Approximately one out of three women over 50 will have a fracture due to Osteoporosis - Study:
The New Year may be over, yet the festive season is likely to continue in many homes where so much labour and effort were made to make it a special event under the new Covid-19 era.
The brunt of the work will invariably fall on the shoulders of women, whether young,middle aged or elderly- often leaving negative impacts on their health. Bone specialists have expressed their concerns especially regarding women with Osteoporosis who could suffer from a further deterioration of their muscles caused by having to carry excessive weights such as heavy pots and pans, clean the garden and house, polish the floor, wash loads of dirty linen and hang them up in the garden.
As recent studies have shown that Osteoporosis is on the rise in Sri Lanka and the victims are largely women, they are now demanding that health authorities should pay more attention to this negative outcome which often aggravates during the many festivals we celebrate all the year round- starting from New Year in January through the National New Year in April to Thai Pongal and Vesak and climaxing in Christmas festivities.
For the benefit of our Sri Lankan women with bone and posture problems, the Sunday Observer spoke to Head of Rehabilitation Services, MJF Charitable Foundation, Dr. Gopi Kitnasamy to explain what Osteoporosis is, how it occurs and when, and changes in lifestyles, eating habits and diet they need to make in order to prevent further bone loss during any period that requires them to perform physical activities beyond their usual routine work.
Excerpts
Q: Since many readers still don’t understand what Osteoporosis means, could you explain it to them in simple layman language?
A. Osteoporosis is a chronic, debilitating disease whereby the mass and quality of bone are reduced. The bones become porous and fragile, the skeleton weakens, and the risk of fractures greatly increases. The loss of bone occurs “silently” and progressively, often without symptoms until the first fracture occurs, most commonly at the wrist, spine or hip. Osteoporotic fractures negatively affect quality of life and often result in pain, loss of function and, in the worst cases, death. Approximately one out of three women over 50 will have a fracture due to Osteoporosis (more than breast cancer) as will one out of five men over 50 (more than prostate cancer).
Q:At what age does it start to develop?
A. There is nothing permanent about living bones. Younger, active people produce more new bone tissue than they lose, and therefore their bone density increases. Generally we achieve maximum bone density and strength (peak bone mass) around the age of 30. Like a muscle, it can grow and it can shrink. It is in a constant state of change. Unfortunately, the biggest change comes with age. As people get older their bones begin to deteriorate. Even as early as age 40, bones are no longer as strong as they once were. Bone density gradually begins to decline as we age, and most of us also become less active. For women, bone loss is usually most rapid during the first few years after menopause due to loss of oestrogen.
Q: Can children get Osteoporosis?
A. Rarely. But children with disabilities can get Osteoporosis because of less mobility and weight bearing. Bone building in children is a good investment. Exercise builds bone in children and hence children should get plenty of exercise to help build their peak bone mass, during their developing years as their bodies grow providing they are done under supervision and according to the child’s age and height.
Q: So how can we ensure that our bones don’t deteriorate with the passing of years?
A. One of the best ways to build and maintain healthy bones is through exercise. The bones that make up our skeleton are made from living tissue, which renews itself continuously throughout our life. If our skeleton is to do this effectively and remain strong, it needs regular stimulation from physical activity. Bones should be used regularly or they will deteriorate, just as muscles do if they are not used. Bones need a variety of brief, frequent loads every day (e.g., normal daily activities like walking and climbing stairs) to maintain their strength, and bones need to be loaded a bit more than usual (exercise) to improve their strength. Exercise is fundamental to slowing the progression of Osteoporosis.
Q: Are there certain risk factors that could be controlled or modified to prevent Osteoporosis especially at this time around?
A. The following risk factors can be controlled or modified
Excessive alcohol consumption can contribute to Osteoporosis.
Smoking: Cigarette toxins from cigarettes destroy cells that contribute to healthy bone mass density.
Those who are excessively skinny (including those who suffer from Anorexia) are at higher risk of Osteoporosis and are twice as likely to suffer fractures.
Malnutrition: A diet that does not include the 5 food groups will lead to nutritional imbalance, and malnutrition for example of calcium, vitamin D, and protein.
Lack of Exercise: Those who do not exercise are at higher risk of developing Osteoporosis. Office workers who sit for more than 9 hours a day are 50 percent more likely to have Osteoporosis than people who sit 6 hours a day
Diet: Consumption of more than 1 teaspoon of salt, 3 glasses of tea or coffee, and 4 or more cans of soda per day, as well as intake of protein 10-15 percent in each meal, can lead to Osteoporosis.
Q: What are the Risk Factors that cannot be controlled ?
Sex: In terms of cases and onset, women develop Osteoporosis faster than men. Especially post-menopause or if ovaries have been removed. Bone deterioration is heightened due to hormone deficiency, leading to approximately 40-50 percent of women at risk of fracture.
Age: Bone mass density peaks at around 30 years of age, gradually decreasing after.
Genetics: If a family member has a history of Osteoporosis and fracture, this will increase the chances of the younger generations having Osteoporosis.
Nationality: Caucasians and Asians are at higher risk of Osteoporosis
Medication: Certain types of medication (steroid medication) can contribute to lower bone mass density.
History of fracture: Those with fracture have 2.5 times higher chance of another fracture occurring
Q: How do you measure bone density?
A. Bone Densitometry, also called DEXA or DXA, is commonly used to measure Bone Mineral Density (BMD) and to diagnose Osteoporosis, to assess an individual’s risk for developing osteoporotic fractures. DXA is simple, quick and noninvasive. It’s also the most commonly used and the most standard method for diagnosing Osteoporosis.
Q: When should you measure Bone Mineral Density (BMD)?
A. Those without risk factors: Should start BMD check-ups aged 60 and above
Those with high risk factors: Those with a family history of fractures as a result of Osteoporosis, or individuals who consume steroid medication should actively seek regular BMD check-ups.
Q: Any other related issues ?
A. Fractures caused by Osteoporosis of the bones in the spine (vertebrae) usually occur in the lumbar (lower) or thoracic (middle) areas of the spine. It is estimated that only one out of three vertebral fractures come to clinical attention. The most common cause of Kyphosis (curvature in spine) in adults is from vertebral fracture due to Osteoporosis. Kyphosis causes loss of height, poor posture, and a shift in the center of gravity - greater risk of falling - fracture. Exercising your back during middle-age can help prevent your vertebrae from weakening or fracturing when you get older. Posture correction exercises, abdominal and back muscle strengthening will relieve pressure on the spine, help to improve posture and reduce discomfort.
Q: What is your advice on exercise for those with an underlying medical condition?
A. People with medical conditions or those who have not been exercising regularly should consult a Doctor / a Physiotherapist before starting any exercise program. Start slowly and progress gradually. Short duration, intense exercise builds bone most efficiently. If exercise time needs to be reduced, it is better to reduce the length of each session rather than the number of sessions per week.
Q: Have you any simple guidelines that readers can follow regarding activities to be avoided ?
A. The following activities should be avoided:
High impact exercise
Abdominal curl-ups /forward bending from the waist
Trunk rotational torsion movements with any loading
Jarring or twisting movements
heavy lifting
In addition to the above mentioned activities, also avoid exercise machines, abdominal exercises, bicep-curl machines, cross-country ski machines, rowing machines, stationary bicycles with moving handlebars, and any other machine that involves trunk rotation or forward bending.
Q: What activities should be encouraged?
A. Weight-bearing and high impact exercise is required to stimulate bone formation. Sports that involve walking, running, sprinting, jumping, skipping, jogging, stair-climbing, weight-lifting, aerobics, tennis, dancing, are good. Low impact, low load sports like swimming and cycling are beneficial for cardiovascular health and improving muscle strength. Remember, muscle strength and bone strength are related. Muscle strengthening exercises can help to rebuild bone in those who have developed Osteoporosis. Overall, Exercise also has added benefits beyond Osteoporosis treatment and prevention such as reduced risk of heart disease, weight management and the prevention of high blood pressure.
Q: Indoor accidents especially during this time are common. How can they be minimised or eliminated?
A. Every year, about two out of five people over 65 will fall at least once. Simple steps you can take at home to prevent indoor accidents, prevent fractures from falling, or any impacts that can cause imbalance, especially in older family members. Remove objects that can cause falls or tripping such as electrical wires, telephone cords, ropes, rugs and doormats. Install handles along the walls and a rubber mat to prevent slipping in and around the bathroom. Make sure there is enough light in your home, especially in stair and hallway areas around. If you are moving around at night, always make sure to turn the lights on. Ensure that there are no slippery areas; and clean up any spills immediately to prevent risk of accidents. The stairs should not be slippery and should ideally be wide, not steep, have handles or banisters to grip onto; stairs should be well lit. Wear shoes that are not slippery. Some medications may cause dizziness that can lead to falls; similarly one should limit alcohol consumption or quit drinking altogether, to reduce the risk of accidents.
Q: Your message to readers ?
A. Maintain a balanced, healthy diet and lifestyle – exercise alone cannot prevent Osteoporosis. Calcium and vitamin D are also required for building and maintaining bone mass. Also remember, smoking and excessive alcohol intake contributes to bone loss.