World Osteoporosis Day: Laziness is making your bones weak; healthy diet with milk, eggs & nuts will help

Do you have a history of multiple fractures? Do you find it difficult to stand or be active for long hours? Is there a general feeling of malaise, and weakness? It’s time to get tested for osteoporosis.

Osteoporosis means the deterioration of bone density – the term originated from ‘osteo’ meaning bone and ‘porosis’ meaning decreased density or porosity. It is a significant medical concern, which increases fracture risk, morbidity, mortality and even loss of active years.

An estimated 200 million suffer from osteoporosis. The condition affects the higher age-group the most – mostly people at the age of 60 and above. In this elderly age group, post-menopausal women have a higher incidence of osteoporosis than males.

What causes osteoporosis?
Healthy bone requires a titration in gain and loss of calcium that is dependent on diet, hormonal balance and physical activity. Any alteration in this finely tuned physiology can lead to poor bone quality.

Diet devoid of calcium and proteins or inadequate absorption of calcium and vitamin D (malabsorption syndromes such as celiac disease, lactose intolerance, etc) reduces bone and tissue healing, and strength. Excessive alcohol intake, tobacco use and anorexia can lead to dietary deficiencies causing osteoporosis.

Hormones such as thyroid, estrogen, testosterone are required to run the body machinery. Hormonal imbalance can result in increased bone loss. It especially causes decreased estrogen followed by menopause, further leading to rapid osteoporosis.

Some essential medicines like antiepileptic drugs for epilepsy, PPI for acidity, chemotherapy for cancer and steroids for rheumatoid arthritis can also result in osteoporosis as their side effects. But, these drugs cannot be stopped as it can result in more harm.

Sedentary lifestyle and lack of exercise is another major factor causing osteoporosis. Vitamin D deficiency due to lack of sunlight exposure is an added factor.

Other causes are advanced age, previous family history (heredity) and gender (women are more affected than men).

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Young individuals with gastrointestinal issues affecting the diet or suffering from hormonal imbalance and excessive weight loss/gain must consult a specialist to prevent bone weakness.

Can younger women get it?
Demographically, more women are affected than men mainly because of their physiology. Women go through menses, childbirth, breastfeeding and hormonal changes which men do not. This results in increased bodily losses.

A healthy young woman having a healthy lifestyle (that includes a balanced diet and regular exercise routine) without any medical illness need not worry about osteoporosis. However, young individuals with gastrointestinal issues affecting the diet or suffering from hormonal imbalance and excessive weight loss/gain must consult a specialist to prevent bone weakness.

Women who lack exposure to sunlight and an exercise regime are at further risk. All these factors add to decreased bone strength resulting in osteoporosis in women with advancing age.

What are the early signs one should look out for?
Bone pains, general weakness, malaise and easy fatigability are some of the symptoms of early bone weakness. This is more pronounced in the elderly where it can be clinically seen in their stooping posture and inability to stand or be active for long durations.

In established osteoporosis, fractures are common even with an insignificant and trivial fall. Most-commonly affected areas are spine, wrist and hip. History of multiple fractures should also raise red flags. Fractures in osteoporosis are challenging to treat as they heal slowly and have poor strength to hold implants.

Can a balanced diet delay it?
Healthy diet is the best way to keep osteoporosis away. Bone is a tissue which requires constant maintenance and repair.

A balanced diet containing proteins, carbohydrates, minerals and multivitamins is essential. Milk and milk products, fish, soy, tofu and nuts are good sources of calcium. Pulses, sprouts, egg, milk and meat/poultry are rich sources of proteins.

Daily protein requirement is 1 gm/kg as per the body weight daily. Daily calcium requirement in adults is 1000-1500mg per day (including food sources).

Vitamin D is not naturally available in foods, and needs to be supplemented or fortified in foods. Daily Vitamin D requirement is 400-800 IU/day.

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Healthy diet is the best way to keep osteoporosis away.

What precautions must one follow?
Healthy lifestyle is of utmost importance in prevention of most health diseases, including osteoporosis.

Daily exercises of moderate activity for 150 minutes a week – including two days every week of strength training.

A balanced diet with recommended daily intake of proteins, carbohydrates, and roughage with nutritional supplements (vitamin D , minerals and antioxidants) can keep the body healthy and prevent diseases.

Daily sunlight exposure of 15-30 minutes of mid-day sun is recommended by health experts in the US. However, absorption of sunlight depends on the skin pigmentation, clothing and environmental factors.

Adequate sleep is essential for the body to repair. Try to get a recommended sleep time of 6-8 hours per day.

Is osteoporosis treatable or curable?
Osteoporosis is a treatable and preventable disorder with timely diagnosis and management. Treatments can be divided into three types – exercise, diet and medications.

It can be screened by X-Rays, and the vulnerable population get Dual Energy Xray Absorptiometry (DEXA) scans – a gold standard for diagnosis. It gives an estimate of bone density at the most-common sites of fracture (lumbar spine, upper femur, etc). It gives a reading of T-score – where 0 to –1 is normal, -1 to -2.5 is osteopenia, less than -2.5 is osteoporosis. The estimate of the degree of osteoporosis, in turn, will help in deciding further treatment.

Treatment is a multi-pronged approach which involves healthy nutrition, exercises and medical management. Medication in the form of Vitamin D, calcium, bisphosphonates, hormones – teriparatide, and biologicals are used.

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Women who lack exposure to sunlight and an exercise regime are at further risk.

Medicines can make bones strong by either decreasing calcium loss or increasing calcium absorption. Drugs such as Bisphosphonates and Denosumab that prevent bone destruction can help in preventing bone loss. A bone building medication is Teriparatide which is similar to parathyroid hormone.

Hormones supplementation like estrogen in women, testosterone in men, parathormone and calcitonin increase calcium intake into the bones. All the above mentioned medications must be prescribed by a registered medical practitioner in adequate dosage. These medicines must be administered under supervision of a medical practitioner only.

Hence, prevention is far more important than cure. A healthy lifestyle involving a balanced diet and regular exercises is essential. Performing laboratory tests to identify levels of Vitamin D, serum calcium, phosphorus and alkaline phosphatase helps in identifying bone disorder early on.

What advice would you have for caregivers?
For caregivers, it is essential to get expert advice from an authorised medical practitioner on required tests and necessary treatment as soon as osteoporosis is suspected.

Handling individuals with osteoporosis with care and gentleness is critical. Using walking aids, fixing wall supports for assisted walking, anti-skid flooring and correct footwear are important.

Using orthotics and braces (functional braces, lumbar brace etc) to maintain posture aids in patient confidence and comfort. Keeping a watch on a complete healthy diet and exercises with required medications is key to management.

– The author is Consultant Orthopedic, Trauma & Joint Replacement Surgeon at Masina Hospital

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