Be aware of your bones

Women’s Health & Fitness Magazine, January 2011

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Defined

Recently 37-year-old Gwyneth Paltrow was diagnosed with osteopenia, which is the precursor to osteoporosis, She was given the diagnosis after a bone scan was taken after she had suffered a leg fracture, revealing dangerously low levels of vitamin D.

Dr Pamela Leader, a Chiropractor in Dubai and vice President of the Emirates Chiropractic Association, explains that osteoporosis is a skeletal disorder characterized by compromised bone strength predisposing a person to an increased risk of fracture. “This is a slow developing condition of the bones, which has no symptoms until it is too late to treat,” she says and in its latter stages, results in fractures of the hip bone, wrist or spinal bones.
“But the good news is that it can usually be prevented by lifelong lifestyle measures if you understand and implement them early enough,” she says. Further elaborating, Dr Ravinder Kumar Bhatt, a specialist physician in Dubai, says, “|t is expected that 30 percent of women who are above age 50 have osteoporosis and the lifetime risk of fracture in osteoporotic women is as high as one out of two.” In fact, the risk of fracture due to osteoporosis is equivalent to the combined risks of breast, ovarian and uterine cancers in women.

Causes

Why are women more affected by osteoporosis? Essentially due to the hormonal changes that begin to occur in the premenopausal years when estrogen levels begin to fall in women, Leader points out that the effects of bone loss are more marked.
“They can lose 20 to 30 percent of their trabecular bone and 5 to 10 percent of their cortical bone during this accelerated phase and the loss continues slowly thereafter” she says, pointing out that men also suffer from osteoporosis but since they have larger longer bones to begin with, and no huge hormonal changes, their bones usually weaken later and more slowly

Diagnosis

Osteoporosis, says Dr Bhatt, is diagnosed by assessing bone mineral density of fracture prone sites. “Dual energy X-Ray absorptiometry is the gold standard technique to measure site-specific bone density” he says and is a painless procedure, which takes around 30 seconds to scan one site. “The following group of people should undergo a Bone Mineral Density (BMD) test: those suffering from oestrogen deficiency, early menopause (as in under age 45), absence or cessation of menstrual periods, primary or secondary hypogonadism in both genders, prolonged corticosteroid therapy, maternal family history of hip fracture, and/or low body mass index,” he says, adding, “Chronic disorders associated with osteoporosis include anorexia nervosa, malabsorption syndromes including chronic liver disease and inflammatory bowel disease, primary hyperparathyroidism, post-transplantation, chronic renal failure, hyperthyroidism, prolonged immobilisation, Cushing’s syndrome as well as previous fragility fracture, particularly of the hip, spine or wrist, and/or loss of height.”

Getting Good Bones

In childhood, bones grow and repair very quickly but this process slows down as you get older Bones stop growing in length between the ages of 16 and 18, but continue to increase in density until you are in your late 20s. From about the age of 35, you gradually lose bone density This is a normal part of ageing, but for some people it can lead to osteoporosis and an increased risk of fractures.
Reaching a good bone mass during the late teens, therefore, says Dr Leader, is paramount. “This means having a good 5 balanced diet, which contains g adequate calcium and protein together with enough, but gi not too much exercise and 5 good rest,” she says which is not easy to achieve if you sit in front of a video game or TV most of the time.
“Almost everything we do and eat has an effect on the bones,” she says and chronic diseases like liver disease, thyroid disease, celiac disease and rheumatoid arthritis have a negative effect on the bone density too.

“Many avoidable lifestyle choices also, have a huge impact on your bone strength throughout life,” she adds. Smoking, inactivity excessive caffeine, alcohol intake and eating disorders like anorexia nervosa and bulimia can also reduce your bone strength in the long run.
“Unfortunately some drug therapies can also have a bad effect on bone; for example Prednisolone, a corticosteroid medication at 5 to 7.5 milligrams daily for over two months, or much less in the elderly negatively effects bone mass density” she says and also some forms of chemotherapy for breast and prostate cancer can accelerate bone loss. ” If your family has a history of fractures you have a higher risk, as some factors are hereditary” she says, as well as small thin-boned women are most at risk.
Ethnicity can also predispose an individual to osteoporosis, says Dr Bhatt.
“Osteoporosis among indian men and women are equally common, which is contrary to the western data that shows in the 60s age group, osteoporosis is more common in women as compared to men and later on in the 80s, the incidence is comparable,” he says, “Also osteoporosis among indian females is at least a decade earlier as compared to their Western counterparts.”

Other factors

Although exercise, says Dr Leader, is vital for the development of peak bone mass in childhood and adolescence, excessive and elite level exercise undertaken in the adolescent years may have detrimental effects on the attainment of peak bone mass.
“This is especially true if menstruation stops and even worse if the young female has disordered eating habits and low body mass,” she says, and this also applies to young women who take their exercise regime to extreme, exercising hard every day and at times changing their menstrual cycle.
Hormone replacement therapy reduces the likelihood of fractures due to osteoporosis out has some significant risks if used in the long term. vitamin D is also crucial in preventing osteoporosis;
“A good diet with a little sunshine in the cooler hours of the day for vitamin D production, together with regular daily resistance exercise, can go a long way towards preventing osteoporosis,” says Dr Leader, “The long hot summer here finds most of us confined to homes, offices and malls, which offer no sunshine,” she says, therefore we can easily find ourselves deficient by the time October comes around.
She advises: “Get yourself tested for vitamin D deficiency and BMD if you are around the menopausal age or have had significant risk factors during your life.”

Treatment

If you have osteoporosis, Dr Leader points out that there are a number of drug therapies available to help strengthen the bones and decrease the risk of fracture.
“After assessing your bone mass density, your doctor will prescribe the correct course oftreatment for you,” she says, and this may include calcium and vitamin D tablets, but they may be just part of your treatment.
Prescribed medication which can help, suggests Dr Bhatt, include alendronate, calcitonin, raloxifene, estrogen, tibolone and PTH fragments.
“However an individual needs to consult an endocrinologist before starting any of these therapies regarding benefits and adverse effects,” he advises.

Prevention

The old saying, prevention is better than cure, is absolutely true for osteoporosis and it begins in early childhood, says Dr Leader, through the teens, and continues into old age.
“A long healthy period between menses, (first period) and menopause is helpful but cannot always be controlled,” she says, we can also exercise, get a little sun and a healthy calcium-rich, balanced diet, avoid bad habits such as excessive smoking, alcohol and coffee, and go for regular checkups “This will enable us to live the fullest quality rich lives we can,” she says, adding, “if you cannot exercise due to pain, a chiropractor can help restore the correct movement to your spine and joints, thus allowing you to get moving again.
In fact, chiropractors can treat people with osteoporosis; “We often do and have some very gentle methods to use with anyone suffering with this condition, and we are also well equipped to spot the likelihood of this being a part of your problem, send you for the right tests and diagnose or rule out osteoporosis,” concludes Dr Leader.