M K Mam
World Osteoporosis Day is celebrated every year on October 20th. by International Osteoporosis Foundation. The day marks a year-long campaign dedicated to raising global awareness of the prevention, diagnosis and treatment of osteoporosis. This year the campaign will feature “THAT’S OSTEOPOROSIS” as a headline, and for the first time, will highlight emotionally impactful visuals and stories of real people living with osteoporosis in all regions of the world. The campaign will emphasize the direct link between osteoporosis and broken bones. Key message of 2019 campaign is that osteoporosis is the hidden, underlying cause of painful, debilitating and life-threatening fractures. Emphasis will beon making the people aware of the risk factors for osteoporosis, and take a Osteoporosis Risk Checkto seewhetherone could be at risk of osteoporosis. In case a person has risk factors for osteoporosis and fracture,the person should have a bone health assessment and take necessary action for its prevention.
What is osteoporosis: Osteoporosis is one of the major public health problems worldwide and its prevalence is increasing. It is a systemic disorder of bones characterized by low bone mass, increased bone fragility and susceptibility to fractures.The mechanical strength of bone is markedly reduced, making it vulnerable to fractures following a minor trauma, fall, a sneeze, or a sudden movement. It occurs most commonly in elderly postmenopausal women, but men are also affected. The condition usually remains undiagnosed until it is complicated by fractures that occur following a minimal trauma. Rightly said that it is a silent disease -so called a “silent thief” which slowly nibbles away at the bones and goes unnoticed for years until it is complicated by fractures that occur following a minimal trauma.Common sites of these fractures are the spine, hips and the wrist. These fractures especially the hip fractures are associated with lot of morbidity and mortality. Management of such fractures involves lot of cost and puts enormous financial burden on the affected person, family and the society as a whole. These fractures also cause a lot of psychological and social problems thus affecting the quality of the life of the person. India being second most populous country in the world is the home of a very large population of osteoporosis patients. Unfortunately, most of patients with osteoporosis go undiagnosed and untreated in our country, even in the most high risk patients who have already had a fracture.
Who is at risk: Some people are more at risk than others of getting osteoporosis and sustaining a low trauma fracture.It can be due to many factors that cause or contribute to osteoporosis. Risk factors are clinically important as it will help in identifying the people who are most likely to sustain a fracture in future. Once a person knows that he is at risk, he or she can take all necessary measures i.e. diagnostic, preventive and treatment.Risk factors can be classified into i) factors which can be influenced or modified ii) factors which may not be influenced or modified.
Risk factors that can be influenced: Chronic inactivity: Insufficient physical activity is certainly one of the important risk factors for osteoporosis. Insufficient physical activity results in less stimulation of the bones and hence lower bone mass- osteoporosis.People who spend a lot of time sitting have a higher risk of osteoporosis as compared those who are more active.Research has shown that trabecular bone is lost at the rate of 1% per week when a patient is put to bed rest and its restoration is at about 1% per month- certainly much slower than its loss. The physical activity especially weight bearing exercises that one performs while on the feet when bones and muscles work against gravity stimulates the bone cell to form new bone and thus increases bone mass.Simple walking, going up stairs, running, jogging, jumping, dancing, volleyball, and basketball are some of the weight-bearing exercises which one can do to prevent osteoporosis. We need to change our sedentary life style and remain physically active as much as we can and as long as we can. Basic mantra is that we should sit less and move more.
Tobacco use: Cigarette smokingand use of tobacco products are known to be detrimental for bones. It speeds bone loss , doubles the risk of osteoporosis. It damages bone cells, reduces blood flow to bone, decreases the production of some of the hormones that are good for bones like estrogen in women and testosterone in men, although exact mechanism is not known. Smoking has a negative influence on bone mineral density and has been rightly labeled as “bone terrorist number one”. It has been reported that smokers have almost double the risk of hip fractures compared to nonsmokers. As such a big NO to smoking. Excessive alcohol intake: Risk of osteoporosis and fractures increases with excessive alcohol intake. Alcohol damages bone cells directly, inhibits calcium absorption and damages the liver – the organ where activation of vitamin D occurs. Other accompanying factors with chronic alcoholism like poor nutrition further add up to the problem. Research also indicates that the effects of heavy alcohol use on bone may not be reversed, even if alcohol consumption is terminated. Looking at the harm it does, it has to be avoided.
Poor Nutrition: Nutrition is essential for the maintenance of the bone health and any deficiency of minerals especially calcium, phosphorus and the vitamins like vitamin D, K and C increases the risk of osteoporosis. Calciumis the most important mineral for the prevention and treatment of the osteoporosis, so we must take a diet rich in calcium. Low calcium intake contributes to diminished bone density and early bone loss. Men aged 50-70 years need 1000 mg per day of calcium and the women age 51 and older and men age 71 and older need 1200 mg per day.Adequate supply of vitamin D is important for calcium absorption and mineralization of bone.Again because of life style changes people hardly spend any time outside in sun, with the result we see a widespread deficiency of the vitaminD as its natural synthesis in skin through exposure to sun light does not occur.An intake of 800 to 1000 international units of vitamin D per day for adults is recommended.
Low body weight : “Slim women, thin bones ” is a well-known old saying. Studies show a close connection between osteoporosis and low body weight. A low body weight and low muscle mass result in less stimulation of the bones and hence lower bone mass. Under weight or the slim ladies certainly have a high risk of osteoporosis and fractures. Looking trim and slim is fine, but not at the cost your bone health. We need to have an adequate nutrition, exercise and maintain proper weight of the body.Hormones: Early menopause in women whether surgical or natural is an important risk factor. Again deficiency of testosterone in men leads to osteoporosis. So an appropriate measures have to be taken.
Medications: There are lot many drugs which weaken the bones and the most important one is corticosteroid- commonly known as cortisone and prednisolone. Long-term use of corticosteroid medications interferes with the bone formation process.
Medical problems: Several medical conditions like rheumatoid arthritis, diabetes mellitus, inflammatory bowel disease, chronic kidney disease etc. are associated with increased risk of osteoporosis.
(The author is Former Vice Principal, Prof. & Head Orthopaedics, CMC, Ludhiana, Past President-North Zone Orthopaedics Association)
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