Ministry Of Health Saudi Arabia

Orthopedic Diseases

Osteoporosis .. Silent disease

What are bones made up of?
Bones are the proteins, minerals, and vitamins constituting the cells which build the living, dynamic and integral bone tissues, and it has the ability to grow and fix itself.

How is osteoporosis defined?
Osteoporosis or bone thinning is a disease characterized by decrease in bone mass and density; that's to say, bones become more porous, fragile, and breakable due to the loss of calcium. And the most common fractures are those occurring in the areas of hip, spine, and wrist.

Harm of Backbone Fractures:
Backbone fractures can lead to dire consequences such as getting shorter and severe pains in the back and deformation. As regards hip fractures, it usually requires surgical intervention, and may deprive a patient of leading an independent life, or the ability to move freely.

Main Functions of Bones:

Providing the skeletal support for the body.
Serving to protect the human body's organs.
Creating an environment for producing the blood cells.
Acting as reserves of minerals such as "calcium".
Diagnosing Osteoporosis:
There are no well-defined symptoms for the osteoporosis; therefore it is called "the silent disease". For the bone mass keeps decreasing without a person sensing that, until a fracture occurs. Hence, an early examination will pay off. And a person suffering from osteoporosis can be detected through the following:

External Appearance:
Back-bending and length-shortening are the sole sign showing that a person suffers from bone-thinning, with the likelihood that a patient could have a spine fracture.

Measuring bone mineral density:
There are many tests assessing the bone mineral density, but the most common one is dual-energy absorptiometry (DXA).

Existence of some risk factors:
Risk factors of bone thinning come under two main categories: fixed risks and changing ones.

Fixed risks of bone thinning are divided into two parts:
1. Main Fixed Risks:

Age:
The more age advances, the less the bone density gets and injury risk increases. Further, most of fractures, i.e. 90%, happen to those whose ages are over 50.

Gender:
A woman is more prone to develop osteoporosis than a man, namely after menopause as estrogen production declines in women. Thus, Statistics underlined that 40-50% of women are suffering from osteoporosis compared to 13-22% of men and nearly a woman out of every three women aging 50 is vulnerable for fractures as a result of bone thinning, more than breast cancer. Also, a man out of five men, whose ages exceed 50, is prone to experience fractures, more than prostate cancer.

Family History:
If either parent suffers from osteoporosis or fractures, especially hip fracture, this in turn will increase the risk that children could get injured as well.

Getting injured with previous fractures:
Those experienced fractures are likely to develop osteoporosis by 86% compared to others, men and women equally.

Race:
Bone thinning is mostly common in the peoples of Caucasus and Asia, and the black-skinned are less likely to develop bone thinning than the white-skinned.

Menopause/Hysterectomy:
If the removal of uterus involved the removal of ovaries, this might in turn increase the risk of developing osteoporosis; this is due to the loss of estrogen.

Rheumatoid Arthritis:
Rheumatoid arthritis and endocrine gland diseases, such as excessive excreting of thyroid hormone, directly affect the bone density.

Lack of the excretion of some hormones:
Lack of Hormones such as estrogen of women and androgenic hormone of men put them at risk of experiencing fractures.

Fixed, secondary risk factors:
They are less widespread, but they could have great impact on the bone health.

These risk factors include other diseases directly or indirectly affecting the bones, such as:

Suffering from asthma.
Experiencing malnutrition and digestive system problems.
Blood-linked disorders.
Having any form of disability.

Medications Instrumental in the Health of Bones:
Some medications could have side effects directly rendering bones fragile, or increasing the risk of being vulnerable for fractures; of which are the following:

Corticosteroids taken orally or inhaled.
Some immunity drugs.
Thyroid hormone drugs.
Steroid hormone drugs.
Inhibitors for rheumatic diseases.
Some neuroleptics.
Specific antibiotics.
Some anti-epileptic drugs.
Antacids
Proton-pump inhibitors.

Risk factors that can be redressed or controlled:
Most of the risk factors are directly instrumental in the biological formation of bones, and lead to a decrease in the bone mineral density. But some of them indirectly heighten the risk of experiencing fractures. These factors include:

Alcohol:
Alcoholic drink consumers are more likely to develop osteoporosis compared to those who are not. This is due to the direct negative effects on the hormone regulating calcium metabolism along with nutrient- poor diet, such as deficiencies of calcium, protein, and vitamin D. Further, alcohol prevents calcium absorbing and bone forming.

Smoking:
Smokers are more prone to develop osteoporosis when compared to non-smokers.

Body Mass Index (BMI) Decrease:
If the body mass index (BMI) were less than 20, regardless of age or gender, as weight loss is linked to losing more bones and increasing of the risk of becoming vulnerable to fractures.

Malnutrition:
When calcium absorbing from the nutritional sources is sufficient, the body greatly increases producing the thyroid hormone, boosting up the bone reconstitution. And this in turn augments osteoclasts in the bones; in order to facilitate freeing calcium of bones, instrumental in providing muscles and nerves with it, alongside the minerals they are in need of.

Vitamin D:
Vitamin D is necessary as well as it helps absorb calcium from the intestines to the blood. Vitamin D is mostly concentrated in the skin along with exposing to the ultraviolet sun beams. Most people are exposed to the sun beams at least 15 minutes daily, and it is usually sufficient. But as regards the elderly and people unable to go out, and during winter months, getting vitamin D from diet and supplementary sources are the sole solution.

Eating Disorders:
Bone thinning can, as well, develop fast due to eating disorders such as anorexia nervosa and bulimia.

Estrogen Deficiency:
Estrogen deficiency of women leads to bone loss in a manner similar to that occurring to women after menopause. These diseases diminish bone building and its strength.

Lack of Physical Activity:
Those adopting a sedentary lifestyle are more vulnerable to hip fractures than those doing a lot of physical activities. And women sitting more than nine hours a day are prone to experience hip fracture injuries than those sitting less than six hours daily.

Recurring fall:
It is caused by visual impairments, muscle weakness, body's position instability, using some drugs causing giddiness and drowsiness, intrinsic and extrinsic risks, balance loss, neurological and muscular functional disorder, and dementia. Also, sleeping pills widely used by the elderly lead to the increase of fall and fracture dangers.

Prevention and Treatment:
It is worth knowing that osteoporosis is greatly treatable, as well as the ability to avoid several fractures.

Drugs:

If "bone thinning" is diagnosed or there was a risk of developing osteoporosis, then there is a wide range of effective medications; in order to maintain bone density and diminish the risk of experiencing fractures.
It is significant that medications go with a patient's needs, but they must be taken upon the prescription of a doctor. Thus, calcium and vitamin D are given as supplements for treating bone thinning; in order to guarantee the maximum effectiveness of drug-treating.

Prevention:
To prevent ourselves from osteoporosis, it is advisable to have high intake of vitamin D.

Exposing to Sun Beams:
It is recommended that hands and face be exposed to sun beams for less than 20 minutes daily.

Keeping away from physically-demanding activities:
Women and girls at their adolescence age exercising or doing highly physically-demanding activities experience estrogen deficiency; this in turn is instrumental in making younger-aged women lose bones. That's to say , all athletes, males and females alike, exercising too much without having sufficient intake of calories are vulnerable to the increasing risks of bone thinning.

Improving on Lifestyle:
People middle-aged and over are recommended adopting a healthy lifestyle; this is through avoiding smoking and alcoholic drinks, consulting a physician, assessing the risk of getting injured with osteoporosis, and taking medications and supplements. This is with the aim of maintaining bone mass and reducing fracture risks.

Maintaining an ideal weight:
It is advisable to make sure of having an ideal body weight as it is among the factors causing bone thinning.

Healthy Nutrition:
Following a balanced diet in each stage of human life enhance the strength and health of bones; meaning that it is recommended adopting a healthy diet comprising of nutritious, diverse meals that contain sufficient amounts of calories in terms of protein, fats, and carbohydrates, as well as vitamins and minerals; especially vitamin D and calcium in both childhood and adolescence stages. As such, good nutrition help build bone mass and maintain it; this in turn lessens the vulnerability to osteoporosis later, especially for adults.

Calcium:
Calcium is the basic component of building the bone tissue; 99% of calcium of the body is found in bone. It acts as storage for maintaining the calcium levels in the blood, and it is instrumental in the functions of the muscles and nerves. Thus, amounts of calcium the body is in need of vary according to life stages, meaning that it abounds in the first years of childhood and at adolescence years, in parallel with the rapid growth of skeleton. Also, body's efficiency in terms of calcium absorbing lessens as age advances. And, this is among the reasons that render the elderly as well in need of consuming higher intake of calcium.

Sources of Calcium:
Milk and other dairy products are the most nutritious sources rich in calcium. And dairy products have one more privilege as they are excellent sources of protein and other micronutrients alongside calcium. There are also calcium-rich nutritious sources including some vegetables such as cauliflower, broccoli; and canned fish along with edible bones such as sardine and salmon; walnut and nuts especially the Brazilian ones; and some fruits such as oranges, apricots, and dried figs.
Similarly, there are calcium-enhanced foods such as calcium-enhanced bread and cereal; fruit juice, soya beverages, and some types of commercial mineral waters containing great deal of calcium as well. These foods provide a proper alternative for those having difficulty digesting lactose and vegetarians; yet, they are indispensable to milk. Therefore, calcium-enhanced dietary supplements are advised to be taken.

Factors Rendering Human Body Unable to Absorb Calcium:
Some leafy produce such as rhubarb containing oxalate which prevents absorbing calcium in these types of vegetables; still, they do not interfere with absorbing calcium from the calcium rich foods eaten at the same time. The same goes for the dried beans and cereal and seed chaff containing phytic acid.
Further, caffeine and salt are instrumental in making body lose calcium and it is not recommended having excessive intake of them. In addition to this, it is advisable to cut back on fizzy drinks; especially that such beverages are inclined to force milk out of the diet of the children and adolescents.

Importance of Exercise:
Exercise and health of bones are closely linked to all ages as it is important for building strong bones and maintaining them; and preventing muscles from getting flaccid.

Benefits of Exercise for Bones:

Patients with diseases rendering them bedridden for longer periods such as spinal cord injuries; this in turn leads to bone loss, muscle damaging, and increasing the risk of fractures within few weeks.
Exercising during childhood and adolescence stages helps develop and strengthen bones; consequently, reducing the risk of experiencing fractures later in lifetime.
Many studies showed that there is a strong link between exercising and outliving in terms of keeping bone mineral density. All the more, it diminishes the risks of hip and arm fractures; and spine breaking at ageing years.
Studies suggested that bone density of those exercising is remarkably higher than those not regularly doing exercise. There are exceptions with regard to the activities involving highly intensive activities, rather than weight, such as swimming.
Studies underlined that exercising pre-forty lessens the risks of falls in terms of the elderly.
Long-term regular exercise maintains the health of bones, and help children build strong bone; and the elderly maintain their bones. It also is instrumental in preventing osteoporosis and falling in terms of the elderly.
Those suffering from fractures can benefit from exercise; namely training under a medical supervision with the aim of boosting up the strength and function of muscles. This in turn leads to more agility and improving on lifestyle.
Exercising is remarkably significant for the elderly, especially as regards women who have the higher rate of bone tissue loss post-menopausal period. That's to say, exercise builds muscles and enhance balance, and prevents falling, which is the principal cause of fractures. This is especially important; namely for the elderly.
There is no specific age for exercising; and it is never too late for those who have never done exercise at all.

Synopsis:
It is recommended following the next three steps: