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Building Stronger Bones

As age catches up with you, chances are you have ignored the health of your bones until a tiny trauma one day results in a painful fracture you can’t explain. Osteoporosis continues to baffle many women and take them by surprise, but our experts assure us that it’s a treatable and reversible condition.

A part of the normal ageing process, osteoporosis is, simply put, a condition where the bones may become porous and waste away. In average human beings, the bone density gradually starts wearing off from the age 30 onwards, but for some, this bone loss is more rapid. Women are more likely to develop this condition since they have lighter frames and smaller bones to begin with.

Breaking a bone due to osteoporosis is tougher to deal with compared to fractures in those who do not have the condition. Osteoporotic bones often heal more slowly and less completely than normal bones, probably because they contain fewer bone minerals and other materials essential for healing.

Often, osteoporotic spinal fractures can have a devastating impact. They lead to chronic back pain, loss in height, deformity, immobility, increased number of bed ridden days, and even reduced pulmonary function. Their impact on women’s quality of life can be profound, resulting in a loss of self-esteem and development of a distorted body image and depression.

Two experts in Bahrain give us the lowdown on this condition and provide tips on keeping it at bay.

Preventing Osteoporosis
Our expert: Dr Jamal Saleh, orthopaedic surgeon, founder Orthocare Centre

“Certain individuals are at a higher risk of developing osteoporosis earlier than others. These include people who have medical conditions such as rheumatoid arthritis, lactose intolerance, cancers, multiple sclerosis, and diabetic bone disease or mal-absorption syndromes. Too much smoking, abuse of alcohol or the use of corticosteroids also puts the bones at a greater risk,” he observes.

However, from his own experience Dr Jamal knows that osteoporosis should not be confused with low bone mineral density, a condition that can arise out of Vitamin D deficiency.

“I was only 41 when I was diagnosed with osteoporosis. I’d been suffering from a mal-absorption syndrome for years and had stopped consuming dairy products since then. I had been on corticosteroids, which put me in the high risk category. I started exercising and took regular doses of Vitamin D and calcium supplements in addition to the medication. Now, my bone mineral density levels are back to normal. I’m not sure whether it was osteoporosis or just Vitamin D imbalance, which resulted in weak bones,” says Dr Saleh.

The most effective way to prevent osteoporosis in this high-risk group is to have optimal levels of Vitamin D levels, at around 75 ng/dl.

“More than 80 per cent of people in Bahrain are deficient in Vitamin D and without this essential nutrient, the intake of calcium is useless,” says Dr Jamal. “A campaign is now underway in Bahrain to have food such as wheat flour fortified with this vitamin to serve the interests of the larger population.”

Managing Osteoporosis
Our expert: Dr Sumod Sukumaran, orthopaedic surgeon, KIMS Medical Centre

Family studies show that there’s a mother-daughter link in the development of osteoporosis, so if your family members have a strong history of a thin body frame, hormonal imbalance, unexplained fractures and trauma, chances are you have inherited this condition.

Women with such a family history should opt for early screening, including bone density tests from the age of 40 to get an early diagnosis. Once they’ve started undergoing treatment, annual checkups and screenings are recommended to keep track of their progress.

Know your medication
According to Dr Sukumaran, osteoporosis is a highly treatable condition, which can be reversed substantially through medication and changes in lifestyle.

Osteoporosis medications are primarily of two types, medicines that slow bone loss and drugs that increase the rate of bone formation. It’s the hormones that primarily assist in bone building, as they transport minerals and nutrients to the bones. Parathyroid hormones which increase the rate of bone formation form a distinct category of anabolic drugs, and are currently the only osteoporosis medicine approved by the FDA that rebuilds bone. Treatment to boost parathyroid hormones aims at not only building bone but also lowering the risk of bone breakage.

Doctors will sometime prescribe bisphosphonates, which act directly on the bone structure to reduce the rate of bone loss. It is mostly prescribed for post-menopausal women with low bone density or to prevent osteoporosis that is induced by corticosteroids.

Hormone replacement therapy is another treatment option for post menopausal women, depending on whether they’ve had their uterus removed; in which case, only estrogen is prescribed. However, there are side effects to the treatment and patients need to consult their physician before embarking on any long-term medication.

Bone-building exercises
Women who are active and especially those who do weight-bearing activities at least three times a week are far more likely to keep osteoporosis at bay than ladies who lead a sedentary lifestyle. Muscle pulling on the bone builds bone, so weight-bearing exercise – that is, exercise that involves your body supporting its own weight – builds denser, stronger bones. The more bone mass you build before the age of 25 or 30, the better off you will be during the years of gradual bone loss. Exercise can also help you maintain bone density later in life.

“A 30 minute workout six times a week is optimal. Those who have associated problems such as knee pain or arthritis can design their own regimen by opting for safe workouts such as swimming or Yoga to strengthen their bones,” says Dr Sukumaran.

The best exercises for building bones include lifting light weights, jogging, hiking, stair-climbing, step aerobics, dancing, racquet sports, and other activities that require your muscles to work against gravity. Thirty minutes of weight-bearing exercise daily benefits not only your bones, but improves heart health, muscle strength, coordination, and balance. Those 30 minutes don’t need to be done all at once; it’s just as beneficial for you to do ten minutes at a time.

Super foods
A common belief in the medical fraternity is that most degenerative diseases are caused, to an extent, by a modern diet which is a combination of too much sugar, fat, refined flour, salt, caffeine, alcohol and processed foods.

Considering that bones are living tissue, what you eat affects the health and strength of your bones. Ultimately, it all boils down to a healthy lifestyle, which begins with eating healthy, notes Dr Sukumaran. Take good helpings of milk, tofu, cheese and dairy products, which are rich in calcium, as is shell fish, clams, sardines, soy beans, soy milk and dark leafy greens. Vitamin K is as important for your bones as calcium, and for this reason you must top up on green leafy vegetables such as broccoli, green beans and Brussels sprouts.

Fatty varieties of fish such as salmon, mackerel, tuna and sardines are packed with Vitamin D. For a healthy dose of essential minerals such as magnesium and potassium, try to include more of tomatoes, okra, bananas, oranges, papaya, prunes and raisins in your diet.

Say ‘yes ‘to the sun, in small doses
Sunlight is good for you. Twenty minutes of exposure to the early morning or evening sun every day can help your body synthesise the much needed vitamin D, also known as the sunshine vitamin. Vitamin D is primarily responsible for the absorption of calcium and phosphate by the intestines and is highly beneficial for the health of bones, says Dr Sukumaran.

Alarmingly for a country like Bahrain which is blessed with over 3,000 hours of sunshine a year, the majority of the population is deficient in Vitamin D. A study performed between February 2011 and February 2012 by doctors at BDF Hospital found that out of 500 healthy Bahrainis tested, only 68 had optimal levels of Vitamin D in their bodies. This vitamin deficiency is found to be significantly higher in women than in men, which may well explain the early loss of bone density in females.

Fall-proof your home
Small slips and falls are the main source of fractures in the elderly and they should be watchful in this regard, observes Dr Sukumaran. Try to keep the clutter off floors, have the rooms in the house brightly lit and ensure that the stairs have handrails.

“Make sure there are no slippery surfaces in the house and that the washroom is skid-proof. Bath mats on the floor and sturdy footwear is essential. A supportive frame around the toilet bowl and a walking stick or crutches will help maintain the balance,” he says.

Seek Help
Our support group: Bahrain Osteoporosis Society

The Bahrain Osteoporosis Society is a major support group offering guidance and campaigning for awareness about the condition in Bahrain. The group conducts bone density tests and screenings annually and also undertakes research projects. Visit the society’s Facebook page for more details.

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