Dubai: Have you or your loved one ever suffered from a hip or wrist fracture with the slightest fall? Chances are you could be encountering the starting stages of osteoporosis, a debilitating depletion of bone mineral density that leads to bones becoming brittle. Previous studies point out that at least one in three women and one in five men are likely to suffer from fractures after the age of 50 due to osteoporosis.
Worldwide, osteoporosis causes 8.9 million fractures, with one case reported almost every three seconds.
So what is osteoporosis?
The human bone is a living tissue, which constantly breaks down and is remodelled to be assimilated in the body through a process of resorption. However, as we age and due to certain health risks, the resorption process slows down causing a rapid depletion of bone mass,
Dr Luiza Sampaio, rheumatologist from the Dubai Bone and Joint Centre, explained that osteoporosis is a condition that sets in due to poor bone health, usually with advancing age. “Osteoporosis is a disease marked by the depletion of bone minerals that leads to decreased bone mass and a deterioration of the microarchitecture of our skeletal frame,” she elaborated.
Usually this happens to people after the age of 60 years but there are certain high-risk factors such as obesity, cardiovascular disease, women with early onset of menopause, smoking and arthritis, and those on steroid medication are more likely to develop osteoporosis. In addition, global studies indicate that vitamin D deficiency is directly related to osteoporosis. “In case of children who have vitamin D deficiency, they develop rickets,” Dr Sampaio added.
With more than 78 per cent UAE residents suffering from Vitamin D deficiency, health care specialists feel there is cause for concern, especially since osteoporosis is a silent disease
“The disease is asymptomatic and therefore silent and one can go from having healthy bones to becoming osteopoenic, which is the first stage of the condition that can be reversed to being osteoporotic without any external manifestations of the condition. Only when you have a fracture with a simple knock against the wall, you know you have the beginning of the disease,” said Dr Sampaio.
“A simple test or bone scan can prevent you from becoming a victim to this disease,” advises Dr Mohammad Hani, chief radiologist at DBAJ, who runs the Dexa scan.
Explaining how the machine works and what the ideal bone density should be, Dr Hani said: “We have three coloured bars to show your bone health. A patient is asked to lie on his back on the bed fitted with an X-ray machine, which scans the lumbar spine, the hips and the knee, which are the high spots to check bone mineral density.”
Detailing the unit of measurement, Dr Hani added: “Bone Mineral Density is measured in a spectrum of 1.5/bmd/gm cm2 to -2.5 /bmd/cmcm2. The measure is called a T score. The BMD between 1.5 to -1 is considered healthy and the BMD is placed in the green bar. Anything from -1 to -1.5 indicates the patient is osteopoenic where the depletion of bone mass has begun and this can be reversed with timely intervention. A patient with BMD that goes below -1.5 to years to 2.5 indicates severe osteoporosis where bones have lost mineral density and become brittle leading to fractures even with the mildest impact. In such cases, treatment cannot completely reverse the condition but the patient can go from being severely osteoporotic to osteopoenic and thereby prevent fractures.”
Who should go in for a BMD test?
If you have any of the following variables, you are at risk of osteoporosis and must go in for a bone scan
• Low Body Mass Index (BMI) of less than 19
• Vitamin D or calcium deficiency
• You are above the age of 65
• You have had an early menopause
• You have a family history of hip fractures
• you are a smoker
• You have more than 3 units of alcohol per day
• You have poor body balance and have frequent falls
• You have arthritis, hyperthyroidism, hyper parathyroidism, inflammatory bowel disease, primary hypogonadism, diabetes, chronic kidney disease or liver disease
• You suffer from bulimia or anorexia
• You take medication for epilepsy or have steroid medication or use proton pump inhibitors
Dr Sampaio stressed that BMD is important for our skeletal health as, once we age, in nearly 20-30 per cent cases, the chances of fractures increase and also raise mortality risks.
Prevention
1. Exercise for 30 to 40 minutes three to four times a week and include weight-bearing exercises
2. Have a balanced diet with more of proteins, fresh fruits, vegetables, healthy fats and nuts. Avoid transfats and processed foods
3. Expose yourself to at least 20 minutes of sunshine to help the body synthesise Vitamin D
4. Have calcium supplements
5. Avoid smoking, alcohol
6. Go for annual bone scan after the age of 50 and, if there is a parental history of osteoporosis, do it by the age of 40
Treatment
Dr Sampaio pointed out that first, second and third lines of treatment exist for mild to medium to severe forms of osteoporosis and sustained treatment could help either reverse the disease in earlier stages or manage it well if it has reached a very extreme degree.
The therapy includes
* Biophosphates are drugs that slow down bone breakdown and thereby reduce the chances of fractures
* Hormone replacement therapies such as oestrogen replacement
* Denosumab, a drug containing monoclonal antibodies that target only certain cells and prevent bone loss
