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
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
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
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
There are a few easy steps that people
should incorporate throughout life and
especially after 25, as they can help to
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
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
of upload: 20th Nov 2012