To catch the `bone thief'
What should one do to have healthy bones? Some tips on the eve of World Osteoporosis Day tomorrow.
OSTEOPOROSIS, the most common of all bone diseases, is a global health problem. It is increasing at an alarming rate because of the aging of our population. Oct 20 is "World Osteoporosis Day" and to increase awareness, Dr. USHA SRIRAM tries to answer the frequently asked questions on this issue.
What is Osteoporosis?
It is a disease that makes bones thin and break easily ([fractures). It is more common in women, the elderly and in certain medical conditions
How serious is this problem?
The problem can be quite disabling. Millions of people all over the world have osteoporosis and millions of fractures occur each year due to osteoporosis. An even larger number have Osteopenia , which means that the bones have become weak and they are on their way becoming frankly osteoporotic.
Does this problem exist in India?
Indian men and women seem to be more prone to this problem and we sustain fractures about 10-20 years earlier than our western counterparts. This is probably due to our genetic makeup and poor calcium and vitamin D intake (inspite of plenty of sunshine, our dark skin doesn't absorb vitamin D well and our lifestyle nowadays doesn't allow us to be in the sun as much as we need to be). One out of two women suffer from osteoporosis beyond the age of 50 and one out of four have lifetime risk of fractures.
What are the risks for osteoporosis?
Female, age above 50, thin body build, Asian or white race, early menopause (before 45 years) inactive lifestyle, smoking, alcohol (more than 200 ml a week), mother's history of osteoporosis or fractures, personal history of fracture as an adult, low calcium intake, low vitamin D intake, poor sun exposure, medical conditions like Diabetes mellitus, overactive thyroid and the use of certain medications like steroids (used for arthritis or asthma), anti-epilepsy medications and thyroxine (in excess), cyclosporine and Heparin.
Why do we lose bone?
Bone is constantly being remodelled. Our body replaces old bone with new and this is a lifelong process. There are special cells that chew the bone and others to replace the cavity with new bone! When we are young our bones grow in length and in strength. We reach our maximum strength by our early twenties. From the mid 30's we slowly start to lose bone. As we get older, our body makes less bone-friendly hormones. Our bones become unduly thin if anything interferes with bones reaching their maximum strength or if bones are being chewed up more or if new bone is put back less efficiently.
How will I know if I am becoming osteoporotic?
That is the real problem. This thief works quietly and makes a big noise only when something breaks! The first sign of osteoporosis is usually a fracture. We can look out for tell tale signs like loss of height, bending of the back but by then it is too late. The best way to know is to look for risk factors and do screening tests called BMD measurement.
What is BMD?
Bone mineral density is a simple way of knowing how strong or thin our spine and hipbones are. We use a computerised x-ray technique called Dual Energy X-ray Absorptiometry (DEXA). With this technique we can tell if a person is normal, has osteopenia or has osteoporosis. There are other techniques using ultrasound and CT but the DEXA is now the standard tool for BMD.
How can I improve my bone density?
First, make sure that you get adequate calcium and vitamin D in your diet and through sun exposure (dairy products, green leafy vegetables, pulses, grains are good sources of calcium). Second, keep yourself physically active. It's important to do weight bearing exercise (walking, jogging, cycling) for at least 30 minutes three to four times a week. Avoid cigarettes and drink in moderation.
Keep your weight as close to ideal body weight by eating a nutritious diet. Avoid drinking too much coffee and beverages containing caffeine.
If you have medical problems requiring medications, talk to your doctor about your bone health. If your menstrual cycles are irregular or if they have stopped too early (before 45years) consult your physician.
Can medicines actually make my thin bones strong again?
We have a whole variety of medicines that can either stop bones being chewed or actually help new bone formation. We give calcium and vitamin D to everyone because women after menopause need 1,500 mg of calcium. We very rarely get this amount from our diet. We can now monitor our treatment using DEXA and if necessary blood tests called "Bone markers".
What can I do to prevent fractures?
Make sure that you don't do anything that could make you fall. Don't run, climb on ladders and step stools and walk on slippery or unfamiliar surfaces. Keep your home well lit, use hand rails, ensure good visibility and use support systems if you coordination or vision is poor. Some frail elderly do well with padding of hip. But don't let this stop you from regular exercise!
What about men and children?
They are as important and probably as prone to this menace as women. Children need plenty of calcium containing foods, exposure to the sun, physical activity and good nutrition in the growing years. Good strong bones when we are young are like money in the bank. We can draw only from what we have. Men need to adopt the same strategies for optimum bone health.
How can I help the community have better bone health?
Spread the word to eat healthy food, drink milk, get some sunshine, be active, know your bone density if you are at risk and get help from experts on bone health. Bone Appetit!
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