As we know, there are 206 bones in our body which are exquisitely and perfectly set to keep our skeleton in good shape and in a healthy condition. A healthy skeleton reflects the good health of our body.
Today everyone is worried about his health and does his best to keep his body free from diseases. Some are focused on avoiding heart diseases, diabetes or hypertension, others think of avoiding cancer by regular screening tests. However, fewer people think or worry about keeping their bones in healthy condition.
WHAT ARE BONES?
Bones are a live part of our body. They can also breathe. Like skin and muscles they are tissues. Normally bones are composed of a hard and solid outer shell surrounding the connecting plates and rods of bones within which lies the bone marrow. Thus internally they are soft and spongy. Due to such type of structure, they are light, strong and flexible.
HOW DO BONES GROW?
There are two types of cells in our body, which regulate the growth of bones. They are Osteoblasts, Osteoclasts. The function of Osteoclasts is to dissolve the older bones and leave small holes behind. These are bone eating cells. Then the function of Osteoblasts start. These are bone forming cells. They enter into small unfilled spaces (holes) and produce new bones. The remodeling of bones is a continuous process throughout life. With the aging process, old bones are replaced by the new ones. There is one more type of bone cell called an Osteocyte. These cells provide nutrition to our bones. Bones are strongest in early twenties.
WHEN DO BONES BECOME WEAKER?
Between age 20-30 our bone building cycle is in balance. Bones are breaking down and rebuilding at the same rate and their overall strength remains the same. But when an individual approaches middle age, the bones become weaker. We never notice it until finally we start developing a stoop, get occasional backache and lose weight. This is because our spinal vertebrae become weak and collapse under our body weight – resulting in curved spine. Besides the vertebrae, the pelvis, the ribs and long bones of our body are also affected. As we become older, the outer shell of our bones become thin and a stage may come when even a single sneeze or cough can fracture a bone.
WHAT IS THE ROLE OF VITAMIN D IN BONE GROWTH?
In our skin, there is a substance, 7-de-hydrocholesterol which gets activated after coming in contact with ultraviolet rays of the sun. It is converted into vitamin D which is ultimately absorbed into the blood circulation. Cortisol derived from vitamin D is used to increase the absorption of calcium from food into the blood stream. Deficiency of vitamin D leads problems of calcium and phosphorous metabolism leading to Rickets in children and osteomalacia in adults, in which bones become soft with a tendency to deformities and fractures.
WHAT IS OSTEOPOROSIS?
“Osteo” means bones and “Porosis” means spongy or porous. Failure of absorption of calcium and phosphorous in bone marrow result in the reduction of bone mass and this condition is called osteoporosis. It means bones break easily.
WHY DOES OSTEOPOROSIS OCCUR?
Osteoporosis is a slow progressive skeletal disease characterized by gradual loss of calcium. It occurs if a person does not have enough strong bone mass by age 30, before bone loss begins or if bone loss after age 30 happens too fast.
Osteoporosis is often called a silent thief which may rob the bone density of people before the appearance of any symptoms. In this disease, absolute bone mass is less than normal. Normally the bone mass in both the sexes is gradually lost, but in women, the rate of bone mass is accelerated at the time of menopause.
WHAT IS THE ROLE OF OUR SEX HORMONES IN DEVELOPING OSTEOPOROSIS?
Our sex harmones uptake the calcium to the bones. In females during menopause, production of oestrogen slows down. At this stage, the function of new bone forming cells (osteoblasts) also slows down considerably and calcium finds it difficult to reach the bones, ultimately leading to osteoporosis. Thus bones become weak and thin resulting in a higher risk of fractures. Cyclical oestrogen therapy or hormone replacement therapy is sometimes recommended during menopause, so that the oestrogen level does not fall. But taking hormone replacement therapy long term may increase the risk of breast cancer, dementia, heart diseases, stroke and blood clots in legs or lungs. So HRT should not be taken for long time.
In men around 50 years of age, when testosterone production slows down, it becomes difficult for calcium to reach the bones, leading to reduction of bone mass. Approx one in two women around the age of 50 and one in three men around the age of 70, years suffer from this disease. It shows that our sex hormones play a major role in the health of our bones.
WHAT ARE THE RISK FACTORS OF OSTEOPOROSIS?
Having a parent that has/had osteoporosis is a risk factor for the offspring. It is common in thin and short statured persons.
It can occur at any age, but most commonly is found after age 40. It is not just an older person’s health threat. Sometimes it starts in childhood, but has consequences later in life.
Girls having amenorrhoea from eating disorders or from over exercise are also prone to risk of osteoporosis in later age.
Women having early menopause or with early total hysterectomy are more prone to osteoporosis.
Getting too little calcium can increase your chances of getting osteoporosis. Not getting enough vitamin D can also increase your risk for the disease. Vitamin D is important because it helps the body use the calcium in your diet.
Persons who are suffering from thyroid or liver diseases are also prone to the risk of osteoporosis.
Parathyroid glands are the regulators of calcium metabolism in our body and deficiency of this hormone can cause a severe drop in calcium level to produce other neuromuscular complications.
Other factors resulting in osteoporosis are smoking, alcohol, excess of tea or coffee or highly seasoned food.
Bad digestion or diet are possible causes of this silent debilitating disease. Calcium absorption from the intestine is affected due to these factors.
Persons having sedentary or inactive life style are more likely to suffer from osteoporosis.
History of previous fracture also results in higher risks of another fracture.
Aging also contributes to the loss of calcium in the bones, called senile osteoporosis. Urinary loss of calcium is more marked.
WHAT ARE THE MAIN MEDICAL CONDITIONS THAT ARE THE RISK FACTORS?
Malabsorption disorder, Anorexia nervosa, Chemotherapy during cancer treatment,s particularly breast cancer, Prostrate cancer in men with diminished testosterone level, Kidney diseases, liver failure, Hyperthyroidism, excessive thyroid supplements, diabetes,
WHAT ARE THE SYMPTOMS OF OSTEOPOROSIS?
It is a silent disease and doesn’t get detected in most cases until after the patient’s first fracture. Mostly, patients are asymptomatic.
Initially, one feels tired and exhausted after some work. Other common symptoms are backache, which may be due to collapse of vertebrae especially in the lumber region. Fractures may occur even after a minimal trauma, after which complications start.
WHICH ARE THE COMMON BONES PRONE TO FRACTURE?
Osteoporosis affects the spine and hip more than the other bones of the body. The most common bones having risk of fracture are hip, humerous, ribs and wrists. Osteoporosis can even be fatal. Up to 25% of older people who suffer from a broken hip die within a year. Osteoporosis in the vertebrae can cause serious problems for women. A fracture in this area occurs from day-to-day activities like climbing stairs, lifting objects, or bending forward.
WHAT IS THE DIET RECOMMENDED TO PREVENT OSTEOPOROSIS?
Diet plays a very important role in bone health. Osteoporosis can be prevented by improving the digestive system along with intake of food rich in calcium, vitamin D and proteins.
Our diet should contain natural foods, milk and dairy products, fish and eggs, cod liver oil, green leafy vegetables like spinach, cabbage, beans, peas and all types of nuts, dates, figs etc.
Calcium is best absorbed in body in the form of milk and cow’s milk is the richest source of calcium. Soy contains not only calcium but also plant oestrogen and it seems to help maintain bone density.
Fruits like half ripened papaya, chikoo and mango containing phosphorous can help retain calcium in the body. A high protein diet can raise excretion of calcium. In women 50 gms, and in men 65 gms of proteins daily are suggested.
Keeping a good digestive system is essential to prevent osteoporosis. The Calcium we eat in our diet is better for building healthy bones than calcium taken from supplements. Supplements should contain vitamin D also, which facilitates the absorption of calcium. Sometimes calcium supplements may cause constipation. Drinking more water and eating food rich in fibre such as vegetables and fruits can help avoid this. People must be exposed to sunlight for at least 10-15 min daily as sunlight is considered to be the richest source of vitamn D.