Bashir Ahmad Laway
Osteoporosis means weak bones that can break easily. There are many risk factors that increase the chance of developing osteoporosis, with two of the most significant being age and gender.
* Age and gender: Osteoporosis is more common in women than men are and it increases with age in both. Asian women are more likely to develop osteoporosis. Thin people have a greater risk of developing osteoporosis because they have less bone to lose than people with more body weight and larger frames do. Osteoporosis also runs in families.
* Medical conditions: Some conditions like thyroid, parathyroid disease, previous obesity surgery, gastrointestinal diseases like celiac and inflammatory bowel disease and blood dyscrasias like myeloma increase the risk of osteoporosis.
* Drugs: Some medications cause side effects that may damage bone and lead to osteoporosis. These include steroids, medications for breast cancer and seizures.
* Eating and lifestyle habits: Osteoporosis is more common in people with deficiency of calcium and vitamin D; People who lead sedentary (inactive) lifestyles have a higher risk of osteoporosis. Smoking and alcohol use increases the risk of fractures.
* Nutrition and exercise in childhood: Bone-healthy nutrition and regular, vigorous exercise during childhood and adolescence are the key ways in which to maximize a child’s genetic potential for strong bones – and a first step to osteoporosis prevention in later life.
Symptoms of Osteoporosis
Osteoporosis mostly does not produce any symptoms until a bone is broken with a minor trauma. Some symptoms include pain in the back or neck if there is a vertebral fracture, decreasing height, a stopped posture or receding gums. A bone breaks much more easily than expected Osteoporosis is not a cause of pain in the knees which most of the people think.
How is osteoporosis diagnosed?
Diagnosis of osteoporosis is based on detection of low bone density on imaging. Routine X-rays will only detect osteoporosis if there is loss of more than 30% of bone density. It may also reveal an asymptomatic fracture. Dual energy x-ray absorptiometry (DXA) scan is the most sensitive way of measurement of bone density. However, the DXA scan need to be done by a trained person and the results interpreted by a trained clinician. Routine machine made report may sometimes be misleading. All women over the age of 65 should have a bone density test. The DEXA scan done earlier for women who have risk factors for osteoporosis. Men over age 70, or younger men with risk factors, should also consider getting a bone density test.
When should osteoporosis be treated with medication?
Main goal of treatment of osteoporosis is to prevent fractures. There are three ways of finding weather a person will need treatment or not. Previous history of fracture, low bone mass on DXA scan or high future probability of a fracture calculated with an online score called FRAX. Many women may need treatment in presence of other risk factors even if bone density is not severely decreased, a condition called osteopenia.
How can you prevent osteoporosis?
Diet and lifestyle are two important factors, which are modifiable to prevent osteoporosis.
Diet
Getting an adequate supply of calcium and vitamin D is the mainstay of both prevention and treatment of osteoporosis. To maintain strong, healthy bones, you need a diet rich in calcium throughout your life. The rich sources of calcium are milk, broccoli, calcium-fortified juices and breads, dried figs, and calcium supplements. It is best to try to get the calcium from food and drink. For those who need supplements, remember that the body can only absorb 500 mg of calcium at a time. One should take your calcium supplements in divided doses, since not anything more than 500 mg is absorbed. The recommended amount of daily calcium intake is 1,000 mg to 1,200 mg daily via diet and/or supplements. Taking more than this amount of calcium provides additional bone strength but may be associated with an increased risk of kidney stones, calcium buildup in the blood vessels and constipation. Vitamin D is also important because it enables the body to absorb calcium. The recommended daily allowances of vitamin D is around one to two thousand units per day. Vitamin D comes from sunlight exposure a few times a week or by drinking fortified milk. Many people do not have adequate levels and might need to take supplements.
Lifestyle
Maintaining a healthy lifestyle can reduce the degree of bone loss. Begin a regular exercise program. Exercises that make your muscles work against gravity (such as walking, jogging, aerobics, and weightlifting) are best for strengthening bones. Do not drink too much alcohol. Do not have excessive amounts of caffeine. Do not use tobacco at all.
Prevent falls inside your home
* Keep your floors free of clutter, including throw rugs and loose wires and cords. Use only non-skid items if you have mats, carpets or area rugs.
* Make sure your lighting is bright enough so that you can see well.
* Do not use cleaners that leave your floors slippery.
* Clean up any spills that happen immediately.
* Use grab bars in the bathroom and railings on stairways.
Prevent falls outside your home
* Make sure lighting is adequate in all areas outside your home.
* Use a backpack or other type of bag that leaves your hands free.
* Keep areas outside in good repair and free of clutter.
* Wear sensible shoes with non-slip bottoms
* Take your time. You might be less careful if you are in a hurry.
Summary
* Osteoporosis is common especially in women of more than 50 years age.
* Patients with osteoporosis are at high risk for fractures after routine activities.
* Screen every women for osteoporosis after the age of 60 years and men after 65 years. Adequate intake of calcium is essential to prevent and treat osteoporosis.
* Every effort should made at home to prevent a fall and hence prevent a fracture.
(The author is Professor & Head Department of Endocrinology, SKIMS, Srinagar)
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