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Osteoporosis: What is it
?
Literally, the word osteoporosis means "porous bone". Bone consists of
an organic compound called "collagen" which keeps its flexible shape,
and an inorganic compound of calcium and phosphorus, which retains its
strength and hardness. Inside, bone looks like a sponge with small holes
throughout. In osteoporosis, its as if the holes in the sponge become
larger more porous and increasingly fragile.
Osteoporosis: a
debilitating disease:
Osteoporosis is a condition of decreased bone mass, making the bone
brittle, weak and more susceptible to fracture. Elderly people are
commonly affected, especially women after the menopause, and as people
live longer, the number of victims of this debilitating disease is
increasing. Osteoporosis comes without symptoms or warnings, in the form
of fracture in the wrist, spine or hip. Fracture of the spine may lead
to loss of height and bending of the back (stooped posture) while hip
fractures can limit an individual's mobility and independence.
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The bones: A process of
gain and loss:
Throughout life, bone is constantly renewed through a process in which
old bone is replaced with new. Early in life, more bone tissue is added
than is removed. Maximum bone density or strength (peak bone mass) is
reached between the ages of 25 and 35, when it starts to decline slowly
as one gets older. This process of bone loss is accelerated in women
after the menopause due to decreased production of estrogen by the
ovaries. Estrogen is a female hormone which plays an important role in
maintaining bone density. Gaining a high peak bone mass at skeletal
maturity is of utmost importance. Those who have low peak bone mass will
be more susceptible to osteoporosis when they are old. Many risk factors
are involved in osteoporosis that influence attainment and maintenance
of peak bone mass. The person most likely to be affected is a petite,
sedentary postmenopausal woman with a life long history of calcium
deficiency.
Osteoporosis: The size
of the problem:
Osteoporosis has reached epidemic proportions in Western countries,
affecting one in every three women over fifty. In the U.S. up to 30
percent of women over 65 have one or more spinal fracture and more than
250,000 individuals suffer from hip fractures every year, and of that 20
percent die of associated complications. Those who survive are often
incapacitated and need long-term continuing care. Not only does
osteoporosis cause a great deal of suffering, disability and even death
in the elderly, but the financial burden on the health care system and
economy is enormous. How serious is osteoporosis of Saudi population is
not known. It is the impression of many physicians that the disease is
not uncommon and it is getting more evident. With the rapid development
in health care in Saudi Arabia, and the dramatic changes in standard of
living, life style and dietary habits it will not be surprising to see
more and more patients with osteoporosis, unless preventive steps are
seriously considered. In a study done in King Khalid University Hospital
it was shown that 58% of post menopausal Saudi women suffer from
osteopenia and osteoporosis.
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Osteoporosis:
Role of calcium and vitamin D:
Adequate calcium intake is vital for attaining peak bone mass as well as
maintaining it. For young adults, the daily calcium requirement is 1000
mg. For pregnant women or those over age 50, the recommended daily
allowances increase to more than 1,500 mg., while lactating women need
2,000 mg of calcium daily in order to prevent bone loss. There is a wide
range of products which gives the choice to get required amount of
calcium.
Dietary Sources Of Calcium
Whole Milk, 1 cup 291 mg
Low Fat Milk, 1 cup 297 mg
Skimmed milk, 1 cup 302 mg.
Low fat yoghourt, 1 cup 415 mg.
Swiss cheese, I oz. 272 mg.
Cheddar cheese, 1 oz. 191 mg.
Brick cheese, I oz. 191 mg.
Pink Salmon, 3 oz. 167 mg.
Sardines, 3 oz. 372 mg.
Vitamin D plays a crucial rule in maintaining normal calcium levels in
the body. About half of our vitamin D comes from dietary sources (milk
and dairy products) and the remainder from the reaction of our skin to
ultraviolet light from sun exposure. Older people may be vitamin D
deficient due to limited exposure to sun, decreased intake of milk and
dairy products, and decreased intestinal absorption of Vitamin D. Lack
of vitamin D in children and young women is not uncommon in the Saudi
population and this may lead to Rickets and osteomalacia "soft bone"
which may be nutritional in nature or due to insufficient exposure to
sunlight. Although there is plenty of sunshine all year round in Saudi
Arabia, people, particularly women, are sparsely exposed to sunlight.
The recommended daily dietary allowance of vitamin D is 400 IU and for
the elderly 800 IU. Regular exercise such as brisk walking and jogging
is essential to the health of the bone. Individuals who exercise
regularly seem to be better protected against bone loss. On the other
hand, immobilised individuals lose bone at a higher rate.
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Osteoporosis:
The importance of sex hormones:
Sex hormones play an important role in maintaining the strength of
bones. The female hormone, estrogen, decreases after menopause and the
bone mass starts to decrease. This is the main reason that women are
four times more likely to develop osteoporosis than men. Men are less
likely to develop osteoporosis because of their greater bone and muscle
mass and because they tend to exercise more than women. Men also consume
more calcium-rich diet than women.
White and Asian women seem to be more at risk than black women. This is
because blacks have a greater bone mass than whites and Asians. Studies
done at the King Khalid University Hospital, King Saud University, in
Riyadh showed that Saudi women have a bone mass lower than that of white
Americans and thus are more susceptible to develop osteoporosis as they
get older.
Osteoporosis: Importance of personal habits, drugs intake and other
diseases:
Protein, caffeine, fibre and alcohol when consumed in excess may
contribute to bone loss. Studies indicate that women who smoke has a
lower bone mass than non smokers and are susceptible to osteoporosis.
Smoking also interferes with estrogen metabolism, rendering estrogen
replacement therapy less effective. Prolonged use of steroids, anti-convulsants,
thyroid hormones, anti-acid and diuretics may lead to severe bone loss
and osteoporosis. Diseases like hyperthyroidism, hyperparathyroidism and
diabetes may be associated with severe bone loss and even osteoporosis.
A diet rich in calcium, phosphorus and vitamin D during the adolescent
and early adult years, helps to ensure proper bone formation and peak
bone mass in adulthood. Essential to the absorption and conservation of
calcium is Vitamin D. Milk and dairy products are major sources of
calcium, phosphorus and vitamin D. The other source of vitamin D is from
exposure of skin to sunlight. Milk also contains lactose, which has been
shown to enhance the absorption of calcium. Calcium and vitamin D
supplements should be considered only if dietary intake is insufficient.
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