April 29, 2011

SOUTH AFRICA: Osteoporosis used to be mistakenly thought of as a normal part of aging

CAPE TOWN / Mail & Guardian / Health / April 29, 2011

Guard against the 'silent crippler'

Johannesburg, South Africa

Imagine leaning on a table for a moment when, with a sudden snap, a bone in your wrist shatters. Imagine doing something as innocuous as turning your head to look at something and a vertebrae in your neck fractures. For many ­people this is the first sign that they have osteoporosis.

Illustration by courtesy of Stop Osteoporois

Called the "silent crippler", it is believed that as many as one in three women and one in five men in South Africa will suffer from this painful and debilitating disease, which means that between four and six million South Africans are at risk. In fact, osteoporosis is so common that it used to be mistakenly thought of as a normal part of ageing. Although it is not restricted to senior citizens, women in their mid-20s can suffer from bone density loss. But it is considered more common in Caucasian and Asian post-menopausal women.

This systemic skeletal disease is caused by a loss of mineral density in the bones owing to a deterioration of bone tissue. The resulting weakness increases the risk of fracture and particularly vulnerable are bones in the wrist, upper arm, pelvis, hip and vertebral column. In some cases with elderly patients, acute and chronic pain can often be attributed to an undetected fracture caused by osteoporosis. The result of multiple fractures of the vertebrae is a stooped posture, a loss of height and reduced mobility.

Of those who suffer hip fractures, about 20% of people will die within one year and more than 50% of those who survive will end up severely immobilised. Those most at risk include (but are not limited to) women who have experienced premature menopause (under 45 years of age), women over the age of 65, low levels of sex hormones, long-term use of cortisone, alcohol abuse and smoking, genetic factors, a family history of the disease, excessive leanness, malnutrition, poor calcium intake before the age of 35 and eating disorders such as anorexia and bulimia.

The treatment of advanced osteoporosis is difficult and the real key to the management of the disease is early detection of bone density loss and prevention therapy.

Ensure that you eat a calcium-rich diet -- dairy products, dark green vegetables such as broccoli, bok choy and curly kale, almonds and Brazil nuts, canned whole fish with bones such as sardines and pilchards, tofu and soya beans. These are just some of the many foods that are rich in calcium.

Moreover, it is believed that a high intake of vitamin D also helps the body to better absorb the calcium. A good dose of sunshine on a daily basis should be enough. And, of course, there are many supplements to choose from that can augment your calcium intake, but do not take more than 500mg of calcium at any one time.

Exercise is also crucial, especially weight-bearing exercise such as a good, brisk walk, stair climbing, jogging for the sporty-inclined, or even a twirl or two around the dance floor. Weight-bearing exercise promotes bone formation and maintains strength, stimulates blood flow within the bone and is more effective than non-weight-bearing exercise such as swimming and cycling.

In terms of treatment there are many potent prescription drugs available for osteoporosis sufferers that generally fall into two broad categories -- those that inhibit bone density loss and those that stimulate new bone formation.

The anti-resorptive drugs include the bisphosphonates, selective oestrogen receptor modulators, hormone replacement therapy and non-sex hormones. Bone-forming drugs are the latest addition in the fight against osteoporosis and these include strontium ranelate and parathyroid hormone. Obviously, your doctor will need to advise you on the options available.

Finally, if you are in the high-risk categories for osteoporosis (as highlighted above) ensure that you have a bone density test on an annual basis. This not only tells you whether you have the disease, it can also predict the risk of fractures.

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