Prof Bashir Ahmad Laway
What is meant by weak bones?
Bones are so weak that break easily upon a minor fall. Osteoporosis is a condition in which bones become thin because of reduced mass.
Normal bone and brittle bone
Normal bone mainly consists of two parts: an inner spongy portion and an outer hard shell. The inner portion mainly consists of small spaces, (like a honeycomb) and outer hard portion makes a dense shell around the spongy portion. When bone is affected by osteoporosis, the holes in the honeycomb structure become larger, the outer shell also grows weaker and thinner, and the overall density is lower, which is why the bone is more likely to fracture. These fractures can occur while doing routine activities such as standing or walking, minor fall, a bump, a sneeze, or a sudden movement. The most commonly affected bones are the ribs, hip, wrist bones and spine. Osteoporosis can occur in people of any age, but it is more common in older adults, especially women.
Who gets osteoporosis?
Anyone can get osteoporosis but women are about four times more likely than men to develop. There are two main reasons for this: The process of bone loss speeds up for several years after the menopause, when the ovaries stop producing the female sex hormone called estrogen. Women undergo rapid bone loss in the first 10 years after entering menopause Men generally reach a higher level of bone density before the process of bone loss begins. Bone loss still occurs in men but it has to be more severe before osteoporosis occurs.
Osteoporosis is common and the risk increases with age. According to global statistics from the International Osteoporosis Foundation, about one out ten women, aged 60 have osteoporosis; while two out of five women aged, 80 have the disease. The reduced quality of life for those with osteoporosis is enormous. Osteoporosis can result in disfigurement, lowered self-esteem, reduction or loss of mobility, and decreased independence.
Risk factors for osteoporosis?
There are many risk factors that increase the chance of developing osteoporosis, with two of the most significant being age and gender.
1. Age and gender: Osteoporosis is more common in women than men are and it increases with age in both. Asian women are more likely to develop osteoporosis. Thin people have a greater risk of developing osteoporosis because they have less bone to lose than people with more body weight and larger frames do. Osteoporosis also runs in families.
2. Medical conditions: Some conditions like thyroid, parathyroid disease, previous obesity surgery, gastrointestinal diseases like celiac and inflammatory bowel disease and blood dyscrasias like myeloma increase the risk of osteoporosis.
3. Drugs: Some medications cause side effects that may damage bone and lead to osteoporosis. These include steroids, medications for breast cancer and seizures.
4. Eating and lifestyle habits: Osteoporosisis more common in people with deficiency of calcium and vitamin D; People who lead sedentary (inactive) lifestyles have a higher risk of osteoporosis. Smoking and alcohol use increases the risk of fractures.
5. Nutrition and exercise in childhood: Bone-healthy nutrition and regular, vigorous exercise during childhood and adolescence are the key ways in which to maximize a child’s genetic potential for strong bones – and a first step to osteoporosis prevention in later life.
Symptoms of Osteoporosis
Osteoporosis mostly does not produce any symptoms until a bone is broken with a minor trauma. Some symptoms include pain in the back or neck if there is a vertebral fracture, decreasing height, a stopped posture or receding gums. A bone breaks much more easily than expected Osteoporosis is not a cause of pain in the knees which most of the people think.
Diagnosis of osteoporosis
Diagnosis of osteoporosis is based on detection of low bone density on imaging. Routine X-rays will only detect osteoporosis if there is loss of more than 30% of bone density. It may also reveal an asymptomatic fracture. Dual energy x-ray absorptiometry (DXA) scan is the most sensitive way of measurement of bone density. However, the DXA scan needs to be done by a trained person and the results interpreted by a trained clinician. Routine machine made report may sometimes be misleading. All women over the age of 65 should have a bone density test. The DEXA scan done earlier for women who have risk factors for osteoporosis. Men over age 70, or younger men with risk factors, should also consider getting a bone density test.
Treatment of osteoporosis
Main goal of treatment of osteoporosis is to prevent fractures. There are three ways of finding weather a person will need treatment or not. Previous history of fracture, low bone mass on DXA scan or high future probability of a fracture calculated with an online score called FRAX. Many women may need treatment in presence of other risk factors even if bone density is not severely decreased, a condition called osteopenia.
Prevention of osteoporosis
Diet and lifestyle are two important factors, which are modifiable to prevent osteoporosis.
Getting an adequate supply of calcium and vitamin D is the mainstay of both prevention and treatment of osteoporosis. To maintain strong, healthy bones, you need a diet rich in calcium throughout life. The rich sources of calcium are milk, broccoli, calcium-fortified juices and breads, dried figs, and calcium supplements. It is best to try to get the calcium from food and drink. For those who need supplements, remember that the body can only absorb 500 mg of calcium at a time. One should take calcium supplements in divided doses, since not anything more than 500 mg is absorbed. The recommended amount of daily calcium intake is 1,000 mg to 1,200 mg daily via diet and/or supplements. Taking more than this amount of calcium provides additional bone strength but may be associated with an increased risk of kidney stones, calcium buildup in the blood vessels and constipation. Vitamin D is also important because it enables the body to absorb calcium. The recommended daily allowances of vitamin D are around one to two thousand units per day. Vitamin D comes from sunlight exposure a few times a week or by drinking fortified milk. Many people do not have adequate levels and might need to take supplements.
Maintaining a healthy lifestyle can reduce the degree of bone loss. Begin a regular exercise program. Exercises that make your muscles work against gravity (such as walking, jogging, aerobics, and weightlifting) are best for strengthening bones. Do not drink too much alcohol. Do not have excessive amounts of caffeine. Do not use tobacco at all.
Prevent falls inside your home
• Keep your floors free of clutter, including throw rugs and loose wires and cords. Use only non-skid items if you have mats, carpets or area rugs.
• Make sure your lighting is bright enough so that you can see well.
• Do not use cleaners that leave your floors slippery.
• Clean up any spills that happen immediately.
• Use grab bars in the bathroom and railings on stairways.
Prevent falls outside your home
• Make sure lighting is adequate in all areas outside your home.
• Use a backpack or other type of bag that leaves your hands free.
• Keep areas outside in good repair and free of clutter.
• Wear sensible shoes with non-slip bottoms
• Take your time. You might be less careful if you are in a hurry.
1. Osteoporosis is common especially in women of more than 50 years age.
2. Patients with osteoporosis are at high risk for fractures after routine activities.
3. Screen every woman for osteoporosis after the age of 60 years and men after 65 years. Adequate intake of calcium is essential to prevent and treat osteoporosis.
4. Every effort should be made at home to prevent a fall and hence prevent a fracture.
The author is Professor and Head, Department of Endocrinology at SKIMS Soura.
Disclaimer: The views and opinions expressed in this article are the personal opinions of the author. The facts, analysis, assumptions and perspective appearing in the article do not reflect the views of GK.