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Osteoporosis- What you should know

Updated on June 23, 2014
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Ian is a Ugandan Orthopedic officer currently working with Fort portal regional referral hospital - Fort portal western Uganda

Osteoporosis is a progressive bone disease that is characterized by a decrease in bone mass and density, resulting in weak bones vulnerable to fractures. According to the world health organization (WHO), osteoporosis is defined as a bone mineral density of 2.5 standard deviation or more, below the mean peak mass. Bone mineral density is a medical term used to mean the amount of matter per square centimeter of bones, and can be measured with the help of a special test calledthe bone mineral density Test’. Bone mineral density test is a test performed by doctors to measure how much calcium and other types of minerals are in an area of a bone.

Fracture Neck of the femur Due to Osteoporosis
Fracture Neck of the femur Due to Osteoporosis

A public health problem

Osteoporosis is a silent Public health problem typically affecting adults over the age of 50 years. The disease may be classified as primary type 1, primary type 2 or secondary. Primary type 1, also referred to as postmenopausal osteoporosis is the most common form, affecting women after menopause as a result of hormonal changes(estrogen in particular). Primary type 2 is also known as senile osteoporosis and occurs after age 75 and is seen in both males and females at a ratio of 1:2. Secondary osteoporosis results from chronic predisposing medical problems and may arise at any age, affecting males and females equally. Prolonged use of medications such as glucocorticoids can also lead to this type. (Glucocorticoid-induced osteoporosis).

According to the international osteoporosis foundation, osteoporosis causes 8.9 million fractures annually worldwide, translating into an osteoporotic fracture every 3 seconds. One in every three women over age 50 years will experience osteoporotic fractures, as will 1 in 5 men. Statistics show that in Europe alone, the disability due to osteoporosis is estimated to be greater than that caused by cancer (with exception of lung cancer) and is comparable to that lost to a variety of chronic non communicable disease, such as rheumatoid arthritis, asthma, and high blood pressure related disease. Despite these findings, evidence suggests that many women who sustain fragility fracture are not appropriately diagnosed and treated for probable osteoporosis. It is also estimated that the life time risk of experiencing an osteoporotic fracture in men over the age of 50 is 30% similar to the life time risk of developing prostate cancer. Although the overall prevalence of fragility fractures is higher in women, men generally have higher rates of fracture related mortality. Studies suggest that by the year 2050, the worldwide incidence of hip fractures in men is projected to increase by 310% and 240% in women, probably due to lifestyle.

Signs and symptoms

Osteoporosis has no typical symptoms. But ounce bones are weakened one may experience symptoms such as back pain, which could be as a result a fracture or collapsed vertebra. There may be loss of height over time and the person may develop a stooped posture. The most obvious sign is a bone fracture which occurs more easily than expected, in any part of the body. These fractures occur because the bones are weak and are no longer able to efficiently support body weight. The bones thus break even under slight pressure. They commonly occur in the hipbones, wrists or spine

Prevalence of Osteoporosis by Age and Sex

Progress of Osteoporosis in the bones of the Spine with Age
Progress of Osteoporosis in the bones of the Spine with Age

How to Reduce risk Of osteoporosis

The most important Risk factor for osteoporosis is advanced age in both men and women, and deficiency of the female sex hormone; estrogen following menopause. There is little one can do to prevent aging, however, there are some predisposing factors which are potentially modifiable, to help keep bones strong and healthy and cut down on the risk of fractures resulting from, osteoporosis.

A calcium rich diet and Vitamin D

Calcium is an important building block for bone tissue. A regular calcium intake is thus important for bone health. The American institute of medicine recommends 1000 mg of calcium per day for adults and 1200 mg for women after menopause. Foods rich in calcium include; Milk and other dairy products, leafy green vegetables, fish as well as lean meat. Vitamin D is essential for absorbing and processing calcium. Adequate levels of calcium intake in fact maximize the positive effect of physical activity on bone health during the growth period of children.

Vitamin D is naturally made in the body when the skin is exposed to the sun. However as we age the body’s efficiency to process vitamin D reduces and thus old people are at risk of vitamin D deficiency. It is how ever not restricted to old age as it can affect all age groups. Normal adults need about 600 IU of vitamin D, while adults above 70 years require 800 IU of vitamin D, to prevent fragility fractures. A few foods contain Vitamin D such as Milk and some brands of yoghurt fortified with vitamin D. Whole grain foods such as nuts and beans as well as fruits are also important in the diet for strong bones since they contain nutrients such as proteins, vitamin B12 vitamin C, and magnesium. A study done on elderly men and women showed that higher dietary protein intake was associated with a lower rate of age related bone loss.

Avoid smoking.

Many people smoke for various reasons despite vivid warnings that smoking is dangerous to their health. I happened to interact with one patient who I was treating for Lower back pain. After giving a long explanation about how he could protect his back, I made a comment that he also needed to quit smoking because it would kill him. in response he asked, " so you don't smoke?" "Of course not!" I answered. and he was like," so you wont die?". I was lost for words for a while. There is overwhelming evidence that smoking is associated with decreased bone strength. It is thought that tobacco inhibits activities of osteoblasts (Bone forming cells), although the precise mechanism through which this happens is still debatable. Some schools of thought argue that smoking reduces the body’s efficiency of absorbing calcium.

Avoid excess alcohol consumption

Research shows that chronic heavy alcohol drinking greater than three units per day increases risk of reduced bone mineral density and hence fractures. On the other hand there is evidence that moderate alcohol consumption is beneficial in slowing bone loss. Combining alcohol with smoking is pleasurable for many people but doubles the risk of weak bones, and accelerates the aging process in the body.

Regular exercise

It is said that there are three principles to a healthy stress free lifestyle; adequate quality food, adequate sleep and adequate physical activities. Regular exercise is vital in dealing with several health issues and bone health is no exception. Living a sedentary life style not only affects the heart but is in fact a serious risk factor for osteoporosis. Weight bearing activities like walking, jogging, stair climbing are great for archiving peak bone mass and there is significant correlation between bone mass muscle strength. May be it is time to quit the elevator and escalator. According to the international osteoporosis foundation, child hood and adolescence are valuable times to improve bone mass through exercise. Children should thus be allowed adequate play time in addition to quality meal time. They further state that epidemiological evidence suggests that physical activity is associated with reduction in hip fractures in both women and men, and that bone density in postmenopausal women can be maintained or increased with therapeutic exercise.


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