Indentifying and preventing the silent bone disease

On the occasion of World Osteoporosis Day on 20 October, Middle East Health spoke to Dr Humeira Badsha from the Dr Humeira Badsha Medical Center and Anlene Ambassador Board member, about the disease, its prevalence and what can be done to prevent and manage it.

Middle East Health: What is osteoporosis?
Dr Humeira Badsha: Osteoporosis is a condition in which the bones have reduced mineral density and quality and become fragile and brittle, leading to a higher risk of fractures. The Greek word osteoporosis translates as ‘porous bones’ in English.

MEH: What are the main causes of osteoporosis?
HB: There are modifiable and non-modifiable risk factors for osteoporosis. Dietary imbalances, especially low intake of calcium-rich foods, and unhealthy lifestyles are some of the major risk factors for developing osteoporosis. The World Health Organisation (WHO) has identified osteoporosis as a major public health issue.

There can be instances where osteoporosis develops as the result of other health conditions, or use of certain medications. This is known as secondary osteoporosis, and can occur at any age.

People with a parental history, particularly of hip fracture, are genetically more predisposed to fractures.

Physical inactivity and sedentary lifestyles tends to result in more bone loss. Low exposure to sunlight can lead to low vitamin D levels. Without sufficient vitamin D, calcium absorption may be compromised and bones become weaker. Urbanisation, where people tend to live and work indoors, as well as traditional clothing, are major factors that limit exposure to sunlight in the Gulf countries.

Insufficient intake of calcium-rich foods, such as dairy products, can accelerate bone degeneration and the risk of onset of osteoporosis.

High consumption of caffeinated drinks, such as tea, coffee and carbonated drinks, can adversely affect bone health. Smoking can lead to lower bone density and higher risk of fracture; the risk increases with age. Chronic medical problems or prolonged use of medications such as corticosteroids can lead to secondary osteoporosis.

It is estimated that 30-50% of patients on long-term corticosteroid therapy have higher fracture risk; risk of a hip fracture rises twofold in women and 2.6-fold in men.

Low body weight is associated with greater bone loss and increased risk of fractures. Impaired neuromuscular function, as evident in reduced muscle strength, impaired gait and body balance could also indicate increased fracture risk.

MEH: How is it diagnosed?
HB: Osteoporosis is often diagnosed after a fracture has occurred. A bone density test (a Dual-energy X-ray Absorptiometry or DXA) is used to diagnose osteoporosis. It is a quick and painless scan that measures the density (strength) of bones, usually at the hip and spine, but it can also be carried out very simply on the heel of the foot. The result from this test is called a T-score. Before referring a patient for a bone density scan, a doctor will also assess risk factors for osteoporosis such as age, medical history and lifestyle.

The Anlene Bone Health Check provides free bone scans to the public across the GCC using ultrasonometer technology. The machine measures aspects of the heel bones strength, density and quality and provides the individual with an estimate of their risk of poor bone health. The test is not used for diagnostic purposes, but it allows individuals to have an indication of whether they are neglecting their bone health.

MEH: What can doctors do to improve diagnosis of osteoporosis?
HB: We should create awareness of the disease among our patients. All patients should be screened for risk factors for osteoporosis, they should be counselled, and appropriate tests should be ordered.

MEH: What can people do to avoid getting osteoporosis?
HB: Like any lifestyle-related disease, osteoporosis is largely about the choices we make – what we eat and drink, and what we do. Awareness and prevention can help millions of people lead a quality life without the fear of brittle bones, disability, pain and premature death due to osteoporotic fractures.

There are a few easy steps that people should incorporate throughout life and especially after 25, as they can help to prevent osteoporosis:

1) Eat a calcium rich diet

Eat a healthy, balanced diet that includes foods high in calcium (approximately four glasses of regular milk per day delivers the required amount of calcium); magnesium (found in green leafy vegetables and some nuts and seeds) and zinc (found in oysters, red meat and some nuts and seeds). Alternatively, only two glasses of milk fortified with these vital nutrients are required to meet the recommended calcium intake and provide the nutrients important for bone health.

2) Embrace vitamin D

As vitamin D cannot be stored in the body, daily intake can either be attained through around 20-30 minutes of sun exposure daily, or by consuming vitamin D-rich foods like salmon, tuna and eggs, or a fortified milk.

3) Adopt an active lifestyle

Exercise regularly – aim to take 10,000 steps per day. Walking around the office and shopping in malls all count towards this target. Weight bearing exercises – like brisk walking, jogging, tennis, golf and netball are particularly good for bone heath.

4) Avoid smoking

Some studies have shown that significant bone loss has been found in older women who smoke; second-hand smoke exposure when you are young may increase the risk of developing low bone mass and the more cigarettes you smoke, the greater the risk of fractures in old age.

5) Have regular bone health checks

Undergo a periodic bone-health checkup. Bone-health checks help evaluate overall density and strength of bone tissues. Advanced technology has made the checkup simple, quick and efficient. For instance, the Anlene Bone Health Check uses noninvasive ultrasonometer technology that completes the test in two minutes. As bone changes can occur slowly, check-ups need only be every one to two years.

MEH: How it is treated? What medications are available?
HB: There is no cure for osteoporosis and it can only be managed. The aim of treatment of osteoporosis is to build up the density and strength of the bones to prevent any future fractures. Even so, it is difficult to completely build up bones that have been weekend by osteoporosis, so prevention is just as important as treatment.

The most effective ways to treat and prevent osteoporosis include ensuring your diet is rich in calcium and vitamin D, avoid smoking, avoid drinking lots of caffeinated beverages and alcohol, do regular weight-bearing exercise and have your bones scanned at regular intervals. Prescribed medications available in the Middle East that stop bone loss and increase bone strength include the group of medications called bisphosphonates: (alendronate or fosovance which is a weekly tablet; Ibandronate or bonviva (a monthly tablet); and zoledronic acid or aclasta (a yearly injection). Other medications include strontium ranelate, Denosumad, and teriparatide.

MEH: There have been numerous campaigns across the Middle East over the past several years to improve awareness of osteoporosis. Are these having any effect?
HB: Definitely. There seems to be more awareness of osteoporosis as a silent disease and we see an increasing interest among people to get screened and treated if needed.

MEH: What are the latest epidemiological figures for osteoporosis in the region? Do they represent an increase in the disease over the past several years or is there an improvement? How does this compare to other parts of the world?
HB: There are significant information gaps on the incidence of osteoporosis in the GCC. As many cases of osteoporosis remain undiagnosed, the incidence of fracture is an indicator of the prevalence. Hip fracture cases in some GCC countries appear to be relatively low compared to other regions, possibly due to our relatively young populations. As we age, it is predicted the Middle East will account for the highest projected proportional increase in hip fracture rates globally.

MEH: What would you advise doctors tell their patients about osteoporosis?

HB: Osteoporosis is a silent disease. We should focus on the screening of postmenopausal and elderly men and women, and people for risk factors such as those with fragility fractures, steroid use, heavy smokers etc. Women should be doing regular bone health checks (every one to two years). Prevention is also key for osteoporosis as there are no symptoms. It’s important for doctors to continue to remind patients of the importance of daily calcium and vitamin D intake to ensure their long-term bone health.

Anlene is nutrient-rich adult milk specially formulated for optimal bone health.

 Date of upload: 20th Nov 2012


                                               Copyright © 2012 MiddleEastHealthMag.com. All Rights Reserved.