Dubai: Lack of Vitamin D, no exercise and poor nutrition can make your bones weak, and one day as you accidentally hit against a wall or bump hard into something with your hip, the femur bone can crack. It sounds scary —and it is.
“Normally, the impact of the car door or the elevator door hitting your shoulder should not break the leg or arm bone,” says Dr Abdul Rahim Al Suhaili, head of Nuclear Medicine, Dubai Hospital and Vice-Chairman of the Emirates Osteoporosis Society.
The fracture occurs because the inner part of the bone becomes hollow over a period of time. “The outer shell looks fine but inside, it will be full of holes.”
There are 30 per cent chances of a person dying in the first year after a fracture of the femur (the bone between the hip and the knee joints). “The chances are high for further complications as lung infection and clot formation takes place making the patient bedridden and disabled.”
Studies have earlier shown that at least one in four people in the UAE are in the danger of having brittle bones. “We do not want to treat these fractures, we want to prevent them from happening,” says Dr Al Suhaili.
He believes it is essential to warn people about the deterioration of their bones ahead of time. Osteoporosis, he says, is like a silent killer. “Every day it takes away a little bit from your bones, until they collapse.”
Osteoporosis was first understood during the US-Russian Space Race, says Dr Al Suhaili. The two nations were trying to keep their astronauts in space for longer and longer periods. “When the astronauts returned back to Earth, they were found to be very weak, they could barely stand. The explanation being since you do not need a skeleton in space because of the lack of gravity, the astronauts started losing bone mass. “Today if you observe astronauts in space stations, they are on the treadmill or doing stretching exercises to keep their bones strong.”
Bone damage, he says, can be reversed but very slowly. It takes 15 years for the bone to become hollow inside and the process to stop it takes equally long.
Fragile bones are a huge problem in the UAE as well as in the region and this despite the fact that there is plenty of sunshine here, says Dr Al Suhaili. “The skin is a factory for producing Vitamin D and we need to get sunlight every day,” he says. Times have changed in a way that people now spend most of the time walking in malls in artificial light. They have developed an inordinate fear of the sun.
On the other hand, if an individual, particularly a woman, has to cover up for cultural reasons, she should ensure that in the privacy of her home, she benefits direct sun exposure. But there is a caveat: “The sunlight should not come through the glass because it filters the ultra-violet rays.”
Bone-friendly tactics
Vitamin D is essential for bones as it helps absorb calcium and phosphorous from food. These minerals are essential for healthy bones. (For a list of foods that have high levels of Vitamin D, see box). But sunlight still remains the main source to enjoy healthy, strong bones. “The other sources are not as good as what God created,” says Al Suhaili, warning that people could overdose themselves from Vitamin D supplements and it could lead to toxicity.
Besides Vitamin D, it is also necessary to consume calcium and exercise everyday to strengthen bones and prevent them from breaking. It is unfortunate, he says, that not many people drink milk nowadays, which supplies calcium.
Sedentary lifestyle is another risk factor for osteoporosis. “You need to do resistant exercises such as lifting weights, etc,” he advises. The greatest villians however smoking and drinking. “In many cases, it has been found that the bones of smokers are much thinner. It could be because they never exercise and are always indoors.” Alcohol too is very harmful as it hampers the absorption of calcium and Vitamin D.
Despite being aware of these basics, people are still largely indifferent to their bone health, the doctor rues. “We have unfortunately become lazy,” he says. “When you check the bone density of the older generation, we find it much thicker than the newer generation,” he says. “They [the older generation] used to work hard, had good exposure to sunlight and ate ‘normal’ food.”
Under the circumstances, it is essential to warn people about bone disease which is why every year the World Osteoporosis Day is marked on October 20. It launches campaigns around the globe to raise awareness of the prevention, diagnosis and treatment of this affliction.
For women who need to know the health of their bones, he advises they undergo a bone scan. To check the strength of the bones and the possibility of fracture, they would need to fill out a questionnaire. The purpose of the questionnaire is to assess the family history and other conditions that could impact on the respondent’s health. If a father, grandparent or a sibling has had or has the affliction, the risk of getting osteoporosis is high, says the doctor. “If your mother has osteoporosis, it is more likely you too will have this disease.”
It is estimated that a majority of the bone mass is determined by genetics and if you are found to be predisposed to osteoporosis, regular exercise, proper diet and regular bone testing is essential, says the doctor. In such circumstances, “You need to get your bone density tested every year.”
Regarding the treatment of osteoporosis, Dr Al Suhaili says the method is dependent on the patient’s case and condition. There are medications that help slow down the ‘dissolving’ process in the bones. For both men and women, there are hormone replacement therapies. For women, it starts after menopause and for men, testosterone hormone therapy helps increase bone density. There are other medications as well that slow the bone loss process and have to be taken either monthly, weekly, depending on the circumstance.
For bones that fracture however, the only treatment is surgery. The same is true of dislocation, such as shoulder dislocation, etc., he says.
Children and bone health
It’s not adults alone who are being encouraged to get active and eat well to stave off osteoporosis. Children who are not active and sit all day long in front of the computer and play games, will not have strong bones in their adulthood, he says.
To give children a great head-start on bone health, weaning babies on to milk fortified with calcium is essential, advises the doctor. Besides getting calcium and Vitamin D, it is also important that children eat about five servings of fruits and vegetables a day. It is advisable to keep children away from eating too much red meat.
What about vegetarians?
According to the doctor, vegetarian do perfectly well with their meatless diets and get plenty of calcium from their diet. They appear to have larger bone mass than meat-eaters who are at higher risk of losing their bone density because meat has a calcium-leaching capability and inhibits calcium absorption.
Menopause and bone health
Women who menopause before the normal age (average age is 51) are more likely to get osteoporosis. “Hormonal change causes osteoporosis and in some women, the backbone will bend in the shape of the letter ‘e’,“ he says.
Pregnant women
Pregnant women and lactating mothers should have more calcium. “The baby takes the calcium from the mother,” says the doctor. He recommends these women should have at least 1 gm of calcium supplement in their diet.
Men
In men, osteoporosis occurs because of changes to the skeleton caused by ageing or from other things that speed up bone loss. “The bone is constantly changing and growing and as we get older, the bone gets thinner and can become fragile.”
Bone fragility can also be caused by diabetes, hormone disorders such as hyperthyroidism or being underweight. The other risk factors are kidney problems, or if you are on corticosteroids or undergoing chemotherapy.
