OSTEOPOROSIS.

Laxmi Pujan was over sixty-five years old. Mrs. Deshpande was levering herself up from the seated position using her left hand. "Crack". It sounded like twig breaking. Actually, she had just fractured the bone of her left forearm! The culprit - Osteoporosis.

What is Osteoporosis? - It literally means 'bones that are porous'. Bone is a growing tissue that changes throughout life. Healthy bone has a honeycomb appearance when viewed under the microscope. It is being constantly absorbed and replaced by the body. As people age, bones naturally get thinner, new bone formation does not keep pace with bone removal. The bones thus lose minerals, mass, and structure becoming weaker and more brittle. Under the microscope, the honeycomb appearance becomes more rarefied, the holes and spaces increasing as the bone becomes weaker and is more likely to break. Even simple acts like bending over or lifting things can cause a fracture.

Symptoms - Osteoporosis is silent with the condition going largely undiagnosed. The most common symptom is a complaint about back pain or chronic pains. Many people experience no symptoms until they suffer a bone fracture: commonly of the hip, spine or wrist. Other bones can also break. While in some, it may cause permanent pain, in others it can even cause a loss of height. When the vertebrae or the bones of the spine are affected , it often leads to a hunched or stooped posture.

Bone Health - The basic mechanisms considered responsible for the development of Osteoporosis are poor bone mass acquired during growth and development and the accelerated loss of bone in the period after peak bone mass is achieved. Good bone health achieved in younger years will go a long way in preventing osteoporosis in the later years. Strong bones built before thirty years of age is considered the best defense against developing osteoporosis. The important sources of bone-strengthening material are calcium, phosphate, Vitamin D, Vitamin C and Proteins. The skin produces Vitamin D from sunlight, which helps in the absorption of calcium. Bones tend to weaken due to low levels of calcium, phosphorus and other minerals in them. both acquisition of bone mass and loss of bone are modulated by environmental and genetic factors. However, you can invest in healthy bones; eat a bone-friendly diet rich in calcium and Vitamin D; do weight bearing exercises; lead a healthy lifestyle - no smoking or excessive alcohol intake; get regular bone density tests done and talk to your physician for medication available for the prevention and treatment of osteoporosis when appropriate. 

Risk Factors - Having a family history of osteoporosis, being thin, being white or Asian, getting limited physical activity, smoking, regular consumption of cola drinks, and drinking excessive amounts of drinks increases the risk of osteopenia and eventually osteoporosis. Certain healthy problems and medical procedures among others that may increase the likelihood of osteoporosis are:

• Auto-immune disorders like rheumatoid arthritis, lupus, multiple sclerosis or ankylosing spondylitis.
• Digestive and Gastrointestinal Disorders like celiac disease, inflammatory bowel disease or weight loss surgery.
• Medical procedures like gastrectomy or gastrointestinal bypass procedures.
• Cancer of the breast or prostate. 
• Haematological disorders like multiple myeloma, sickle cell disease or leukemia and lymphoma.
• Neurological diseases like stroke, Parkinson's disease, spinal cord injury, multiple sclerosis.
• Blood and bone marrow disorders like thalassemia.
• Mental illness like depression or eating disorders.
• Endocrine Hormonal Disorders like diabetes, hyperparathyroidism, Cushing's syndrome, thyrotoxicosis, irregular periods, premature menopause, low cycles of testosterone and estrogen in men.
• Other conditions like AIDS/HIV, chronic obstructive pulmonary disease including emphysema, chronic kidney disease and lever disease. Organ transplants,polio and post-polio syndrome, poor diet including malnutrition, scoliosis and weight loss.

Certain medicines may cause bone loss - These include among others, aluminum containing antacids, some antiseizure medicines, cancer chemotherapeutic drugs, cyclosporine A, Gandotropin releasing hormones, heparin, lithium, medroxyprogresterone acetate for contraception, methotrexate, steroids such as cortisone and prednisone and tamoxifen (pre-menopausal use). It is important to talk to your health care provider to limit the dose and duration to the needful minimum and take steps to prevent bone loss while on any of these medications.

Osteoporosis and Indians - Some common reasons suggested for the occurrence of osteoporosis in the Indian population are:

• People preferring to stay out of the sun.
• Use of clothing like the 'burqa' and covering the head with a 'pallu' both of which limit the exposure to the sun.
• Vegetable diets, poverty, illiteracy and lack of a balanced diet causing diabetic deficiencies of proteins, vitamin C, Calcium and Phosphates, all of which are important for bone health.

Diagnosis - A Bone Mineral Density test is the best way to diagnose osteoporosis. The test measures the density of bones (bone mass) and helps decide if medication is necessary to help maintain the bone mass, prevent further bone loss and reduce the risk of fractures. If your bone density is lower than normal peak density but not low enough to be diagnosed as osteoporosis, then is classified as Osteopenia. Those diagnosed with osteopenia and other high-risk groups like post-menopausal women and those above fifty need early screening and diagnosis so that corrective measures can be instituted. Prevention is the best because after the onset of this condition only supportive therapy is available. There is no cure. The approach suggested to prevent osteoporosis includes a balanced diet, regular exercise, regular check-ups, a Bone Mineral Density test and medication when appropriate. Prevention of falls and injury is also necessary to avoid compression fractures, especially in the elderly. While bone health is a long-term investment made at an early age. It is never too late, and definitely never too early to make the investment.
Myths and Facts -

Myth: Osteoporosis is not very serious or deadly condition.

Fact: Osteoporosis creeps up without any warning symptoms until the first fracture occurs. The life-time risk, for a woman or man, of dying from hip fracture complications is the same as for dying of breast or prostate cancer respectively.

Myth: Osteoporosis is the problem of elderly women.

Fact: Women have naturally smaller and thinner bones than men, putting them at a higher risk. However, an estimated 10 to 25 percent of men develop osteoporosis during their life-time. Men tend to suffer osteoporotic fractures a decade later in life than women. In older men and women of the same age, women have about 90 percent of the spine fractures, but men have about one-third of the hip fractures. Meanwhile, the risk of developing osteoporosis or osteopenia increases in younger women suffering from auto-immune disorders, digestive and gastrointestinal disorders, diabetes-mellitus, thyroid disorders, amenorrhoea, depression, eating disorders or breast cancer.

Myth: Osteoporosis is a natural part of aging.

Fact: While some bone density is lost with aging, not everyone is doomed to suffer broken hips and hunch-backs. The bone mass acquired during youth is an important determinant of the risk of osteoporotic fracture later in life.

Myth: The only risk factor for osteoporosis is advancing age.

Fact: Age is a major risk factor, especially for those older than 65 years. But there are a whole host of other risk factors, some of which are hereditary and some, such as sedentary lifestyle and medication, which can be controlled or managed.

Myth: Broken bones are the only way to tell if one has osteoporosis.

Fact: Often osteoporosis is detected only when a bone fracture occurs. However, a bone density test every few years for those at higher risk of developing osteoporosis helps monitor and detect any bone loss. The test gives important information about the bone strength and probable risk for fracturing a bone in the future.

Myth: A bone density test is painful and complicated.

Fact: The bone density test is simple and comfortable. A bone densitometer is a large, padded exam table and measures bone density by using a small amount of radiation. While one lies on the back, a scanner passes over the spine and hip area and using small amounts of X-ray the densitometer measures the amount of bone mineral that directly relates to bone strength.

Myth: Drinking milk and taking calcium supplements guarantee prevention of osteoporosis.

Fact: While calcium is important, bone is made of protein as well as minerals. Calcium is essential but is not enough to prevent osteoporosis. There are at least 17 other nutrients that are important for bone health. Many dietary sources contain protein, phosphorus and other nutrients important for bone health. Additionally, regular exercise and making other healthy lifestyle choices like not smoking all contribute to good bone health.

Myth: Only osteoporosis medications can prevent future bone loss.

Fact: Certain medications to prevent and/or treat osteoporosis have been approved. Most of the drugs act by inhibiting the cells that cause bone break down, while one actually stimulates the growth of new bone. Along with the medication a bone friendly diet is recommended.

SEVEN EASY SOURCES OF CALCIUM.     

• Sesame seeds.1 Tablespoon=280 mg.
• Almonds........ half-cup of roasted nuts=200 mg.
• Figs................ half cup of dried figs=120 mg/2 fresh figs=55 mg
• Amaranth....... 1 cup of this grain=275 mg.
• Turnip greens. 1 cup=200 mg.
• Buttermilk...... 1 cup=284 mg.
• Yoghurt.......... 1 cup=415 mg.

The Daily Value for Calcium as per the US FDA is 1,000 mg for adults and children aged 4 years and older. 
(Based on an article written by Dr. Vasundhara Atre, Transplant Anaesthesiologist, Medical Journalist and author of 'Heartbeat - How to prevent a heart attack' & 'On the Inside', published in The Times of India dated 20th October, 2016, Thursday).

---------------------------------------------------------------------------------