OSTEOPOROSIS- DIAGNOSIS, PREVENTION AND MANAGEMENT

It may come as a surprise to a lot of people but bones are living tissue; they grow and replenish throughout life. In fact, the human skeleton renews completely every five to ten years.?

FUN FACT: At birth, we have 300 bones, but with age many of these bones fuse, for example the skull bones, and by adulthood, we are left with only 206 bones.

Bone tissue is composed of flexible collagen fibres, interspersed with minerals, such as Calcium and Phosphorus, which gives them strength and makes them rigid. They are the heaviest part of our bodies and make up nearly 15% of the body weight. The skeleton is built to bear high impact stress, such as running, walking and jumping.

How does age affect bone growth

Throughout life, bone cells are destroyed and replaced by new cells, but there is a decline in the rate or replacement as we age. In childhood and adolescence, bones grow at a rapid rate and outpace bone loss. In our 20s and early 30s, bone mineralisation is at its peak, which means that bones are the strongest they would ever be. As we approach our 40s, our body is not able to replace cells at the rate they are being destroyed and there is a net loss. A healthy lifestyle plays a big role in how rapidly the bones decline; good nutrition, including adequate Calcium and Vitamin D and exercise, can stabilize bone loss.?

Estrogen and Testosterone, both have a protective role in bone health. As women approach menopause, there is a sharp decline in Estrogen levels, which leads to an accelerated rate of bone loss. For men, the loss is gradual as Testosterone levels decline more gradually over a long period of time. By the mid sixties, bone loss in men catch up to the levels of females and bone mass gradually decreases for the rest of your life. This puts both men and women at greater risk for fractures as they age.

What is the Difference Between Osteopenia and Osteoporosis

The difference between osteopenia and osteoporosis is the degree of decline in bone density. Osteopenia is the beginning of the loss of bone mass resulting in some weakness of bones and if not treated at this stage, will lead to osteoporosis. Osteoporosis is the name given to a condition when the loss of bone is so marked that there are structural changes in bone tissue which can lead to fractures.?

Symptoms of Osteoporosis

Osteoporosis affects men and women of all races but the greatest risk is for elderly Caucasian and Asian women. In early stages, the condition is a-symptomatic. And it is imperative to find the condition at this stage, so that appropriate treatment can be started. As osteoporosis progresses, symptoms start appearing, which may include

• Back pain- may be caused by a collapsed vertebra
• Stooped posture
• Loss of height
• Spontaneous fractures- these are bone breaks which occur without an accident or impact

Risk Factors for Osteoporosis

Risk factors for osteoporosis include?

Unchangeable Risk Factors

? Age- risk of osteoporosis increases with age

? Sex- women are at a higher risk for developing osteoporosis

? Race- White and Asian women are at a higher risk

? Body frame- petite men and women are more likely to develop osteoporosis as they have less bone mass to draw from

Hormone Levels

? Sex Hormones- decrease in Estrogen level after menopause is the single biggest risk factor for osteoporosis. Treatment for prostate cancer, which decreases the level of Testosterone is also likely to accelerate bone loss

? Increased Thyroid Hormone- this may be a result of Hyperthyroidism or excess use of Thyroid hormone-a medication used for treating hypothyroidism; both these conditions can lead to osteoporosis

? Other Hormonal Abnormalities- such as hyperparathyroidism and overactive adrenal glands can also lead to osteoporosis

Dietary Factors

? Low Calcium and Vitamin D- a diet poor in Calcium and Vitamin D can lead to less dense bones and over a lifetime can be a precursor to osteopenia and osteoporosis.

? Eating Disorders- such as Anorexia or severe restriction of food intake can result in weakened bones

? Gastro-intestinal surgery- stomach reduction surgery, which may be done for weight loss reduces surface area for absorption of nutrients, including Calcium

? Medications- long term steroid use is strongly associated with osteoporosis. Certain medications used for cancer, seizures and gastric reflux may also lead to bone loss

Lifestyle Choices

? Sedentary lifestyle- people who lead an active lifestyle and include weight bearing exercises in their daily routine have a lower risk for osteoporosis compared to those who spend a lot of time sitting

? Smoking- Nicotine is toxic to all cells including bone cells and may lead to bone loss

? Alcohol use- excessive alcohol consumption increases the risk of osteoporosis

How is osteoporosis diagnosed

Bone mineral density (BMD) test, also called dual energy X-ray absorptiometry (DEXA) is one of the bests tests to look at bone density. These X-rays use a small amount of radiation to determine how solid the bones of the hip, spine or wrist are. DEXA scans are recommended for post-menopausal women and men over the age of 60 years or at an earlier age if you have family history of osteoporosis.?

How to Safeguard against Osteoporosis

Calcium?

Between the ages of 18 and 50 years, men and women require 1,000 mg of Calcium a day, which increases to 1,200 mg for women after menopause and for men after the age of 65 years.

? Good sources of Calcium include?

? Dairy products- milk, yoghurt and cheese

? Green leafy vegetables

? Calcium fortified cereals?

? Soy products, such as tofu

? Canned salmon and sardines with edible bones

Calcium supplements are available for those who are unable to get enough Calcium through food.

Vitamin D

Vitamin D helps in absorption of Calcium and also independently helps in building strong bones. Recommended daily requirement is 600-800 IU for Vitamin D. Normal levels of Vitamin D is higher than 20 ng/ml, however it is recommended to maintain levels closer to 50ng/ml for healthy bones

Good sources of Vitamin D include

? Exposure to sunlight- recommended to stay outdoors for 30 minutes a day

? Cod liver oil

? Fatty fish, such as trout, salmon and mackerel

? Vitamin D fortified milk and cereal

Most multi-vitamins also contain the recommended dose of Vitamin D.

Get Physical

Regular exercise helps build strong bones, especially weight bearing and strengthening exercises. For the legs, best exercises include those which use heal strike movements, such as walking, running, dancing and climbing stairs.?

Resistance exercises such push-ups, lifting weights, rowing and working out with resistance bands help strengthen bones in the arms.

Aim to get at least 30 minutes of exercise, five days a week.

Quit Smoking

Nicotine and other chemicals in cigarettes slow bone growth and also decrease blood supply to the bones. This results in weaker bones, which are more likely to break as you age. This can be a major concern in the spine, which, is less perfused to start with. Once you quit smoking, these risks decrease, but it can take several years to improve your bone health

Limit Alcohol intake

Alcohol can directly affect bone formation by interfering with osteoblast (bone growth cells) activity; it also leads to more falls and can cause fractures. Heavy drinking is more than 15 drinks per week for men and more than 8 drinks per week for women. No more than one drink a day for women and two drink a day for men is recommended

Treatment with medications

If you have osteoporosis or osteopenia, your rheumatologist may recommend medications to slow bone loss. There are several classes of medications available to treat osteoporosis.

? Hormone and hormone related therapy- these include Estrogen (usually for younger women), Testosterone (for men who have low levels) and a selective estrogen receptor blocker, Raloxifene, which acts like Estrogen with the bones.

? Anti-resorptive meds- which impede bone re-absorption by the body, thus decreasing bone loss- these include medications, such as bisphosphonates

? Anabolic meds- these help in building new bone tissue and include medications such as Romososumab and Teriparatide