Osteoporosis is a silent disease-By Dr Harold Gunatillake

Your bones in the body,especially those that are weight bearing such as the spine, and hips should be strong to carry out everyday functions. When you are young, they are strong, engaging in activities such as sports and being active, keeps the bones strong.

Age being a risk factor, leading a less active life, and especially among women when they reach their menopause with low sex hormone, tend to soften their bones being more porous and the density and the quality of the bones weaken and become more fragile due to accelerated bone loss, that occurs after menopause.

This condition is called osteoporosis of the bones which is a silent process without early warning symptoms. In the US. there are over 10 million suffering from osteoporosis and another 44 million suffering from low  bone mass called osteopenia, according to the National
Osteoporosis Foundation.

Our bones are constantly changing, developing and strengthening and are most dense, in our twenties. As we age some of the mineral contents gets depleted and the bone cells begin to dissolve the matrix of the bone, called resorption while new bone cells are formed to
replace them. This process is called remodelling.

In youth there is a balance between resorption and bone formation, but with age the bones become porous, brittle and prone to fractures.

Asians, including Sri Lankan men and women being of smaller stature and leading sedentary lives have a very high incidence of hip fractures-meaning fractures of the neck of the femurs with the slightest fall. They also have less bone to lose than people with larger frames and more body weight.

Also common among Asians including Sri Lankans, are the spine and wrist fractures.

We are born with about 300 soft bones and with age the cartilage attached to them gets replaced by hard bone. Some of these bones later fuse together, so that an adult skeleton has 206 bones.

The structure of our bones consists of a hard-outer layer  called the cortical which is strong and tough, and an inner spongy layer called the cancellous bone.

Bone forming cells are called osteoblasts and the bone resorbing cells are called osteoclasts. Osteoblasts seem to work most efficiently to form bone around the age 30 for both sexes. When you are about 35 years bones breakdown faster than new ones being replaced. In
short, osteoclastic activity takes over from the efficient osteoblastic activity, causing a gradual loss of bone mass.

Women seems to undergo more rapid osteoclastic activity -that is bone loss in the first few years after menopause, as less oestrogen is secreted in the ovaries that enhances the bone formation.

Nutrition-wise, low calcium intake and low vitamin D levels in the body can lead to bone loss. Vitamin D helps to absorb calcium from your food and participate in the structure of the bone.

To prevent osteoporosis, you need to consume adequate amounts of food rich in calcium and vitamin D throughout life.Foods such as seeds, cheese, yogurt, sardines and canned Salmon, beans lentils, leafy veggies provide enough calcium and vitamin D.

You could boost your increase of vitamin D levels by spending time in the sun, consuming fatty fish and seafood, eating more mushrooms, egg yolk and supplements.

There are certain dietetic risk factors to think of, if you have osteoporosis. Eating salty foods, drinking too much soda, and spending most of your time indoors are among habits that should be avoided. A healthy diet as described earlier with exercise, among other things, can
help to prevent the risk of osteoporosis.

Daily exercise is important to keep your bones strong. Walking 10,000 steps a day would be enough. For some regular workouts that include weight-bearing aerobic activity and strength training in a Gym workout is recommended.

There are certain drugs usage long term can lead to osteoporotic bones, such as corticosteroids. Heparin, blood thinners, antidepressants, aromatic inhibitors used to treat breast cancer.

Alcohol abuse and smoking are also cause for osteoporosis. You could get osteoporosis of the bones, after being bedridden for a few weeks after any debilitating illness

There are no symptoms during the early stages of osteoporosis. Loss of height and a curve in the upper back may be early signs.

Your doctor will do a bone mineral density test (BMD) if he suspects you have osteoporosis. The test uses special X-ray machine to measure the mineral content at three different bone sites.

This test is recommended to women over the age of 50
years. The drug of choice for osteoporosis is Bisphosphonates.The others include alendronate (Fosamax), risedronate (Actonel) and ibandronate (Boniva). Studies have shown that alendronate can reduce the risk of spine and hip fractures by up to 50%.

For advanced osteoporosis your doctor may prescribe injections, includes teriparatide (Forteo), abaloparatide
(Tymlos) and romosozumab (Evinity). In addition to above medication you may have to take 1,200 milligrams of calcium per day from food or supplements.

Being active, and participating in sport activities during you school days, exercising daily and eating the right foods will prevent this disabling disease.
Ref: Article by Carl Nierenberg -Live Science Contributor

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