Dr M K Mam
Osteoporosis is one of the major public health problems worldwide and its prevalence is increasing. Despite that lot many people somehow are not aware of it, many carry lot of wrong notions about it. General feeling is that osteoporosis- weakness of bones is just a part of aging , it is normal with age, it is inevitable as bones naturally age with age. It is true that bone loss increases with age, however the research has shown that osteoporosis is just not a part or consequence of aging, there is much more to it than aging. Another misconception is that osteoporosis is only a women problem, only women get it and men are not affected with it. The fact is that men can also be affected, although women are more often affected than men. People also wrongly feel that it is only a problem of elderly. The truth is that it can affect younger people also, however elderly are more often affected. Another common misconception is that not much can be done to prevent or treat it. This is absolutely wrong, the truth is that osteoporosis can very well be diagnosed, prevented and treated. As a matter of fact, we can have strong bones at any age, yes we can have strong bones at any age, we can rebuild bone strength at any age. As such, it is pertinent to sensitize and educate people about osteoporosis and what all can be done to prevent it.
What is osteoporosis
Osteoporosis is a systemic disorder of bones characterized by abnormal reduction of bone mass, increased bone fragility and susceptibility to fractures. The mechanical strength of bones is markedly reduced, making them vulnerable to fractures following a minor trauma. It occurs most commonly in elderly postmenopausal women, but men are also affected. It usually goes unnoticed for years until it is complicated by fractures that occur following a minor trauma. Common sites of these fractures are the spine, hips and the wrist. These fractures especially of the hip are associated with lot of morbidity and mortality. These fractures also cause a lot of psychological and social problems thus affecting the quality of the life of the person. Not only quality of life is reduced but also quantity of life is reduced . Management of such fractures involves a huge cost, thus putting enormous financial burden on the affected person, family and the society as a whole. India being second most populous country in the world, is the home of a very large population of osteoporosis patients and the number is increasing every year. Unfortunately, most of such patients in our country go undiagnosed and untreated even in very high risk ones who have already had a fracture .
Osteoporosis usually remains undiagnosed until it is complicated by fractures that occur following a minor trauma. Usual complaint is backache that is diffuse , loss of height, progressive round kyphosis deformity of back. However, the very common presentation is a fracture of hip, wrist or spine on a minor trauma . Back pain and tenderness- pain on pressure is usually diffuse but it may be localized if there is a fracture. X-Rays of spine may show some evidence of osteoporosis, however these signs excepting a fracture are usually unreliable and appear late. Diagnosis of osteoporosis is based on bone mineral density (BMD) as assessed by dual energy x-ray absorptiometry (DEXA) especially of hips and spine. Testing of BMD is the gold standard in diagnosis of osteoporosis. It tells whether bone density is normal, low or very low and if someone is at increased risk of sustaining a fracture. It also helps in monitoring the response to treatment. Relevant lab tests are done to rule out the underlying cause if any of the osteoporosis.
Prevention- what all can be done
Considering the risk of fractures and subsequent complications- morbidity and the mortality following such fractures, and then a very high cost involved in treatment, it is imperative to prevent it. Prevention is always better than cure.
Regular physical activity is very good for the overall wellbeing of the body and mind, so is the case with bones. The physical activity especially weight bearing and resistant exercises stimulate the bone cell to form new bone and increase bone mass. Simple walking (30 minutes a session- 150 minutes a week ), going up stairs, running, jogging, jumping, dancing, weight lifting , outdoor games are some of the weight-bearing exercises which one can do to prevent osteoporosis. We need to change our sedentary life style to an active one. Basic mantra is to move more and sit less. We should remain physically active as much as we can and as long as we can.
Yoga has a positive effect on the physical, mental and spiritual wellbeing of a person. It strengthens muscles, bones and whole body. Studies have shown that yoga done every day can prevent osteoporosis and in some cases can slow down its progression. We need to understand that yoga and exercise has to be a regular lifelong daily activity. Research has shown that regular physical activity, started especially in childhood and adolescence is a cheap and safe way of improving bone strength and prevention of osteoporosis.
An optimal diet with adequate amount of proteins, calcium and vitamin D along with vitamin C, K is essential for prevention and treatment of osteoporosis. Calcium is the most important mineral for the prevention and treatment of the osteoporosis. 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. Children and young people need more calcium than an adult as bones are developing and growing. The demands of calcium also increase during pregnancy and lactation. Milk and other dairy products like yogurt, cheese etc. are rich in calcium and high in calcium absorption. Again fresh green vegetables, fruits and wheat products are also important sources of calcium.
Vitamin D is important for calcium absorption and mineralization of bones. An intake of 800 to 1000 international units of vitamin D per day for adults is recommended. Chief dietary sources of vitamin D include fish like salmon etc. , egg yolk, cod liver oil, fortified milk and yoghurt. Food sources alone usually do not provide sufficient vitamin D . Vitamin D is naturally synthesized in skin through exposure to sun light. A 15-minute sunbath can produce adequate quantity of vitamin D by way of the skin.
High alcohol intake has to be avoided as it is harmful for the bones. It damages bone cells directly, inhibits calcium absorption and damages the liver – the organ where activation of vitamin D occurs. Finding out whether you have risk factors is essential so as to identify those who are at greatest risk and are most likely to sustain a fracture in future. Accordingly the person can take all necessary measures i.e. diagnostic, preventive and treatment..
Educating the people that osteoporosis is just not a part or consequence of aging but a disorder of bones that can be prevented, diagnosed and treated, is of utmost importance. We need to make them aware of the gravity of the problem– its adverse effects on the individual and the society and what all can be done to prevent it.
(The author is former Vice Principal, Prof. & Head Orthopaedics, CMC, Ludhiana, Punjab)
Dr M K Mam