JCI Accredited Hospital
|
JCI Accredited Hospital
|
| Home About Services Our Doctors Articles Contact Forum |
| Articles : Women Only : Osteoporosis: this silent thief can be stopped |
|
Issam Mardini, M.D.
 These broken bones, also known as fractures, occur typically in the hip, spine, and wrist. Consider an insidious condition that drains away bone--the hardest, most durable substance in the body. It happens slowly, over years, so that often neither doctor nor patient is aware of weakening bones until one snaps unexpectedly. Unfortunately, this isn't science fiction. It's why osteoporosis is called the silent disease or silent thief. And it steals more than bone. It's the primary cause of hip fracture, which can lead to permanent disability, loss of independence, and sometimes even death. Collapsing spinal vertebrae can produce stooped posture and a "widow’s hump." Lives collapse too. The chronic pain and anxiety that accompany a frail frame make people curtail meaningful activities because, in extreme cases, the simplest things can cause broken bones: Bending to pick up something, a strong hug or a sneeze! A hip fracture almost always requires hospitalization and major surgery. It can impair a person's ability to walk unassisted and may cause prolonged or permanent disability or even death. Spinal or vertebral fractures also have serious consequences, including loss of height, severe back pain, and deformity. A combination of genetic, dietary, hormonal, age-related, and lifestyle factors all contribute to this condition. The osteoporosis seen in postmenopausal women is the most common and best-studied, but there are other causes that may be treated differently. In western countries, one in 2 women and 1 in 4 men older than 50 will suffer a vertebral fracture. There are no statistics in the UAE, but it is a sure fact that the numbers are predicted to rise as the UAE population ages. Changing attitudes and improving technology are brightening the outlook for people with osteoporosis. Nowadays, many women live 30 years or more--perhaps a quarter to a third of their lives--after menopause. Improving the quality of those years has become an important health-care goal. Although some bone loss is expected as people age, osteoporosis is no longer viewed as an inevitable consequence of aging. Diagnosis and treatment need no longer wait until bones break. There is no cure or proven preventive treatment for osteoporosis, but the onset can be delayed and the severity diminished. Most important, early intervention can prevent devastating fractures. Osteoporosis has been described as a geriatric disease with an adolescent onset, highlighting the importance of beginning to take steps--in exercise and diet--early in life to reduce its disabling impact in later years. Bone Life Bone consists of a matrix of fibers of the tough protein collagen, hardened with calcium, phosphorus and other minerals. Two types of architecture give bones strength. Surrounding every bone is a tough, dense rind of cortical bone. Inside is spongy-looking trabecular bone. Its interconnecting structure provides much of the strength of healthy bone, but it is especially vulnerable to osteoporosis. We tend to think of the skeleton as an inert erector set that holds us up and doesn't do much else. That's not true. Every bit as dynamic as other tissues, bone responds to the pull of muscles and gravity, repairs itself, and constantly renews itself. Besides protecting internal organs and allowing us to move about, bone is also involved in the body's handling of minerals. Of the 2 to 4 pounds of calcium in the body, nearly 99 percent is in the teeth and skeleton. The remainder plays a critical role in blood clotting, nerve transmission, muscle contraction (including heartbeat), and other functions. The body keeps the blood level of calcium within a narrow range. When needed, bones release calcium. A complex interplay of many hormones balances the activity of the two types of cells--osteoclasts and osteoblasts--responsible for the continuous turnover process called remodeling. Osteoclasts break down bone, and osteoblasts build it. In youth, bone building prevails. Bone mass peaks by about age 30, then bone breakdown outpaces formation, and density declines, since the volume of bone remains about the same. 
The skeleton is like a retirement account for minerals, but in our skeletal "account" we can deposit bone faster than we withdraw it only during our first three decades. After that, withdrawals are greater than deposits, and all we can do is try to minimize the net loss. Osteoporotic fractures are the sign of the bankruptcy that occurs when too little bone is formed during youth, or too much is lost later, or both. You've got to get as much bone as you can and not lose it. The most important risk factor for osteoporosis is a low bone mass. The upper limit of bone mass that you can acquire is genetically determined. But even though you may be programmed for high bone mass, other factors can influence how much bone you end up with. For instance, men tend to build greater bone mass, which is partly why more women face osteoporosis. But there's another reason. With the decline of the female hormone estrogen at menopause, usually around age 50, bone breakdown markedly increases. For several years, women lose bone two to four times faster than they did before menopause. The rate usually slows down again, but some women may continue to lose bone rapidly. By age 65, some women have lost half their skeletal mass. There are several steps you can take to prevent osteoporosis: Osteoporosis is largely preventable for most people. Prevention of this disease is very important because, while there are treatments for osteoporosis, there is currently no cure. There are four steps to prevent osteoporosis. No one step alone is enough to prevent osteoporosis but all four may. They are:
Calcium is needed for the heart, muscles and nerves to function properly and for blood to clot. Inadequate calcium is thought to contribute to the development of osteoporosis. Nutrition surveys have shown that many women and young girls consume less than half the amount of calcium recommended to grow and maintain healthy bones. Depending on your age, an appropriate calcium intake falls between 1000 and 1300 mg a day. If you have difficulty getting enough calcium from the foods you eat, you may take a calcium supplement to make up the difference. Your skeletal calcium bank has to last through old age. Frequent deposits to this retirement account should begin in youth and be maintained throughout life to help minimize withdrawals. Most women get much less calcium than they need--as little as half. Nutritionists recommend meeting your calcium needs with foods naturally rich in calcium. Adequate calcium intake in childhood and young adulthood is critical to achieving peak adult bone mass, yet many adolescent girls replace milk with nutrient-poor beverages like soda pop. Bone health requires a lot of nutrients and you're likely to get most of them in dairy products. They're a huge package rather than just a single nutrient. With so many low-fat and nonfat dairy products available, it's easy to make dairy foods part of a healthy diet. People who have trouble digesting milk can look for products treated to reduce lactose. A serving of milk or yogurt contains about 350 milligrams of calcium. Fortified products have even more. How Much Calcium Do You Need? Age Recommended Intake
Calcium is critical, but even a high intake won't fully protect you against bone loss caused by estrogen deficiency, physical inactivity, alcohol abuse, smoking, or medical disorders and treatments. Vitamin D Vitamin D is needed for the body to absorb calcium. Without enough vitamin D, you will be unable to absorb calcium from the foods you eat, and your body will have to take calcium from your bones. Vitamin D is needed to help the body absorb calcium. Most people appear to get enough vitamin D because the skin produces it in sunlight and is also found in egg yolks, saltwater fish and liver.. And many foods, such as milk products and breakfast cereals, are fortified with vitamin D. But older adults and people with little exposure to sunlight may need a vitamin D supplement. 
Exercise If you go to the doctor and get a prescription, and that's all you do, you're probably not going to be helped very much. Exercise is crucial to good bone health. If you exercise regularly in childhood and adolescence, you are more likely to reach your peak bone density than those who are inactive. Calcium intake is critical, and those who need it most--younger women and girls--may not get enough. But calcium alone can't build bones. The truth is, you don't have to do very much to get most of the benefits of exercise. Thirty minutes of brisk walking five days a week is plenty. Add a little weightlifting, and that's even better. It's always smart to ask your doctor before starting a new exercise program, especially if you already have osteoporosis or other health problems. The best exercise for your bones is weight-bearing exercise such as walking, dancing, jogging, stair-climbing, lifting weights, racquet sports and hiking. Swimming is not as beneficial since there is no weight bearing activity although it is great for stretching and preventing back pain. If you have been sedentary most of your adult life, be sure to check with your healthcare provider before beginning any exercise program. The greatest benefit for older people is that physical fitness reduces the risk of fracture, because better balance, muscle strength, and agility make falls less likely. Exercise also provides many other life-enhancing psychological and cardiovascular benefits. Increased activity can aid nutrition, too, because it boosts appetite, which is often reduced in older people. The biggest reason older people don't get enough calcium, is that they simply don't eat much. A healthy lifestyle with no smoking or excessive alcohol use Smoking. Smoking is bad for your bones as well as for your heart and lungs. Women who smoke have lower levels of estrogen compared to nonsmokers and frequently go through menopause earlier. Postmenopausal women who smoke may require higher doses of hormone replacement therapy and may have more side effects. Smokers also may absorb less calcium from their diets. Alcohol. Regular consumption of 2 to 3 ounces a day of alcohol may be damaging to the skeleton, even in young women and men. Those who drink heavily are more prone to bone loss and fractures, both because of poor nutrition as well as increased risk of falling. Medications that cause bone loss. The long-term use of glucocorticoids (medications prescribed for a wide range of diseases, including arthritis, asthma, Crohn's disease, lupus, and other diseases of the lungs, kidneys, and liver) can lead to a loss of bone density and fractures. Other forms of drug therapy that can cause bone loss include long-term treatment with certain antiseizure drugs, such as phenytoin (Dilantin®) and barbiturates; gonadotropin releasing hormone (GnRH) analogs used to treat endometriosis; excessive use of aluminum-containing antacids; certain cancer treatments; and excessive thyroid hormone. It is important to discuss the use of these drugs with your physician, and not to stop or alter your medication dose on your own. Medications for Prevention and Treatment Although there is no cure for osteoporosis, currently bisphosphonates (alendronate and risedronate), calcitonin, estrogens, parathyroid hormone and raloxifene are approved by the US Food and Drug Administration (FDA) for the prevention and/or treatment of osteoporosis. An important treatment option became available to women in November 2002. Forteo (teriparatide) is the first treatment that stimulates new bone growth to increase bone mass. Forteo is a portion of human parathyroid hormone, which works in the body to regulate the metabolism of calcium and phosphate in bones. The treatment is given in daily injections and is approved only for postmenopausal women who are at a very high risk for bone fractures since it may cause a severe form of bone cancer. All other drugs approved for osteoporosis treatment act by slowing the turnover of bone, rather than stimulating new bone formation. Increases in bone mass are most pronounced in the first year or two after treatment with the drugs begins, then taper off. Any gain is helpful, even if it doesn't continue; because increases in bone mass help reduce fracture risk. Fosamex, a non-hormonal therapy increases bone mass as much as 8 percent and reduce fractures by as much as 30 percent to 40 percent, depending on skeletal site. To avoid damage to the esophagus, Fosamex should be taken according to the instructions. These instructions include taking the drug in the morning upon awaking and at least half an hour before eating. The drug should be taken with a glass of water, and the person should remain upright for half an hour after taking it. Fosamex should not be taken by people who cannot stand or sit upright or who have disorders that prevent esophageal emptying into the stomach. While estrogen may be a good option for some women, new guidelines developed in 2003 by the FDA advise doctors to consider alternative treatments. These changes were prompted by studies indicating that women who take estrogen or estrogen with progestin products after menopause are at higher risk for other conditions, including cardiovascular disease and breast cancer. Because of this, estrogen-containing products should only be considered for women at significant risk of osteoporosis. Bone Mineral Density Tests Because the changes at menopause increase a woman's risk, many physicians feel it's a good time to measure a woman's bone mineral density, especially if she has other risk factors for osteoporosis. Routine X-rays can't detect osteoporosis until it's quite advanced, but other radiological methods can. A Bone Mineral Density test (BMD) is the only way to diagnose osteoporosis and determine your risk for future fracture. Since osteoporosis can develop undetected for decades until a fracture occurs, early diagnosis is important. A BMD measures the density of your bones (bone mass) and is necessary to determine whether you need medication to help maintain your bone mass, prevent further bone. There's a profound relationship between bone mass and risk of fracture. A bone mineral density (BMD) test is a special type of test that is accurate, painless and noninvasive. A newer technique for evaluating bone strength is ultrasound, and the FDA has approved several instruments for this purpose. These machines use the same principles that are employed when using ultrasound to look at fetuses during pregnancy. Although this measurement examines different properties of bone than do X-ray-based bone densitometers, the results are also useful for prediction of fracture. The devices for ultrasound measurement are easier to use. Because they don't use X-rays, they are safer and may be used for repeated examinations, even in pregnant women and children, so they provide a means for better public health practice. Readings repeated at intervals of a year or more can determine the rate of bone loss and help monitor treatment effectiveness.
Exercise daily to maintain your body shape, bones and prevent depression which is more common in women around menopause. Avoid tanning which destroys your skin. Tanning today is associated with ignorance rather than beauty, wealth or health. Use instead tanning lotions. You will get all the vitamin D from your daily unavoidable sun exposure when driving or walking around.
|
|
CopyRight Emirates Hospital © 2011 MOH License Number: 1841/2/8/31/7/11 |