Boosting Your Bones

Dealing with Osteoporosis Effectively

A common misperception is that bones are hard but lifeless structures that support and protect the body, much like what concrete pillars are to a building. The truth is that bones are active living tissue; with new bone being formed daily, as old bone is, similarly, actively removed. This bone turnover keeps the skeleton always relatively young and healthy.

Bones also function to anchor the organs of the body, especially muscles to facilitate movement. The macro and micro architecture of bone thus is always optimised to provide strength and resist breakage in the required planes of movement. Bone also functions as a massive store of calcium and other minerals in the body and generally speaking the larger the store or bank, the better as it means that the body has more in reserve.

Humans reach peak bone mass not in their early twenties, as many would guess but closer to age thirty. This means that before the age of thirty the rate of new bone formation exceeds the rate of removal of old bone and after the age of thirty the reverse happens. With this concept in mind, one quickly understands that reaching a higher peak bone mass helps to reduce the risk of an excessively low bone density in older age. It also means that reducing the risk of low bone density and brittleness in old age actually starts in childhood and is a lifelong process.

Osteoporosis

The simplified explanation of osteoporosis is it is meant to describe bones, which become thinner, less dense and hence more brittle in old age. A more scientific definition would be to quantify the loss of bone by comparing the bone of a particular patient to the bone of a young adult, as well as to other members of the age matched population. The instruments used to quantify such bone density vary from small portable ultrasound machines to full sized DEXA scans.

The pros and cons of the various methods of article suffice to say that generally DEXA scans are regarded as the gold standard for clinical practice. The pleasant news is that such scans are done very quickly, painlessly and are relatively inexpensive. Post menopausal women especially with risk factors, as described below are advised to have these scans done.

The clinical significance of preventing osteoporosis is that if markedly reduces the rates of fractures in the spine, wrist and hip. The burden of osteoporosis to the population is very real and significant. 30% of all post menopausal women have osteoporosis and 40% of these get a fracture due to a relatively low impact (fragilely fractures) in their lifetime.

Bone Health

So knowing the facts above, one is well advised to take care of his or her bone health.What simple steps can we take?

Dietary Calcium and Vitamin D

Consume food rich in calcium. The dietary recommendation for calcium is 1000 milligram (mg) per day. In post menopausal women, the recommendation is higher at 1200 mg per day. A pregnant lady should take 1500mg calcium per day. Rich sources of calcium are in dairy products sardines, broccoli and soya bean based products.
Getting sunlight daily boosts the body’s production of Vitamin D while consuming fish, egg yolk and fortified milk also helps. As explained in the earlier part of this article, consumption of foods rich in calcium and vitamin D starts in early life. The higher the peak bone mass the better

Physical Activity

Exercise helps stress bones so that they adapt and become stronger. Weight bearing exercises like walking; jogging and stair climbing are particularly beneficial. Many forms of exercise are easily incorporated into a person’s daily routine, say taking the stairs rather than driving a car. Another potential effect of exercise is it improves muscle strength, balance and coordination. These benefits by themselves reduce the rate of fractures as the reduce of the risk of falls

Avoid Smoking

Nicotine is toxic to the bone forming cells in the body and is best avoided

Caffeine and Alcohol

Excessive caffeine and alcohol, as a rough guide more than 3 drinks per day, increases the risk of osteoporosis while moderate amounts are not harmful

Control of Illnesses

Certain medical illnesses such as excessive thyroid hormone and low testosterone levels in males contribute to osteoporosis. These illnesses if treated are much less likely to the deterioration of bone mass. Sometimes doctors have no choice but to treat some diseases with drugs like corticosteroids and cytotoxics. These drugs themselves predispose to osteoporosis and the treating doctor may minimise the adverse effect on bone by:
Only delivering the medication to the site concerned, say by injection or inhalation, so as to avoid the need for oral ingestion

Giving the patient medication for osteoporosis as he or she is being given the steroid medication

Established Osteoporosis

This article will be read by some who already have established osteoporosis. In such instances, besides taking the general precautions mentioned above, do consider consulting a doctor as osteoporosis is treatable. The doctor may simply advise or prescribe supplements of calcium, vitamin D or vitamin C. He/She may consider medications, which increase bone mineral density by reducing the rate of bone resorption. These groups of medications are broadly called anti resorptives.

For more severe cases, there are never more powerful anti-resorptives as well as potent anabolic agents, which actually build new bone. With these newer agents, it is actually possible to reverse a patient who has established osteoporosis to reach a state where the bone strength is acceptable for the patient’s age.

So my final advice to the younger population reading this article is having an early start in building up your bone. Reaching a good peak bone mass helps you avoid problems in later life. For those who already have osteoporosis, do not despair for more than ever before, doctors have their disposal, medications which can help improve your condition significantly.