HEALTH & FITNESS

Bone-breaking
Osteoporosis is called a silent thief. Patients are often unaware of the disease until a sudden bump or a fall causes a fracture. One in two women and one in three men in India over the age of 50 are suffering from this disorder
Dr Ravi K Gupta
The numbers of fractures of back bone, wrist and hip are growing rapidly, not because we are getting more falls due to clumsiness, but because our bones are becoming more prone to fractures due to decrease in the mass of mineralised bone per unit volume i.e the density of the bone known as brittle bone disease or osteoporosis.

Bonding with grandkids may prevent depression in elderly 
New York: An emotionally close relationship between grandparents and their grandkids may ward off depression in both, a new study has found. US researchers found that grandparents and grandchildren have real, measurable effects on each other's psychological well-being long into grandchildren's adulthood.

 

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Bone-breaking
Osteoporosis is called a silent thief. Patients are often unaware of the disease until a sudden bump or a fall causes a fracture. One in two women and one in three men in India over the age of 50 are suffering from this disorder
Dr Ravi K Gupta

The numbers of fractures of back bone, wrist and hip are growing rapidly, not because we are getting more falls due to clumsiness, but because our bones are becoming more prone to fractures due to decrease in the mass of mineralised bone per unit volume i.e the density of the bone known as brittle bone disease or osteoporosis. The weak bones tend to get fractured even from minor episodes such as jerky ride on a vehicle, waiving a hand or even while moving the arm for picking up a glass of water.

The annual incidence rate of osteoporotic fractures of back bone, wrist and hip is growing rapidly.
The annual incidence rate of osteoporotic fractures of back bone, wrist and hip is growing rapidly. Thinkstock

Currently it is estimated that over 200 million people worldwide suffer from this disease. According to World Health Organisation (WHO) estimates, one in two women and one in three men in India over the age of 50 are suffering from osteoporosis.

The risk of developing a fracture from osteoporosis is at present the second common public health disorder in the elderly, the first being cardiovascular diseases. Due to the increase in life expectancy, it is estimated that by 2050, the worldwide incidence of hip fracture is projected to increase by 240 per cent in women and 310 per cent in men.

How it develops

Bone is a living, dynamic tissue. Throughout our lifetime, the old bone mass is continuously being reabsorbed by the cells known as osteoclasts and the new bone is continuously being added by the cells known as osteoblasts.

During the period of growth till adulthood, new bone is added at a rate that is faster than old bone is being removed, until peak bone mass is reached between the age group of 25- 40 years. After the age of peak bone mass, the resorption of bone overtakes the speed of bone formation resulting into the slow onset of osteoporosis.

Factors like physical activity, direct exposure to sunlight, a diet rich in vitamin D and calcium, calcitonin and fluoride stimulate bone formation.

Effect of smoking and alcohol: Women who smoke have lower levels of female hormones than non-smokers and often get menopause earlier, putting them at higher risk of developing osteoporosis. Regular alcohol consumption of two to three ounces a day or more can also be damaging to the skeleton, even in young men and women.

Risk factors

  • Common among women
  • Caucasians
  • Prior bone fractures
  • Ovariectomy or menopause
  • Gonadal insufficiency
  • Diabetes Mellitus
  • Sedentary lifestyle in the artificially lit rooms
  • Family history (heredity)
  • Small body frame
  • Alcohol
  • Smoking
  • Chronic malnutrition
  • Advanced age
  • Diseases like hyperparathyroidism, hyperthyroidism, Hypercortilism (Cushing's Syndrome), myelomas, lymphomas
  • Intake of drugs like steroids and antiepileptic drugs

Symptoms

Osteoporosis is often called a "silent thief". Patients with osteoporosis may not know that they have the disease until their bones become so weak that a sudden strain, bump, or fall causes a fracture. Severe osteoporosis usually causes a collapse fracture of vertebrae producing symptoms of severe back pain, loss of body height and/ or deformity of a stooped posture. Other common fractures include a hip fracture, wrist fracture and fractures of upper arm. The risk of getting a second fracture becomes manifold after one osteoporotic fracture. Perialveolar bone loss resulting in loose teeth or teeth loss is another symptom produced by the osteoporosis of the jaws.

Diagnosis

Diagnosis is made by estimation of Bone Mineral Density test (BMD). These tests are safe, painless, and non-invasive and are used to confirm a diagnosis of osteoporosis and help predict fractures and measure the rate of bone density loss. The BMD of the patient is measured and compared with the BMD of the young healthy individual of the same sex. The unit for the measurement is T score which is the difference expressed as standard deviation compared to young reference population.

Management

The osteoporosis has emerged as a public health problem and should be managed with a multipronged approach which include:

  • Musculoskeletal rehabilitation
  • Prevention and treatment
  • Treatment of symptomatic disease and its sequelae

Musculoskeletal rehabilitation

Skeletal loading exercises should be routinely incorporated into the daily routine which will act as a prophylaxis against the development of this silent disease. The treatment of established osteoporosis includes adoption of measures for preventing the falls by giving ambulatory assistive devices like walking sticks and walking frames, muscle strengthening exercises and gait training exercises.

Prevention and treatment

A high protein diet supplemented with calcium and Vitamin D is important for prevention as well as treatment of osteoporosis. The best method to provide natural vitamin D to the body is the exposure of the naked skin to direct sunlight. The sunlight coming through the glasses is not effective for production of Vitamin D. Every day at least two hours of exposure to sunlight to at least 33 per cent of the surface of the body is considered as adequate exposure to sunlight. The other important factor is incorporation of physical activities in the daily life. Good bone building exercises include running, skipping, aerobics, tennis, and brisk walking.

In established osteoporosis, the patient should take pharmacological agents with the advice of a medical expert. The common pharmacological agents include:

  • Calcium and vitamin D supplements which stimulate the osteoblast for the formation of bone.
  • Bisphosphonates are non-hormonal drugs, which help maintain bone density and reduce fracture rates. These act by inhibiting the osteoclast thus reducing the speed of bone resorption.
  • Hormone replacement therapy (HRT) is oestrogen replacement for women at the menopause, which help maintain bone density and reduce fracture rates for the duration of therapy.
  • Selective Oestrogen Receptor Modulators (SERMs) are drugs which act in a similar way to oestrogen on the bone, helping to maintain bone density and reduce fracture rates specifically at the spine.
  • Parathyroid hormone stimulates new bone formation and significantly increases bone mineral density and reduce fracture rates
  • Calcitonin: It acts by reducing the activity of osteoclasts.

Treatment of symptomatic disease

The symptoms of osteoporosis are mainly related to the fractures. So if there are any symptoms of pain, deformity or inability to use a limb resulting from fractures, the healing of the fracture is the only measure to cure the symptoms permanently. The fractures of the vertebrae in the spinal column can usually be treated by non-operative measures like braces and analgesics. The fractures of the wrist and upper arm usually require additional measures like plaster casts or slings. While hip fractures almost always require surgical intervention.

The writer is Professor, Orthopaedics, Government Medical College Hospital, Chandigarh

Chilling facts

  • Approximately 1.6 million hip fractures occur each year worldwide, the incidence is set to increase to 6.3 million by 2050.
  • The annual incidence rate of osteoporotic fractures in women is greater than the combined incidence rates of heart attack, stroke and breast cancer.
  • According to World Health Organisation (WHO), osteoporosis is second only to cardiovascular disease as a global healthcare problem.
  • A 50-year-old woman has a similar lifetime risk of dying from hip fracture as from breast cancer.

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Bonding with grandkids may prevent depression in elderly 

New York: An emotionally close relationship between grandparents and their grandkids may ward off depression in both, a new study has found. US researchers found that grandparents and grandchildren have real, measurable effects on each other's psychological well-being long into grandchildren's adulthood.

"We found that an emotionally close grandparent-adult grandchild relationship was associated with fewer symptoms of depression for both generations," said Sara M Moorman, Department of Sociology at Boston College.

The study also found that giving tangible support to or receiving it from their grandchildren affected the psychological well-being of grandparents but not grandchildren.

Tangible support, also called functional solidarity or instrumental support, includes anything from rides to the store and money to assistance with household chores and advice.

"Grandparents who experienced the sharpest increases in depressive symptoms over time received tangible support, but did not give it," said Moorman, who co-authored the study with Jeffrey E Stokes.

Comparatively, the researchers found that grandparents who both gave and received tangible support experienced the fewest symptoms of depression over time.

"Encouraging more grandparents and adult grandchildren to engage in this type of exchange may be a fruitful way to reduce depression in older adults," said Moorman. Researchers used data from the Longitudinal Study of Generations, that included seven waves of data collection between 1985 and 2004.

The sample comprised 376 grandparents and 340 grandchildren. The average grandparent was born in 1917 and the average grandchild in 1963, making them 77 years old and 31 years old, respectively, at the midpoint of the study in 1994.

The study was presented at the 108th Annual Meeting of the American Sociological Association. PTI 

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Health Notes
Genetic birth defects up risk of childhood cancer

Washington: Children born with genetic birth defects like Down's syndrome are at an increased risk of developing childhood cancer, says a study. Scientists have said that children born with non-chromosomal birth defects have a two-fold higher risk of cancer before age 15, compared to children born without birth defects. However, cancer risk varies by the specific type of birth defect, and is not significantly increased in many common birth defects; Science Daily reported citing the study published in PLOS ONE.

High cigarette tax also makes people drink less

Washington: A recent study says higher cigarette tax can also lead to less alcohol consumption among smokers. The study published in the journal Alcoholism: Clinical and Experimental Research compared 11,000 persons in 31 states in the US that raised cigarette taxes between 2001-2002 and 2004-2005, with a similar number of people from 15 states in which taxes remained the same. Male smokers in states with higher tobacco tax drank almost 10 percent less alcohol and reduced seven times of their drunken revelry per year than those in the states with the same tax rate, Xinhua reported. Lab studies with animals have also shown the link between nicotine and alcohol. Researchers found that exposing a key part of the brain involved in reward and motivation to nicotine increases the response of dopamine-emitting neurons to alcohol. The study was carried out by researchers from Yale, Stanford and the Roswell Park Cancer Institute. Agencies

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