interested to see what the data looks like for our specific area. I wonder how fast you will be able to recruit patients. I'm curious how people will respond - if they want to participate or is they are hesitant to participate. We'll just have to wait and see.
    Yajaira G
    How interesting!! What do some of the treatments consist of? How often are treatments administered? Do you know why breastfeeding and menopause contribute to bone density loss?
    It is interesting how your project can be so helpful to your community due to their age. I wonder what the side effects are to the different types of treatments, and how the treatments differ.
    Hi Nathan! Awesome question! Through my research I have found that there are various treatments for Osteoporosis, and they can be taken orally or through injections. The usual first choice for Osteoporosis treatment is Bisphosphonates which are pills taken weekly/monthly or through an IV infusion. Bisphosphonate can cause an upset stomach, heartburn, and mild flu-like symptoms. They have to take a drug holiday from bisphosphonates due to increased risk of developing femoral fracture or Osteonecrosis. It has to be taken on an empty stomach and for an hour they cannot lie down, bend over, eat, or drink. Patients who cannot take bisphosphonate due to reduced kidney function or hypocalcemia (low blood calcium), have the option to take denosumab (Prolia) which are delivered through injections. Side effects from denosumab can be infections in the skin, abdomen, bladder, ear, inner lining of the heart. Delaying or skipping Prolia can increase the risk of broken bones. Another side effect of denosumab is Osteonecrosis which is when the bone tissue in the jaw deteriorates due to lack of blood supply. Estrogen paired with progestin is used to treat women at high risk of fractures who cannot take any other Osteoporosis drugs but can increase the risk of blood clots, endometrial cancer, breast cancer, and heart disease. Raloxifene is another hormonal treatment for Osteoporosis; it mimics estrogen and may cause hot flashes and increases the risk of breast cancer and blood clots. There are also bone building drugs to treat the silent disease such as Forteo, Tymlos, Evenity. Forteo and Tymlos are daily injections and can increase the risk of bone cancer. Evenity is relatively a newer drug and not much is known about the long-term side effects. What is known about the drug is that there may be increased risk of stroke, heart attack, cardiovascular death, kidney problems, osteonecrosis, insomnia, joint pain, and headaches. It is common to combine drugs to treat Osteoporosis such as Evenity and Priola by increasing bone growth and stabilizing the bone mass at a constant healthy amount. Besides medication, patients are also advised to exercise, practice good nutrition with calcium and vitamin D in their diet such as yogurt, leafy greens, citrus fruit, no smoking, and limiting overconsumption of alcohol.
    Hello Yajaira!! Treatments for Osteoporosis can be taken orally or through injections or IV infusions. It depends on the treatment and the mixture of treatments. Some pills can be taken weekly/ monthly. Some injections/ IV infusions would be monthly or every 6 months. Through my research, female's hormones drastically drop during menopause leading to bone degradation. During the breastfeeding phase, if the baby requires Calcium, they will take it from the mother leaving the mother depleted of it.

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