A prevalent problem affecting everyone but predominantly women especially after menopause. The best way to prevent it is by establishing a strong skeleton bank account. Henrylito D. Tacio explains how.
ELIZA wasn’t worried when her doctor diagnosed a mild curvature of her upper spine eight years ago. She was only 32 and in otherwise excellent health. Then, last year, her right wrist commenced aching and her back would tire easily. After tests, she learned that, at age 40, she had the brittle bones of a woman more than twice her age.
Jean felt a stab of pain in her left hip as she waited in a grocery checkout line. The 45-year-old executive had always been healthy and active, then suddenly she could barely stand. When she went to her family doctor, she found out that several of her vertebrae had fractured. The radiologist studying her X-rays thought he was looking at the bones of a 70-year-old woman.
Eliza and Jean share a potentially crippling, even lethal affliction, both never even though about osteoporosis, which literally means porous bones. Many Filipinos are not aware of this bone disorder. A study conducted in 1995 showed that among Asians, Filipinos have the lowest awareness about this disease.
Because it affects mostly women, osteoporosis is commonly thought as an old woman’s disease. But men are not exempted, although it is less common among men for obvious reasons. Men have larger skeletons; their bone loss starts later in life and progresses more slowly, and they do not experience the rapid bone loss that affects women when their estrogen production drops as a result of menopause.
Bone is a naturally dynamic tissue, continually torn apart, and then rebuilt. During this process, bone-eating cells (called osteoclasts) break down bone tissue, creating cavities in it. Then bone-forming cells (known as osteoblasts) refill the cavities with fresh tissue.
How to Live Longer
In his book, How to Live Longer, Dr. Willie Ong shares this thought: To have strong bones, you need to store calcium in your bones at a young age. The build-up stage occurs early in life and peaks at age 30. After this, there’s more bone breakdown than build-up, hence our bones become thinner.
Dr. Carolyn Becker, an American endocrinologist, likens skeleton to a bank account.We put in bone deposits during our first 30 years or so; then we start to withdraw, she explains.The bigger our account, the more we have to draw on the rest of our lives.
Among women, the biggest cause of bone thinning is menopause, due to marked reduction in estrogen levels.Up to 40 percent of post-menopausal women have it because they are hormonally more susceptible, Dr. Ong points out. Women can lose up to 20 percent of their bone mass in five to seven years following menopause, according to the US National Osteoporosis Foundation.
Regarding of age, other important factors that may contribute to the risk of osteoporosis, according to Dr. Ong are: family history of osteoporosis (it runs in families), surgical removal of ovaries, a diet high in caffeine and low in calcium, smoking and excessive alcohol consumption, use of certain medications including thyroid medications or steroids, and lack of exercise.
There are three tests to know whether your bones are healthy or not, informs Dr. Ong. The DEXA test or bone density test is mandated by the World Health Organization. It measures density at the hip, spine, and wrist. In PDXA, bone density at a specific site is tested. A scan of wrist, finger, or heel is taken. The most common is the X-ray where fractures and other bone problems are evaluated. X-rays are not really a screening tool for osteoporosis, Dr. Ong says.
Bone density decreases slowly, so at first, osteoporosis produces no symptom, notes the home edition of The Merck Manual of Medical Information. Some people never have symptoms at all.
When bone density decreases so much that bones collapse or break, aching bone pain and deformities develop. Chronic back pain may occur if vertebrae collapse (vertebral crush fractures). The weakened vertebrae may collapse simultaneously or after a slight injury. Usually, the pain starts suddenly, stays in a particular area of the back, and worsens when a person stands or walks.
The area may be sore when touched, but usually the soreness goes away gradually after a few weeks or months. If several vertebrate break, an abnormal curvature if the spine (known as a Dowager’s Hump) may develop, causing muscle strain and soreness, the Merck manual informs.
Other bones may fracture, often because of minor stress or a fall. One of the most serious fractures is a hip fracture, a major cause of disability and loss of independence in the elderly. Fracture of the arm bone (radius) where it joins the wrist, called a Colles fracture, is also common. Fortunately, fractures tend to heal slowly in people who have osteoporosis.
In his book, Dr. Ong guarantees eight sure ways to protect your bones and keep away the bone-sapping osteoclasts. Topping the list is taking high calcium foods like milk, cheese, yogurt, dilis and fish. If you can’t drink milk, you may opt to eat lots of dark green leafy vegetables which also contain calcium, he writes.
Young children need about 525 milligrams of calcium per day while adults ought to have about 800 milligrams. Breast feeding and pregnant women require more: 1,200 milligrams.
In order for you to get the necessary calcium, avoid eating diet high in protein and sodium. Eating a 10-ounce steak or any meat will interfere with your calcium absorption, informs Dr. Ong, who is a heart physician. Be sure to temper your diet with carbohydrates and fats, too.
If you’re a coffee aficionado, limit yourself to a light cup of coffee. Too much coffee, he says, cause a person to lose calcium in the urine.
Another tip: avoid alcohol and smoking, which are toxic to bones. Alcohol has detrimental effect on osteoblasts: They make your bone cells lazy and sluggish to do their job. The result, you get weak bones. And if you’re drunk and fall over, you might crack your bones. Dr. Ong suggests one or two alcoholic drinks, although it is much better not to drink and smoke at all!
It is even not wise to drink soft drinks, especially the dark colored ones, as they contain phosphorous which can draw calcium out of your bones. If you can’t help but drink soft drinks, then you need to take more calcium supplements to replace the ones you will lose, Dr. Ong says.
The heart doctor also recommends moderate exercise. Any kind of exercise will do although light weight-bearing exercises are the best like using light dumbbells and brisk walking. Running, dancing and aerobics are also good but only if you have time and can take any of it.
When taking calcium supplements include also getting vitamin D. Calcium carbonate with vitamin is good for women who also take iron supplements.
Women who are experiencing severe or bothersome menopausal symptoms can ask their doctors about drug options. Estrogen supplements, which are effective in preventing (but not treating) osteoporosis, can safely be given for five years from the start of menopause to suitable patients. But physicians and patients should consider the side effects also before prescribing it. These side effects include increased tendency for thrombosis, blood-pressure elevation, stroke and breast cancer.
For women who have breast cancer, selective estrogen receptor modulator (SERM) may be used. SERMs have the same side effects as those of estrogen supplements, Dr. Ong states.
Bisphosphonates are the most effective treatment for osteoporosis. Studies show they can decrease bone breakdown, reduce spine fracture risk by 30-50 per cent, and lessen hip fracture risk by 24-50 per cent. However, these drugs are quite expensive and need supervision from a doctor.
If you have osteoporosis, your doctor can help you make a decision on which drug option is best for you, says Dr. Ong, who was given the Outstanding Filipino Physician award in 2007 by the Department of Health.