Dr. Shyam P Lohani

Bones are composed of living, growing tissue. Bones support the body structure and protect our vital organs. They also store calcium and other minerals essential for various physiological activities. When calcium is needed, it breaks down bones and rebuilds new ones. Until the age of 30 years, the body builds more bones than it breaks. Bone breakdown occurs faster than bone formation after the age of 35 years, which causes a gradual loss of bone mass. As the bone mass decreases, it may give rise to a condition called osteoporosis, a most common bone disease.

Osteoporosis literally means porous bone. It is a condition where bones become thin and lose their strength and leads to compromised bone strength. This results in an increase in the risk of fractures leading to broken bones, which cause pain, disability, and make daily activities extremely difficult and often painful.

Global scenario
Every three seconds, an osteoporotic fracture occurs. A recent estimation revealed that more than 200 million people are suffering from osteoporosis. Worldwide, one in three women over 50 years and one in five men will experience osteoporotic fractures in their lifetime (International Osteoporosis Foundation, 2021).

Osteoporosis is the most common bone disease seen in humans. The condition is seen more commonly among Caucasians, women, and older people. Osteoporosis is a risk factor for fracture. Osteoporosis affects millions of people of all sexes and races worldwide and its prevalence is growing as the composition of elderly people is increasing throughout the world. It is termed a silent disease because fractures may occur without preliminary symptoms that cause secondary health problems and even death.

There typically are no symptoms in the early stages of loss of bone mass. The earlier symptoms may include waning gums, weakened grip strength, weak and brittle nails. But once bones have been weakened by osteoporosis, signs and symptoms such as back pain, caused by a fractured or collapsed vertebra, loss of height over time and a stooped posture may be seen. There are unavoidable as well as avoidable risk factors for osteoporosis.

The unavoidable risk factors include age, sex, ethnicity, and familial history. The principal risk factor of osteoporosis is age. The body breaks down old bone and grows new bone throughout life. However, the rate of breakdown of bones becomes faster than it is able to replace after the age of 35 leading bones to become less dense and more fragile, and therefore more prone to fracture. Menopause is another crucial risk factor that occurs in women between the ages of 45 to 55 years. Menopause is associated with the change in female sex hormones that can cause a woman’s body to lose bone more quickly.

Men also lose bone at the same age, but at a slower rate than women. However, by the time both reach the ages of 65 to 70, women and men are usually losing bone at the same rate. Other risk factors for osteoporosis include being female, being Caucasian or Asian, having a family history of osteoporosis, poor nutrition, sedentary lifestyle, smoking, low body weight, and a small-boned frame. Some of those risk factors for osteoporosis, such as poor nutrition and sedentary life can be controlled. For instance, we can improve our diet and start an exercise program that can benefit our bone health.

Prevention
The most important preventive method is to adopt a lifestyle that can reduce the risk of osteoporosis. Calcium is essential for bones. The dietary modification that includes the intake of sufficient calcium and vitamin D is essential for good bone health. Dairy products are good sources of calcium that reduce the risk of osteoporosis.

People should consume enough calcium daily to ensure healthy bones. Adults aged 19 years and above need 1,000 milligrams (mg) of calcium a day. Women over 51 years of age and all adults after 71 years of age should take 1,200 mg of calcium daily. Dietary sources rich in calcium include dairy foods, such as milk, cheese, and yogurt, green leafy vegetables, such as kale and broccoli, fish with soft bones, and fortified breakfast cereals. In case calcium intake is inadequate, supplements are an option.

Vitamin D helps the absorption of calcium, therefore it plays important role in preventing osteoporosis. Dietary sources of vitamin D include fortified foods, saltwater fish, and liver. However, most vitamin D does not come from food but from sun exposure, therefore it is recommended to perform moderate, regular exposure to sunlight.

The lifestyle modifications such as avoiding smoking, as this can reduce the growth of new bone and decrease estrogen levels in women, limiting alcohol intake to encourage healthy bones and prevent falls, getting regular weight-bearing exercise, such as walking that promotes healthy bones and strengthens support from muscles.

For people who already have osteoporosis, nutrition, exercise, and fall prevention techniques play a key role in reducing the risk of fracture as well as the rate of bone loss. Fall prevention techniques become imperative too to those with osteoporosis and include regular vision screenings and keeping eyeglass up to date, installing grab bars in the bathroom, ensuring plenty of light in the home, and practicing exercise that helps with balance such as standing with the weight in one leg and raising another leg to the side or behind.

The exact prevalence of osteoporosis in Nepal is not known. However, as the elderly population is rapidly growing, it becomes important to promote healthy lifestyles among people at risk of osteoporosis for a better quality of life ahead.

(Prof. Lohani is the clinical director at the Nepal Drug and Poison Information Center. lohanis@gmail.com)