Determining health needs in osteoporosis – The News International

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Osteoporosis is a common yet undertreated health concern

O
steoporosis is a health condition in which the mineral content of the skeleton reduces. This makes the bones more brittle and susceptible to fragility fractures. It is not a life-threatening condition, but the fracture sustained as a result of the disease process causes most patients to die within six months, as they are more susceptible to other bone fractures than their peers. Mostly this condition affects the elderly as a result of normal age-related bone changes.
Risk factors for osteoporosis are the ones that affect bone mineral density. It can be due to hormonal changes, particularly in women with menopause. However, in younger people, it can be due to hereditary conditions. For example, a family member affected with the condition. Short-stature women are more vulnerable to osteoporosis. Also, men and women with a diet deficient in calcium and vitamin D, smoking, consumption of alcohol and steroid use are more vulnerable. Chronic medical conditions such as premature menopause, Cushing’s disease, and hyperthyroidism can be risk factors for osteoporosis. Men on prostate cancer medication and women on breast malignancy treatment can have osteoporosis. Anti-epileptic drugs can also put patients at risk. Similarly, long-term use of both thyroid medications and drugs used to treat gastrointestinal ulcers can be a risk factor for worsening bone health. Steroids or prednisone can also significantly affect bone health when used at high doses or for longer periods. Apart from these risk factors, a low level of physical activity, especially in bedridden patients, also contributes towards osteoporosis.
All women above 65 years of age must undergo a bone mineral density test. The bone mineral density of various bones in the body determines the quality of bone. It is measured by a test known as dual-energy X-ray absorptiometry (DXA), which is a non-invasive test used to assess the amount of calcium and other minerals in a given segment of bone. Any decrease in bone density is picked up to find out about the patient’s susceptibility to fractures and also for treatment response of osteoporosis.
A quick way to increase bone mineral density is to fulfil the daily recommended requirement of calcium 1,200 mg a day for women aged 51 and older and for men aged 71 and older, preferably through a diet rich in calcium. The main sources of calcium include dairy products, almonds, broccoli and salmon fish. Recommended dietary need of vitamin D for adults aged 50 years and above is 800IU per day in the form of supplements. A dietary protein requirement of 1gm/ kg/ day needs to be fulfilled. As a fragility fracture of osteoporosis begets more fractures, general measures to avoid falls need to be taken in daily living.
The first-line treatments include bracing and support to prevent fall hazards (such as slippery tiles), including lumbosacral belts, knee-caps, etc. Elderly women should avoid high heels. The rug’s underside must be anchored to the surface of the floor to prevent rugs from sliding. Getting rid of unused items and arranging things in an orderly manner could help reduce the stress of moving around the house. Install handrails in bathrooms and main lounges. Proper lights should be installed in entrances, halls, and staircases.
Moreover, blood pressure medications, opioids and sleeping pills may cause dizziness and a change of balance, so patient education is a must. Also included are, avoiding activities that involve twisting your spine or bending forward from the waist, for example, conventional sit-ups and toe touches. Assessment and secondary prevention need to be done in those at high-fracture risk. Many effective medications are available to prevent bone resorption and new bone formation. But remember these are only one part of management. It is important that prescribed medications are taken regularly as advised by the doctor without skipping doses.
Lastly, as populations are ageing worldwide, osteoporosis affects people in their millions. The African continent has the highest prevalence.
Osteoporosis is more prevalent in women than men, as per a study published in Ann.Med Surg (Lond), 2018, a large proportion of women in Pakistan suffer from calcium deficiency due to repeated childbirth leading to bone tissue deterioration and fractures. It’s a substantial economic burden on society, and sadly, most studies have been done in urban areas. Hence, estimates of the disease from a much larger section of the rural population are unattainable due to a lack of national data.
It’s a preventable but undertreated disease. Based on existing local evidence, comprehensive measures, including primary, secondary and tertiary prevention of osteoporosis, must be considered a priority.

The writer is a  family physician

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