Orthopedic Diseases
Osteoporosis .. Symptoms and Ways of Prevention
​Bone Formation:
In the living body, bones are very much alive. They have their own nerves and blood vessels and are made of living cells which help them to grow and to repair themselves. As well, proteins, minerals and vitamins make up the bone.
 
What is Osteoporosis?
Osteoporosis, which literally means "porous bone", is a disease in which the density and quality of bone are reduced. As the bones become more porous and fragile, the risk of fracture is greatly increased. The loss of bone occurs "silently" and progressively. Often there are no symptoms until the first fracture occurs.
The most common fractures associated with osteoporosis occur at the hip, spine and wrist. The incidence of these fractures, particularly at the hip and spine, increases with age in both women and men.
 
Spine Fractures:
Spine fractures might have severe effects, such as: loss of height, severe pains in the back and deformation. Hip fractures, on the other hand, usually require surgeries. They may cause less personal independence, or immobility.
 
The major functions of bones are to: 
  • to provide structural support for the body.
  • to provide protection of vital organs.
  • to provide an environment for marrow (where blood cells are produced).
  • to act as a storage area for minerals (such as calcium).
Diagnosis:
Commonly dubbed as the "silent disease", osteoporosis has no obvious symptoms other than a fracture when the bone is already significantly weakened. Therefore, it is important to go to your doctor and undergo preemptive examination. Osteoporosis can be detected through:
Outer Shape:
Curvature of the back and loss of height are the only indications of osteoporosis. The patient might be suffering from spine fractures.
 
BMD Tests:
There are a number of tests for measuring bone mineral density (BDM), the commonest of which is the DXA test.
 
Vulnerability to Risk Factors:
Risk factors are classified into two major groups of factors: fixed factors and modifiable factors. Fixed risk factors are further divided into two subsidiary groups, shown as follows:
Basic Fixed Risk Factors:
  • Age:

As people age, they become more vulnerable to reduced bone mineral density. The vast majority of hip fractures (90%), for example, occur in people aged 50 and older.

  • Female Gender

Women, particularly post-menopausal women, are more susceptible to bone loss than men, because their bodies produce less estrogen. This hormone supports osteoblast survival and tips the balance of bone remodeling in favour of bone formation. Women are more likely to sustain any osteoporotic fractures than men. Lifetime risk of any fracture ranges between 40-50% in women whereas it ranges between 13-22% in men. It is estimated that one of every three women over fifty suffers from osteoporosis (higher than breast cancer), as opposed to one of every five men (higher than prostate cancer).

  • Family History:

A parental history of fracture (particularly a family history of hip fracture) is associated with an increased risk of fracture that is independent of bone mineral density (BMD).

  • Previous Fracture:

A previous fracture increases the risk of any fracture by 86%, compared with people without a prior fracture (men and women alike).

  • Race/Ethnicity:

Osteoporosis is more common in Caucasian and Asian populations and the incidence of osteoporosis and fractures of the hip and spine is lower in black than in white people.

  • Menopause/Hysterectomy:

Hysterectomy, if accompanied by removal of the ovaries, may also increase the risk for osteoporosis because of estrogen loss. Post-menopausal women, and those who have had their ovaries removed, must be particularly vigilant about their bone health.

  • Rheumatoid Arthritis:

Rheumatoid arthritis and diseases of the endocrine system can take a heavy toll on bones. Hyperparathyroidism, for example, results in elevated levels of parathyroid hormone, which signals bone cells to release calcium from bone into the blood.

  • Primary/Secondary Hypogonadism in Men:
Like estrogen deficiency in women (which is observed in case of primary or secondary amenorrhea and premature menopause), androgen deficiency in men, (primary or secondary hypogonadism) increases the risk of fracture.
 
Secondary Fixed Risk Factors:
Secondary risk factors are less prevalent but they can have a significant impact on bone health and fracture incidence.
These risk factors include other diseases that directly or indirectly affect bone remodeling and conditions that affect mobility and balance, which can contribute to the increased risk of falling and sustaining a fracture. Disorders that affect the skeleton include:
  • Asthma.
  • Nutritional/gastrointestinal problems.
  • Haematological disorders/malignancy.
  • Immobility.
Medical Treatments Affecting Bone Health: 
Some medications may have side effects that directly weaken bone or increase the risk of fracture due to fall or trauma. Patients taking any of the following medications should consult with their doctor about increased risk to bone health.
  • Glucocorticosteroids − oral or inhaled.
  • Certain immunosuppressant.
  • Thyroid hormone treatment (L-Thyroxine).
  • Certain steroid hormones.
  • Aromatase inhibitors.
  • Certain antipsychotics.
  • Certain anticonvulsants.
  • Certain antiepileptic drugs.
  • Antacids.
  • Proton pump inhibitors.
Modifiable Risk Factors:
Most modifiable risk factors, which arise primarily because of unhealthy diet or lifestyle choices, directly impact bone biology and result in a decrease in bone mineral density (BMD). Some modifiable risk factors also increase the risk of fracture independently of their effect on bone itself. Following are some of these factors:
  • Alcohol:
    • People drinking alcohol have an increased risk of sustaining any osteoporotic fracture, compared to people with moderate or no alcohol intake.  
    • Alcohol causes secondary osteoporosis due to direct adverse effects on bone-forming cells, on the hormone that regulates calcium metabolism and poor nutritional status (calcium, protein and vitamin D deficiency).
  • Smoking:
    • People with a past history of cigarette smoking and people who smoke are at increased risk of any fracture, compared to non-smokers.
  • Low Body Mass Index: 
    • Leanness (body mass index (BMI) <20 kg/m2) regardless of age, sex and weight loss, is associated with greater bone loss and increased risk of fracture.
  • Poor Nutrition:
    • When insufficient calcium is absorbed from dietary sources, the body produces more parathyroid hormone, which boosts bone remodeling, mobilizing osteoclasts in the bone to break down and sacrifice bone calcium to supply the nerves and muscles with the mineral they need.
  • Vitamin D Deficiency:
    • Vitamin D is also essential, since it helps calcium absorption from the intestines into the blood. Vitamin D is made in our skin with exposure to the sun’s ultraviolet rays. In most people casual exposure to the sun for as little as 10-to-15 minutes a day is usually sufficient. However in elderly people, people who do not go outdoors, and during the winter months in northern latitudes, food or supplemental sources of vitamin D is of importance. At least 800 international units of vitamin D and 1,000 to 1,200 mg of calcium daily can protect against osteoporosis.
  • Eating Disorders:
    • Osteoporosis can also be compounded by eating disorders such as anorexia nervosa and bulimia.
  • Estrogen Deficiency:
    • Estrogen deficiency in women afflicted by these disorders speeds up bone loss in a similar way to that which occurs in post-menopausal women.
  • Insufficient Exercise:
    • People with a more sedentary lifestyle are more likely to have a hip fracture than those who are more active. For example, women who sit for more than nine hours a day are 50% more likely to have a hip fracture than those who sit for less than six hours a day.
  • Frequent Falls:
    • Visual impairments, loss of balance, neuromuscular dysfunction, dementia, immobilization, and use of sleeping pills which are quite common conditions in elderly persons, significantly increase the risk of falling and accordingly increase the risk of fracture.
Prevention & Treatment:
The good news is that osteoporosis is now a largely treatable condition and, with a combination of lifestyle changes and appropriate medical treatment, many fractures can be avoided.
Medications:
  • Doctors may prescribe drug therapy if osteoporosis is diagnosed or if there is an elevated risk of osteoporosis. Today there are a number of effective treatment options available that have been shown to act quickly, to maintain bone density and to reduce the risk of having fractures. It is important that the choice of treatment be tailored to a patient's specific medical needs and lifestyle.
  • Calcium and vitamin D supplements are also usually prescribed with any osteoporosis treatment, in order to ensure adequate levels and maximum effectiveness of the drug therapy.

Prevention:

  • Adequate calcium and vitamin D intake:
  • Exposure to the sun:

Recommended sun exposure of 15 minutes a day to your hands and face will help your body make vitamin D. Avoid overexposure to the sun.

  • Avoid too much exercise:

Women and teenage girls who exercise to an extreme degree can develop amenorrhea (cessation of menstruation) due to estrogen deficiency. Estrogen deficiency in younger women contributes to bone loss, in much the same way that estrogen deficiency after menopause does. 

  • Improvement of Lifestyle:

Aged and middle-aged people have to follow a healthy lifestyle, by avoiding smoking and alcohol, abiding by the doctor's instructions, evaluating the probability of having osteoporosis, and taking the medications required for the preservation of bone mass and the reduction of the risk of fractures.

  • Ensure a healthy body weight:

Being underweight is a risk factor for osteoporosis. Stay within a healthy weight for your height.

  • Good Nutrition:
At every stage of life a nutritious, balanced diet promotes strong, healthy bones. A good diet includes sufficient calories and adequate protein, fat and carbohydrates, as well as vitamins and minerals - particularly vitamin D and the mineral calcium. In childhood and adolescence, good nutrition helps to build peak bone mass (maximum bone density, attained in the 20's) thereby reducing vulnerability to osteoporosis later in life. In younger and older adults, a nutritious diet helps preserve bone mass and strength. And in those who have had a fracture, it speeds and aids recovery and reduces the risk of having another fracture. Varied and enjoyable eating habits, including calcium-rich foods, are a recipe for a lifetime of strong bones and the high quality of life that comes with them.
 
Calcium:
Calcium is a major building-block of our bone tissue, and our skeleton houses 99 per cent of our body's calcium stores. The calcium in our bones also acts as a 'reservoir' for maintaining calcium levels in the blood, which is essential for healthy nerve and muscle functioning. The amount of calcium we need to consume changes at different stages in our lives. Calcium requirements are high in our teenage years with the rapid growth of the skeleton, and during this time, our body's efficiency in absorbing calcium from food increases. With age, however, this absorption efficiency declines, which is one of the reasons why seniors also need to consume higher amounts of calcium.
 
Sources of Calcium:
Milk and other dairy products are the most readily available dietary sources of calcium. Dairy foods have the additional advantage of being good sources of protein and other micronutrients (besides calcium) that are important for bone and general health. Other good food sources of calcium include some green vegetables, like broccoli, curly kale, and bok choy; canned fish with soft, edible bones (the calcium's in the bones!) such as sardines, pilchards and salmon; nuts - especially Brazil nuts and almonds; some fruits such as oranges, apricots and dried figs.
Some calcium-fortified breads, cereals, fruit juices, soy beverages and several brands of commercial mineral water also contain significant amounts of calcium. These foods provide a suitable alternative for people who are lactose-intolerant and for vegan vegetarians.
 
Factors that Prevent the Absorption of Calcium:
Some leafy produce, like spinach and rhubarb, contain 'oxalates', which prevent the calcium present in these vegetables from being absorbed. However, they do not interfere with calcium absorption from other calcium-containing foods eaten at the same time. The same is true of 'phytates' in dried beans, cereal husks and seeds. 
Caffeine and salt can increase calcium loss from the body and should not be taken in excessive amounts. And while no conclusive evidence shows that fizzy soft drinks (e.g. cola drinks) weaken bones, here too, it's best not to overdo it - especially as such drinks tend to 'displace' milk in the diets of children and teenagers.
 
Importance of Exercise:
Exercise is not just important to general health, it helps build bone mass in youth and slows down bone loss in adults. Exercise is also a factor in helping to reduce the risk of falls as it strengthens muscles, increases flexibility, and improves coordination and balance. During physical activity bones receive messages that they need to work and be strong. When there is a lack of exercise, bones do not receive these messages and lower bone mass can result. Regular physical activity on a long-term basis maintains the benefits for bone health.
 
Benefits of Exercise for Bones:
  • Patients suffering from diseases that require long stay in bed, like the injuries of the spinal cord, resulting in damaging bones and muscles, and increasing the risk of the occurrence of fractures within few weeks. 
  • Exercise during childhood and adolescence helps develop and strengthen the skeleton, and reduce, accordingly, the risk of fractures when getting older.
  • Many studies have shown a positive relation between physical activity and age, in preserving the bone mineral density, aside from diminishing the risk of hip, arm and spine fractures in old age.
  • Studies have proven that the bone density of those who regularly exercise are remarkably higher than those who don't. Such non-weight bearing activities, like swimming, are rather exceptions.
  • Exercise helps prevent bone loss and falls in the elderly
  • In the young, exercise helps to build strong bones, helps adults maintain their bones, and protects against osteoporosis.
  • People who have suffered fractures can benefit from special exercises and training (under medical supervision) to improve muscle strength and muscle function for greater mobility and improved quality of life.
  • Exercise is especially important for older women, who have a higher rate of bone tissue loss after menopause.  Exercise builds muscle tone and improves balance, thereby preventing falls, which are a major trigger of fractures. This is particularly important for older people.
  • It is never too late to start exercising.

Summary:

Be sure to follow these three steps:

  • Regular, weight-bearing exercise.
  • Ensure an adequate calcium intake.
  • Ensure getting balanced and integrated nutrition.
These are such important steps for the prevention of this 'silent' disease.

 

 

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Last Update 15 March 2018 10:11 AM
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