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Bare bones

Tuesday, October 23, 2018

Osteoporosis is often referred to as the ‘silent epidemic’ since there are no symptoms until the first fracture occurs.  This is why it is important to maintain strong bones, orthopedists tell Ronita Torcato

Up close in a high resolution image, the innards of a weak and brittle bone resemble dead coral or a sea sponge. The poor bone has become porous and fragile—the specific term used to describe its pathetic condition is osteoporosis which means ‘porous bone’.  Osteoporosis is a disorder which reduces bone density and quality, thereby increasing the risk of fractures especially in the spine, hip, and wrists.  It is one of the most common and debilitating chronic disorders.  Age and gender are the principal risk factors for this bone condition—the risk is highest for menopausal women. Bone mass begins to reduce after the age of 30 in both men and women. Hormonal changes make menopausal women more prone to osteoporosis.

World Osteoporosis Day was observed last week (October 20), an initiative first started in 2012 to create awareness about the

disease and improve prevention. Closer home, the  Indian Orthopedic Association (est.1955)  has been arranging public awareness programs about bone health and  osteoporosis.

Musculoskeletal pain, a stooped back, and fractures after a minor fall are signs of poor bone health and a major cause of long-term disability as anyone who has suffered from a slipped disc or even a "crick" in the neck knows.  Across the world, one in three women and one in five men aged 50 plus will fracture a limb.  India alone has more than 10 million cases each year.

Osteoporosis can also affect younger people though it is more common in senior citizens.  Falls can also be fatal. According to the World Health Organization (WHO), falls are the second leading cause of accidental injury deaths around the world. People over age 65 have the greatest number of fatal falls globally.

Yet, despite effective medical advances, very few people receive treatment. Less than 10% of older women with fractures actually receive osteoporosis therapy. Like cancer, osteoporosis  is an insidious affliction, dubbed by doctors as the ‘silent epidemic’ since bone loss occurs quietly and gradually—there are virtually no symptoms until the first fracture occurs, usually after a simple stumble or ankle twist.   Which is why regular bone density tests are important.

Long-term use of steroids,

certain chemotherapy drugs, some anti-diabetes and anti-epilepsy medications and other drugs to treat various ailments can lead to bone loss and osteoporosis. Also, certain other illnesses like thyroid, rheumatoid arthritis, inflammatory bowel diseases and  celiac diseases increase the risk of developing osteoporosis. Heredity is another important determinant of heightened risk.

The good news is that a healthy lifestyle  can play an important  role in helping to build and maintain strong bones and  delay the loss of bone mass density and hence fractures. Key to this are adequate amounts of calcium and vitamin D in one’s diet.

Dairy produce is a good source of calcium and can help prevent osteoporosis. Fortified foods, saltwater fish, liver and red meat provide vitamin D. Equally important is exercise—yoga and Pilates are among the best exercises to strengthen joints and bones.

Dr Dipti Patel, Consultant Rheumatologist, Wockhardt Hospital Mumbai Central says “building bone mass when young is a good investment for the future. Inadequate calcium during growth can contribute to the development of osteoporosis later in life.  The requirement for calcium daily increases with age or in cases when you have other medical illnesses and hence cannot completely rely on dietary sources.   Although calcium can’t prevent gradual bone loss after menopause, it continues to play an essential role in maintaining skeletal health. Even if you’ve gone through menopause or already have osteoporosis, increasing your intake of calcium and vitamin D can decrease your risk of fractures.  A program of moderate, regular exercise (three to four times a week) is effective for the prevention and management of osteoporosis. Weight-bearing exercises such as walking, jogging, hiking, climbing stairs, dancing, treadmill exercises, and weight lifting are probably best.  As is a  healthy balanced diet, healthy weight, non-smoking and stopping excess consumption of alcohol.”

Dr Naresh Shivdasani,  an  Orthopedic Surgeon and Consultant at various hospitals says walking, calcium supplements, sunlight -- since most vitamin D does not come from food but from moderate exposure to the sun -- muscle strength exercise and diet are extremely important to prevent or slow down the progression of osteoporosis. He advises “building up bone strength through a healthy diet and weight-bearing exercises while young.  Walking is a form of weight bearing exercise, swimming is not. Rock climbing too. Good muscle strength and coordination helps prevent falls. Mature women in particular should take calcium and vitamin D. Physical work should not be avoided. Bone is like a bank balance, it is  best to have lots, since it is  useful in old age.  Graded exercises are important to build both bone and muscle. Overexertion should be avoided, the response time of muscle  is important to prevent falling and avoiding fractures.”

Dr Pramod Bhor, Orthopedist and Joint Replacement Surgeon, Hiranandani Hospital, Vashi, a Fortis network hospital, advises that “the test for bone density should be repeated at least once a year.  The use of walking aids or braces to avoid falls is recommended for  the elderly;  also, regular exercises for toning of muscles and time-bound food habits, specifically, a regular walk for one hour daily, along with consumption of a  calcium rich diet.  Requirements vary from patient-to-patient so taking OTC meds can give a false sense of well-being. The dosage and frequency of calcium intake should  be monitored by a doctor.”

Dr Arvind G Kulkarni, Head of Mumbai Spine Scoliosis and Disc Replacement Centre, Bombay Hospital, Mumbai   says that “ the tendency of bones to break can be significantly decreased by certain drugs and of course, by remaining active. Specific drugs are now available like terepertide, administered  by a daily injection under the skin (just as insulin is given for diabetes).  This is an expensive treatment and should be reserved for special circumstances. Various other formulations are available which can be given daily, weekly, monthly or once a year depending on the severity of disease. This must be done under medical supervision. There are simple non-invasive techniques available, such as DEXA Scan which accurately measures the bone density and indicates weak bones (osteopenia) or even osteoporosis. This test should be accompanied by a simple blood test for calcium and Vitamin D levels which indicates our mineral metabolism.”

Short Takes

Osteoporosis is a disorder which reduces bone density and quality, thereby increasing the risk of fractures, especially in the spine, hip and wrists.

Osteoporosis can also affect younger people, though it is more common in senior citizens.

Doctors emphasise the importance of calcium as a preventive measure.

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