Osteoporosis and CF

The term “ osteoporosis ” originated in the Greek language: “ osteoporosis ” – bone, and “ porosity ” – perforated. Osteoporosis is a disease of the entire skeleton, characterized by low bone mass and loss of bone tissue. This condition can lead to an increase in bone fracture, and an increase in the risk of fractures. The process of osteoporosis is a quiet process, which takes place over time with no early signs. During this quiet period, processes of bone loss can occur, even up to about 30%, without us being aware of it.

The next stage is where the fractures appear, especially in the spine, thighs, and ribs vertebrae. Bone is a hard, living, and growing tissue and is a reservoir for minerals and nutrients and a place for the production of blood cells. The bone comprises a network of connective tissue fibers (collagen), protein, and minerals such as calcium and phosphorus, which give the bone its strength. There are cells called osteoblasts, which are bone-building cells, and there are cells called osteoclasts – cells that break down bone tissue. Throughout life, natural processes of building and breaking down bone tissue continuously occur. Metabolism depends on the supply of proteins, vitamins, and minerals from the food we eat. Osteoporosis develops when bone destruction processes occur rapidly and significantly more than its production and construction processes. Bone disease in CF patients (C.FBD) was first described in 1979. Decreased bone density and increased incidence of fractures are described in the literature as complications of CF disease. CF patients, who suffer from osteoporosis and undergo daily physiotherapy in the chest area, may suffer from rib crises, which will lead to their inability to properly expel, and a significant decrease in lung function.
Osteoporosis can be easily diagnosed and treated if awareness and alertness to the phenomenon.
Reasons for Decreased Bone Density in Cystic Fibrosis Patients

Nutritional Deficiencies
Nutritional deficiencies caused by the following: Pancreatic insufficiency that exists in 85% of CF patients, and causes a deficiency in the secretion of pancreatic enzymes and bicarbonate, a condition which is not always completely corrected by Giving enzymes to the pancreas.
Negative energy balance – Lung disease causes loss of appetite, especially during inflammation, and an increase in energy expenditure due to the inflammatory process. And in vitamin D, which is necessary for bone building.
Under-absorption of vitamins – fat-soluble, including vitamin D, and vitamin K, which are important for bone building.

Steroid use
Prolonged use of oral or intravenous steroids causes a decrease in bone mass due to the imbalance between construction and the destruction of bone mass, in favor of the factors responsible for the release of bone tissue.

Lack of Exercise
Exercise improves bone density. In situations of inactivity, bone density decreases. The activity should be weight-bearing, thus stimulating the building cells and adding mass to the bone.

Cytokines are substances secreted by the body’s immune system in response to an inflammatory process. In CF disease, high levels of cytokines are secreted, which upset the balance between building and destroying bone mass in favor of responsible factors Unload bone tissue.

Late puberty
It is known that the sexual development of CF patients is delayed compared to other children their age.
The low levels of sex hormones in CF patients are linked to osteoporotic mechanisms, through cytokine involvement. <. These factors increase the risk of pathological fractures, humpbacks and structural changes in the spine.

The most effective way to deal with the disease is to prevent it by early detection and treatment, a bone density test is a test that is not dangerous and does not involve pain or discomfort. The test can diagnose the disease already in its stages. The early ones allow monitoring of the effect of the treatment and predict the risk of developing a fracture on an osteoporotic background. The recommendation is to be tested once a year from 10.
The device is based on X-ray radiation at a very low intensity, so the test can also be performed during pregnancy. The bone density obtained in the test is compared to the normal mean value for age, thus determining the need for treatment. The test lasts about 20 minutes, during which the patient lies on the bed, while the device scans the lumbar vertebrae, forearm, and pelvic bones and measures bone density.
The World Health Organization WHO has defined criteria for the severity of the disease:
between 0 and (1-) standard deviation = normal condition
between (1-) and (2.5-) standard deviation = poor bone density With a slight increase in the risk of developing a fracture (osteopenia). Nutrition
Calcium is the major mineral in bone tissue, accounting for about two-thirds of its weight. When bone mass reaches a peak, and bone strength is determined, adequate calcium intake should be maintained from an early age until the mid-twenties. After this age, one should continue to retire.

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