Maintaining good bone health for life: Avoid the big O(steoporosis)

Bones serve an important function in adulthood in the form of mobility, skeletal strength and structure. The bone is an active organ that is constantly changing and re-builds, modifies and adapts.

One-third of the bone consists of protein and fibres that provide the ‘scaffolding and foundation’ for the minerals and organised calcium crystals that are ‘cemented’ onto, and in combination determines the strength and health of bones.

Building healthy bones

Building healthy strong bones start from a young age. Adults achieve peak bone density or maximum bone strength by the age of 30. After this there is a natural and gradual decline. Hence it is crucial to take steps at an early age to build strong healthy bones and continued throughout life to slow the natural decline in bone strength. These include a healthy balanced diet with adequate protein, calcium minerals and vitamin D in the diet. There are recommended daily nutrient intake¹, which can be economically achieved from meal planning.

Exercise is also crucial to strengthen bones. Specifically, regular weight bearing and muscle strengthening helps build and maintain strong bones. Daily walks, taking stairs, carrying bags are some easy daily activities that can help you achieve this. Avoiding bad habits such as smoking and excessive alcohol intake accelerate loss of bone strength and there are proven benefits to be gained by addressing this early.

Osteoporosis

Osteoporosis refers to the deterioration of bone structure and strength which exposes one to fractures from something as trivial as slipping and falling to the floor. The health and financial burden is not only limited to in-hospital treatment but also to chronic pain, disability and loss of independence. Osteoporosis, knowingly or unknowingly, is present in up to 1 in 5 women or 1 in 1in 10 men above the age of 50.

Symptoms and signs

Unfortunately osteoporosis is an asymptomatic condition and is often identified in someone after they sustain a fragility fracture. Some signs indicating osteoporosis related changes include reduced height, hunch-back posture and chronic back pain.

Identifying Osteoporosis

One way to determine bone strength involves DEXA bone scan. However, the majority of fragility fractures occur in those with normal bone scan results. Hence it is important to consider additional factors that impact bone health that are not captured by the bone scan. Some of the common important risk factors for osteoporosis are mentioned below:

1. History of falls and/or fractures

2. Long term steroid use

3. Diabetes

4. Some medications for weight loss or reflux

5. Thyroid hormone abnormalities

6. Family history of fragility fractures

The aim of treatment for osteoporosis is to prevent future fractures and avoid the burden associated with it. In addition to the suggestions mentioned above there are multiple medicinal options to optimise bone strength. Also important would be to address and minimise events that can lead to falls especially in the elderly such as muscle and balance strengthening, tripping hazards and certain medication side effects.

Take home message

Good bone health starts at an early age. Good healthy habits: Healthy eating, regular exercise and avoiding smoking is key. For osteoporosis, the aim is to avoid the long term consequences of fractures with early intervention. There is now a lot of awareness, information and help available if you are affected by any of the above².

1. Vitamin D 400IU/day, Calcium 700mg/day, Protein 0.75mg/Kg body weight/day

2. www.theros.org.uk

Written by

Dr Vinit K Shah

Consultant Endocrinologist

MP Shah hospital