Osteoporosis is preventable. How?

MANY readers we know would be interested to know how the bone mass deterioration which sets in as we age after 40, could be prevented. Here we got Dr. Chandrani Piyasena, a Member of the Food Advisory Committee of the MRI to explain how this could be done.

Preventing Osteoporosis the silent disease

Osteoporosis is a disease of the skeleton characterized by low bone mass in which bones become brittle and prone to fractures.

In other words, the bone loses density. Osteoporosis is diagnosed when bone density has decreased to the point where fractures occur with mild stress. The more susceptible sites for fracture are the hip, spine and wrist. Men as well as women suffer from osteoporosis, a disease that can be prevented and treated.

After you reach 30 years

Throughout your lifetime, old bone is removed (resorption) and new bone is added to the skeleton (formation). During childhood and teenage years, new bone is added faster than old bone is removed, until peak bone mass (maximum bone density and strength) is reached.

After age 30, bone resorption slowly begins to exceed bone formation. Bone loss is most rapid in the first few years after menopause but persists into the postmenopausal years. Osteoporosis develops when bone resorption occurs too quickly or if replacement occurs too slowly. Osteoporosis is more likely to develop if you did not reach optimal bone mass during your bone building years.

How the system breaks down

Until a healthy person is around 40, the process of breaking down and building up bone is a nearly perfectly coupled system with one phase stimulating the other. As a person ages, or in the presence of certain conditions, this system breaks down. The reasons why this occurs during aging are not clear. Some individuals have a very high turnover rate of bone; some have a very gradual turnover, but the bones break down eventually.

Who is at risk?

Certain factors are linked to the development of osteoporosis. These are called 'risk factors'. Many people with osteoporosis have several of these risk factors.

* Women

* Men

* Teenagers

* Thin people

* Sedentary people

* People of all races and ethnic origins

* Anorexics or Bulimics

* Women with late onset of

menstruation (delayed puberty)

* People with diets low in calcium

* Caffeine (more than 2-5 cups/day)

* Prolonged Immobilization

* High protein diet (meat)

* People who smoke

* People who abuse alcohol

* People with heavy antacid use

* Obese people

* People who over-exercise

* Pre-menopausal women

* Post-menopausal women

* People taking certain medications

such as steroids or thyroxin

* People with family history of

osteoporosis

* People who have lost body height

* Having had no children - (nulliparous)

* History Maternal Hip fracture

There are some risk factors that you cannot change, and others that you can:

Risk factors you cannot change:

* Gender - Your chances of developing osteoporosis are greater if you are a woman. Women have less bone tissue and lose bone more rapidly than men because of the changes involved in menopause.

* Age - the older you are, the greater your risk of osteoporosis. Your bones become less dense and weaker as you age.

* Body size - Small, thin-boned women are at greater risk.

* Ethnicity - Asian women are at highest risk. African-American and Latino women have a lower but significant risk.

* Family history - Susceptibility to fracture may be, in part, hereditary. People whose parents have a history of fractures also seem to have reduced bone mass and may be at risk for fractures.

Modifiable risk factors that may potentiate osteoporosis include:

* Inactivity, especially lack of weight bearing exercise: Like muscle, bone is living tissue that responds to exercise by becoming stronger.

The best exercise for your bones is weight-bearing exercise that forces you to work against gravity. These exercises include walking, hiking, jogging, stair-climbing, weight training, tennis and dancing.

* Extended bed rest (Prolonged immobilization)

* Smoking: is bad for your bones as well as for your heart and lungs. Women who smoke have lower levels of estrogen compared to nonsmokers and frequently go through menopause earlier.

Postmenopausal women who smoke may require higher doses of hormone replacement therapy and may have more side effects. Smokers also may absorb less calcium from their diets.

* Excessive use of alcohol: Regular consumption of 2 to 3 ounces a day of alcohol may be damaging to the skeleton, even in young women and men. Those who drink heavily are more prone to bone loss and fractures, both because of poor nutrition as well as increased risk of falling.

* Excessive caffeine consumption

* Excessive dietary protein consumption

* Lack of dietary calcium: An inadequate supply of calcium over the lifetime is thought to play a significant role in contributing to the development of osteoporosis. Many published studies show that low calcium intakes appear to be associated with low bone mass, rapid bone loss, and high fracture rates.

* Inadequacy of vitamin D - Vitamin D plays an important role in calcium absorption and in bone health. It is synthesized in the skin through exposure to sunlight. While many people are able to obtain enough vitamin D naturally, studies show that vitamin D production decreases in the elderly, in people who are housebound and during the winter.

* Sex hormones: abnormal absence of menstrual periods (amenorrhea), low estrogen level (menopause), and low testosterone level in men.

* Use of certain medications, such as glucocorticoids or some anticonvulsants.

Symptoms

Osteoporosis is often called the 'silent disease' because bone loss occurs without symptoms. People may not know that they have osteoporosis until their bones become so weak that a sudden strain, bump, or fall causes a hip fracture or a vertebra to collapse.

Collapsed vertebra may initially be felt or seen in the form of severe back pain, loss of height, or spinal deformities such as kyphosis, or severely stooped posture.

Detection

Following a comprehensive medical assessment, your doctor may recommend that you have your bone mass measured. Bone Mineral Density (BMD) tests measure bone density in the spine, wrist and/or hip (the most common sites of fractures due to osteoporosis), while others measure bone in the heel or hand. These tests are painless, non-invasive, and safe.

Prevention strategies

The best long-term approach to osteoporosis is prevention. If children and young adults, particularly women, have a good diet (With enough calcium and vitamin D) and get plenty of exercise, then they will build up and maintain bone mass.

Randomized control trials have demonstrated that modest exercise, including brisk walking reduces the rate of bone density loss among post menopausal women. Exercise places stress on bones that builds up bone mass, particularly skeletal loading from muscle contraction with weight training exercises.

However, any exercise of any type is better than none at all, and exercise also provides benefits for prevention of cardiovascular diseases that are more common in the elderly. Athletes tend to have greater bone mass than non-athletes. Exercise in later life will help to retard the rate of bone loss.

Good sources of calcium include milk and milk products, dark green leafy vegetables, such as 'Kathurumurunga', kale, Sweet potato and turnip leaves, pumpkin leaves, Thampala, radish and spinach; sprats, kunissa, sardines and salmon with bones; tofu; gingelly seed and almonds; cereals and pulses. Depending upon how much calcium you get each day from food, you may need to take a calcium supplement.

(To be continued)

First annual conference of aesthetic dentistry

INAUGURAL session of the first such conference of the Sri Lankan Academy of Aesthetic and Cosmetic Dentistry was held recently at Hotel Tourmaline, Kandy.

Pre-conference workshops and academic sessions were held in the Faculty of Dental Sciences, University of Peradeniya. Dental experts in aesthetic dentistry who have earned recognition for their scholarly work in the field of aesthetic dentistry in the world participated at this conference.

His excellency Rajan Pillai, Deputy High Commissioner of India for Sri Lanka was the chief guest and Dean of the Faculty of Dental Sciences Prof. R.L. Wijeyeweera, was the Guest of Honour.

Charter President and the Conference Chairman Dr. V. Vijayakumaran explaining the objectives of the academy said that the main aim of the academy is to provide continuous dental education to the Sri Lankan dentists to upgrade their knowledge in advanced aesthetic dentistry.

Founder of Aesthetic Dentistry in Sri Lanka Dr. V. Vijayakumaran mentioned that this academy was established in 1999 and now it has been affiliated with several international aesthetic dental academies in India, Japan, Malaysia, Singapore, China, Canada, Bhutan, Australia, America and other Asian countries.

This international relationship will bring more opportunities to carry out several collaborative programmes with Sri Lanka and other countries in the field of Aesthetic Dentistry. Dr. K. Kumarasamy, Immediate Past President of the Indian academy of Aesthetic and Cosmetic Dentistry congratulated Dr. V. Vijayakumaran and members for initiating the Academy in this nature in Sri Lanka.

Guest of Honour Prof. R.L. Wijeyeweera the Dean of the Faculty of dental Sciences said that Aesthetic Dentistry is not a treatment only for the affluent but it is a treatment procedure for all, irrespective of whether they are rich or poor. Therefore, it is our abundant duty to train all dentists in all parts of the country to meet this demand.

Chief Guest Deputy Indian High Commissioner of Sri Lanka said that it is very appropriate for Sri Lanka to embark on Aesthetic Dentistry joining hands with the renown Indian experts.

He further said that this would undoubtedly strengthen the long-standing friendship and ties that India and Sri Lanka have been having since independence of both countries.

Prof. R.L. Wijeyeweera dean of the faculty of dental sciences handedover the certificates to the Indian experts who delivered lectures and conducted workshops at this conference.

Chief Guest His Excellency Rajan Pillai handedover the certificates to the Sri Lankan dentists who followed the workshop in implantology at this conference.

Dr. K.W. Wettasinghe, Secretary of the SLAACD delivered the vote of thanks.