Osteoporosis - Prevention is the key

Osteoporosis - Prevention is the key
By Priya Mathew
Dr Ayman Mofti

IT HAS NOT YET captured the imagination of the health fanatics in this part of the world the way more 'popular' diseases such as cholesterol or blood pressure have. But then, Osteoporosis and its implications haven't been under the media glare for long even though its complications have been making life difficult for human beings, especially, the female of the species, for ages.

"For many years there was no easy tool to diagnose the condition characterised by low bone mass due to thin bone and large holes in the bone, which in turn makes the bone fragile and prone to fracture. Furthermore, there was no effective treatment for the condition until about eight to ten years ago," says Dr Ayman Mofti, Rheumatologist with American Hospital Dubai.

That might explain to some extent why the media chose to give Osteoporosis the royal ignore all these years. But that has added to the misconceptions people harbour about the condition.

Facts

Osteoporosis, as we know it, falls into two categories, primary and secondary. The most common one is primary Osteoporosis which is not associated with any other disease. It usually occurs in post-menopausal women due to the drop in hormones leading to bone loss.

Men too are candidates for osteoporosis but it happens at a significantly older age, mainly in their late sixties and early seventies.

The main problem with Osteoporosis is that it goes unnoticed as it does not have any symptoms. "Many people believe that pain is a symptom of Osteoporosis. But actually it is the complications that arise due to Osteoporosis that cause the pain. And the complications can vary from broken vertebrae or fractures that cause severe pain and immobility to spinal deformities in the form of humps," says Dr Mofti.

Figures

Statistics say that 1 in 3 menopausal women develop some kind of fracture due to osteoporosis that will in some way threaten the longevity of their lives.

Of all fractures, hip fracture is the most serious complication as about one fourth of women who have had hip fractures die within a year. About half of them have difficulty walking on their own and become totally dependent on others.

Though hip fractures carry a high mortality rate, the most common fracture due to osteoporosis is the vertebral fracture. Something as delicate as coughing or sneezing is known to cause the collapse of the vertebral bone in women with severe osteoporosis.

Avoiding fractures

No wonder Dr Mofti lays great emphasis on preventing fractures once diagnosed with Osteoporosis. "Studies have shown that about 35 per cent of menopausal women develop some kind of fracture that may impact their lives. You can imagine the enormity of the situation when you compare the figure for men belonging to the same age bracket. It is a mere 14 per cent. And hip fractures take the cake in terms of mortality rate. So extra care has to be taken to prevent fractures."

That would include rearranging the furniture layout of the room if it is not patient friendly as tripping and falling forms a major cause of fractures. Another factor that needs to be taken care is the eyesight. If plagued by vision problems, no time should be lost in rectifying them. If certain types of medication, especially medicines for blood pressure make you dizzy, consult your physician and have them replaced by more favourable medicine.

Prevention is better than cure

As with any other medical condition, the age-old adage of prevention is better than cure holds true for Osteoporosis as well.

In order to prevent Osteoporosis, you need to know whether you are at risk of developing Osteoporosis.

Risk factors

Though one cannot do much about the genetic make up as well as the fact that one is a woman naturally progressing towards menopause, there are a whole lot of other risk factors that can be altered to prevent the onset of Osteoporosis.

Inadequate Calcium intake particularly during young age would affect the amount of bone reserves one would have in old age.

An average person requires about 1000-1500 mg of Calcium a day. Young people who drink milk everyday and consume dairy products would easily get the required quantity. But children with lactose intolerance would need to take Calcium supplements in order to build up optimum bone reserves.

Sedentary life style with little or no exercise, especially weight bearing exercise, increases the risk for developing Osteoporosis.

Habits such as excessive smoking and drinking also put you at risk for Osteoporosis.

Certain medications such as high doses of cortisone used for a long time (3 months or longer) or high therapeutic dose of thyroid hormone supplement are said to affect the bones leading to osteoporosis.

Small built women who weigh less than 55 kg are also at the risk of developing Osteoporosis.

Vitamin D deficiency can also lead to Osteoporosis. A person is supposed to have 400-800 international units of Vitamin D every day. Its deficiency either due to mal-absorption or due to less exposure to sun can cause softening of the bone which in turn makes the bone more fragile. Vitamin D deficiency is more evident in women in this part of the world as they spend most of their time indoors and whenever they venture out they are covered from head to toe by their traditional dress.

Regular screening

Osteoporosis is a silent disease. Majority of the people come to know they have Osteoporosis only after they break a bone or two. That is why Dr Mofti insists on regular check ups for postmenopausal women for Osteoporosis. Women deemed to be at a higher risk should be screened for it every one or two years while women with lowered risk should be screened once in five years.

Currently, the most accurate method available to diagnose Osteoporosis is the DEXA test that measures the bone mineral density. It uses a measuring unit called T-score which compares the bone density of an individual with that of an average young adult of the same sex. The T-score can tell the extent of risk you are at for developing Osteoporosis.

If the T-score turns out to be -2.5 or higher, the person can be considered to have Osteoporosis. Further evaluation is recommended to find out whether the patient has primary or secondary Osteoporosis.

"Many people are still very reluctant to take a test for Osteoporosis. It might be due to their ignorance about the impact of Osteoporosis. That's where the media has a significant role to play. If people are made aware of the consequences of Osteoporosis the way they know about the ill-effects of cholesterol or blood pressure, it would be easy to tackle the problem," says Dr Mofti.

And it is not as if you have to pay through the nose to conduct the test for Osteoporosis. It costs as much as a comprehensive test for Cholesterol, which would vary from Dhs 250 to Dhs 500.

Treatment

"Ideally, we need medicines that would rebuild bone as well as medicines that would reduce the bone loss. Medicines that would actually build up the bones are still understudy while we have several medicines which reduce bone wash out," says Dr Mofti.

Hormone Replacement Therapy is also recommended as a preventive and therapeutic medicine for Osteoporosis though it requires longer period of treatment. Though it has its benefits it has its limitations in that it cannot be used in women who are predisposed towards deep vein thrombosis and breast cancer.

Exercise is also recommended before and after the diagnosis of Osteoporosis. Weight bearing exercises such as lifting weight, walking, etc which put pressure on the bones would do a lot of good as it stimulates the bone.

Eliminating the risk factors would also go a long way in controlling Osteoporosis. It is never too late to quit smoking, cut down alcohol consumption and increase Calcium and Vitamin D intake. All these would help but not as effectively as it would have if implemented before being diagnosed with Osteoporosis. Remember, prevention is the key element in tackling Osteoporosis.