Health – A weekly column prepared by Dr. Balwant Singh’s Hospital Inc.

This segment is a continuation of our discussion on osteoporosis from last Sunday. To recap, we had described osteoporosis as a disease of slow loss of bone minerals weakening the bony architecture, thereby making it susceptible to fragility fractures. Four times more common in women, osteoporosis has a magnitude equal to a worldwide epidemic, yet it is completely asymptomatic till a morbid complication results. Hence, it is infamously called ‘The silent epidemic.’

Earlier we had spoken regarding the causes, methods of diagnosis and complications of osteoporosis, and we will continue with its treatment and the most important aspect of controlling this epidemic, its prevention.

How do I treat my osteoporosis?

A comprehensive osteoporosis treatment programme includes a focus on proper nutrition, exercise, and safety issues to prevent falls that may result in fractures. In addition, your physician may prescribe a medication to slow or stop bone loss, increase bone density, and reduce fracture risk.

Nutrition: The foods we eat contain a variety of vitamins, minerals, and other important nutrients that help keep our bodies healthy. All of these nutrients are needed in balanced proportion. In particular, calcium and vitamin D are needed for strong bones.

Exercise: Exercise is an important component of an osteoporosis prevention and treatment programme. Exercise not only improves your bone health, but it increases muscle strength, coordination, and balance.

Medications: Currently, many medications are available to help women and men battle osteoporosis. To understand how these medications work, we need to remember that osteoporosis results from an imbalance of, withdrawal and deposit of minerals causing bone weakening. Thus there are two major types of medications which can help reverse the bone loss:

Medications which supplement mineral deposits: These would be calcium and Vitamin D pills in the amount necessary to replenish the missing elements from the diet. It is recommended that a person suffering from osteoporosis takes at least 1 gram calcium per day for life. It should be noted that calcium needs change during one’s lifetime.

Vitamin D plays an important role in calcium absorption and in bone health. It is made by the skin through exposure to sunlight and is deficient in elderly, housebound people, and during winter. Depending on your situation, you may need to take supplements ensuring a daily intake of between 400 to 800 units of Vitamin D.

Medications which prevent mineral withdrawal: Currently, certain drugs like Alendronate and its subtypes are widely used in the treatment of fully developed osteoporosis, and are available at most pharmacies with your doctor’s prescription. These have a dual mechanism of action aiding not only mineral entry in the bones but also preventing their exit as well, and they are known to prevent fractures. These are administered orally in a simple weekly or monthly dose. The side effects for these drugs include digestive problems such as difficult swallowing, inflammation of the food pipe and stomach ulcers.

In menopausal women, the administration of female hormones has shown a dramatic reversal of osteoporosis with an increase in the bone mass, however the increased incidence of breast cancer with the use of these hormones limits their use. It would be appropriate to mention that medication in any form should only be used with the advice of your doctor.

If I don’t have osteoporosis now, how do I prevent myself from getting it?

There are many steps you can take to keep your bones healthy:

1) Diet: Supplement your diet with dark green leafy vegetables such as spinach and broccoli, certain calcium-fortified foods such as milk, orange juice, soy beverages and breakfast cereals or breads. You can find vitamin D in egg yolks, cod liver oil, and fish like salmon. Fortified foods including milk and some cereals have some vitamin D. Your skin also naturally makes vitamin D from sunlight. About 15 minutes of sunlight two to three times each week, without sunscreen and with hands, face, and arms exposed can provide enough vitamin D.

2) Smoking/Drinking: Smokers may absorb less calcium from their diets and have less sex hormones. Regular consumption of 2 to 3 ounces a day of alcohol is enough to damage your skeleton.

3) Exercise: Use it or lose it. This phrase best explains the nature of your bones. Simply put, once you do weight-bearing exercises, bones remain at their strongest, the opposite of which weakens them. That’s the reason astronauts develop osteoporosis within weeks of space travel.

Evidence suggests that regular aerobic exercise (ie, walking, running) and regular strength training exercise (ie, free and machine weights, elastic bands) increase bone mass. It is worthwhile noting that the exercises are site specific, meaning if you walk, your hip and spinal bones improve but not your wrists. Also for menopausal women, exercise alone will not maintain or increase bone mineral density without calcium, Vitamin D, and proper hormonal or other bone-building medications. Regular exercise also helps increase balance and coordination and reduces the risk of falls and subsequent fractures.

The recommended protocol for meno-pausal women and men is to walk 30 to 40 minutes four to five times each week. One would engage in an aerobic activity using a treadmill, stepper, or stairs, but avoid risky activities that could cause falls. Regular brisk walking is one of the simplest and most effective ways to exercise. Not only does it strengthen your bones, but walking also reduces body fat, and improves your mood and energy levels. Weight-bearing exercises which have been shown to increase bone density include walking, running, hiking, dancing, gymnastics, and soccer.

Guide to home safety against falls incurring fractures

You can reduce your risk of hip fracture by creating a safe environment in your house that will help prevent falls. Protecting yourself is easy.

Living Areas

Arrange furniture and remove loose objects to create clear pathways.

Remove low coffee tables and floor plant pots.

Ensure bright lighting.

Keep electrics, appliances, and telephone cords out of pathways.

Secure loose rugs.

Do not stand on unsteady stools, chairs, ladders, etc.

Install handrails on both sides of the stairway.

Kitchen

Clean up any liquids, grease, or spilled food.

Store food, dishes, and cooking equipment within reach.

Bathroom

Place a slip-resistant rug adjacent to the bathtub for safe entry and exit.

Install a nightlight in the bathroom.

Place a sturdy, plastic seat in the bathtub

Install handrails on the bathroom walls near the toilet and along the bathtub.

Conclusion

On a concluding note, here is a checklist for you to figure out whether you are in the high-risk category. The more boxes you check, the greater your risk.

I am postmenopausal.

I drink less milk and eat less cheese or yogurt.

I smoke regularly.

I drink alcohol regularly.

I do not regularly participate in exercises like walking, aerobics

or jogging.

I am a woman with a thin, small frame.

My parents had osteoporosis.

I am taking long-term medications like steroids.

I am not taking any calcium supplements.

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