How to Build Strong Bones

Don’t wait for that dreaded bone-weakening disease to strike. The good news: you can reverse bone losses with diet, exercise and medication

I woke up one morning with a nagging pain in my upper back. When a few weeks of rubbing balm didn’t help, I consulted an orthopaedic doctor.

He learnt after asking me a few questions—and so did I—that I had all along been getting too little calcium in my diet. A bone mineral density test soon afterwards shocked me: I had osteopenia, or early-stage osteoporosis that can lead to full blown osteoporosis if left untreated. I’d always believed osteoporosis—a disease where bones weaken and become porous and brittle—afflicted only the elderly.

I learnt that when we’re very young, our bones get longer and denser until we reach full height. Even as we grow, our bone tissue is constantly being broken down and rebuilt. Then (in your early 30s if you’re a woman, and at about 40 if you’re a man), your skeleton naturally begins to slowly lose bone faster than your body can replace it and very gradually your bones thin and become less dense as you age.

Osteoporosis is usually not detected until you suffer a nasty fracture of the wrist or hip, often in a very minor accident or, in some cases, even spontaneously. By the time you’re diagnosed with osteoporosis, your bones will already have lost significant density, making them fragile.

According to the International Osteoporosis Foundation, one out of eight men and one out of three women suffer from osteoporosis in India. The Osteoporosis Society of India put the number of patients at about 26 million in 2003, and projects an increase to 36 million by 2013.

An overwhelming majority of sufferers will be women, because the hormone oestrogen plays a crucial role in a woman’s ability to use dietary calcium to build new bone. So, when a woman approaches menopause, the reduction in the body’s oestrogen production deprives her bones of vital calcium.

Some 20 to 30 percent of bone loss in women occurs in the first five years after menopause, when the precondition, osteopenia, often develops. So women in the 46-to-50 age group are at the greatest risk of developing osteopenia. However, a 2005 study from Mumbai found that a substantial number of younger women too developed osteopenia and osteoporosis. Still in my 30s, I wasn’t alone.

What’s more distressing is that the study found an almost 100 percent incidence of either osteopenia or osteoporosis in women above 60.

Patients with osteopenia usually have pain, most commonly in the back, like I had; and in severe cases, may have suffered a fracture after a trivial injury.

Men, too, are at risk. A decline in testosterone, which occurs naturally after age 60, results in a reduced ability to use dietary calcium to build new bone. (Men also produce a small amount of oestrogen, and fluctuations in this may also play a role.)

A sedentary lifestyle too can contribute to osteoporosis in men, as can the long-term use of medication such as anticonvulsants (taken by epileptics) and corticosteroids (used by asthmatics or those suffering from skin disorders).

Ishaq Raotiwal, 72, of Ratlam, MP,  was getting up from a chair when his walking stick slipped and he fell and broke his hip. Afterwards, Raotiwal learnt that he had osteoporosis, and needed hip replacement surgery—troublesome since he suffered from asthma, was diabetic, and once had suffered a stroke. His doctor says Raotiwal probably developed osteoporosis because of the steroids he was taking for his asthma and the fact that he had been quite immobile for a few years following the stroke. Staying indoors also gave him limited exposure to sunlight.

Younger Indians, too, especially those who work regular night shifts, or have adopted a sedentary indoor lifestyle, or smoke or drink excessively are more likely to develop osteoporosis. Bone loss can also occur in women whose oestrogen levels have dropped due to the removal of their ovaries, and in athletes whose ability to produce oestrogen may be hindered by low levels of body fat.

Symptoms and Indicators

Constant back pain and, less commonly, pain in the chest, hip, wrist and pelvic area.

Developing a hunched back, or loss of height (due to compression of the spinal column).

Tendency to suffer fractures after relatively minor falls.

Amenorrhoea (absence of menstrual periods) is associated with reduced oestrogen levels and, possibly, osteoporosis.

If your doctor can help you find out if you have high-risk genes for osteoporosis, you may be able to take preventive measures early.

Treatments

For osteopenia and osteoporosis, doctors focus on medication to slow bone loss and reduce the risk of fractures. They also suggest lifestyle changes. For severe cases and for fractures, surgery could be an option. Being diagnosed with osteopenia left me shaken, yet I was relieved to have identified the cause of my pain and also to know that I could, with a few dietary changes, reverse my condition.

I was put on calcium supplements, told to include lots of bananas and sesame seeds in my diet, and to increase my exposure to sunlight. After a few months of all that, my pain vanished completely. Today, just four years on, I take no calcium supplements, but I am careful with my diet and ensure that I get an adequate supply of calcium.

Indeed, adults up to age 50 require 1000mg of calcium daily; post meno-pausal women (and men over age 65) should get 1200 to 1500mg a day.

If dietary sources aren’t enough, add calcium supplements. You’ll find a variety of calcium compounds at the chemist’s; the two with the highest levels are calcium carbonate and calcium citrate. For best absorption, calcium supplements should be taken an hour before or after meals in doses of 500 to 600mg at a time.

Calcium needs a partner in its bone-protection work: vitamin D. Most adults need 400 IU (international units) daily. With osteoporosis, you may require 800 IU. Or your doctor may suggest a prescription for calcitriol, which is a combination of calcium and vitamin D. You may also need medication to slow bone loss and increase bone mass. The first choices with many doctors are the drugs alendronate and risedronate. Both have been shown to lower the incidence of fractures.

If you are a postmenopausal woman, your doctor may recommend hormone replacement therapy (HRT), a treatment involving one or more female hormones, used to treat symptoms of menopause, such as hot flashes, vaginal dryness, mood swings, sleep disorders, and decreased libido. Hormone therapy comes as a pill, patch, injection or vaginal cream.

Because HRT replaces lost oestrogen, it prevents rapid bone loss and increases bone density in the hip and spine.

Long-term treatment with HRT is controversial, however, and must be closely monitored by a gynaecologist because it carries increased risk for blood clots, breast cancer and other problems. For oestrogen’s protective benefits without some of its side effects, ask about a new class of drugs called selective oestrogen receptor modulators (SERMs).

SERMs prevent bone loss throughout the body, but they carry an increased risk of blood clots and so are not right for everyone. “HRT has fallen into some disrepute in recent years, because of the risk associated with its long-term use and the expensive and cumbersome monitoring it mandates,” says Dr Arun Mullaji, a senior Mumbai orthopaedic surgeon. “Consequently, it is only useful in very severe cases of postmenopausal osteoporosis. Newer drugs like SERMs should also be taken with a measure of caution, since their long term safety is yet to be proved.”

Prevention: What You Can Do

Lifestyle changes can make a big difference, even if you’ve already been diagnosed with osteoporosis. Keep these bone building and safety tips in mind:

Supply calcium. Calcium-rich foods include soyabeans, sesame seeds, nuts, broccoli, turnip greens, sardines, clams, shrimp, and dairy products like milk, cheese, paneer and curd. Dr Raj D. Chakravarty, head of orthopaedics at Manipal Hospital, Bangalore, suggests avoiding fad diets that deliver a narrow range of nutrients. If you’re at risk (many vegetarians are!) you should also consider taking a calcium supplement. Choose one that combines vitamin D or magnesium and silica, in consultation with your doctor. Reduce your salt intake.

Avoid inactivity. Walk regularly, or work out. “When it comes to bones,” explains Dr Chakravarty, “function determines form. Exercise develops bone. Inactivity causes bone loss. So you can choose to use it or lose it.” Weight-bearing exercises and walking are important throughout life. Consult your doctor about how much exercise is safe for you.

Get some sun. Try to get 30 minutes of exposure to gentle sunlight every day. Avoid the harsh sunlight between 11am and 3pm.

Watch what you drink. Limit beverages, especially colas. Drink water instead. Restrict alcoholic drinks to one a day. Stop at two cups of tea or coffee per day.

Quit smoking. Tobacco use contributes to osteoporosis.

Make it safer. Make alterations to your home and office to prevent falls. Don’t leave stray items on the floor that a family member may trip on. Have anti-skid tiles in bathrooms. Ensure adequate lighting, especially in stairwells. Install handrails in key places, such as in the bathroom and stairs. And remember, running to catch buses or trains increases your chances of tripping.

Get vitamins. Here’s yet another reason to make sure you take a daily multivitamin—the B vitamins it contains could prevent debilitating fractures. Vitamin B12 has recently been shown to play a bigger role than previously thought in keeping bones strong as you grow older. Shellfish, milk, cheese, eggs, organ meats are all good sources of B12. “Supplementing vitamin B12 seems a good idea to help prevent osteoporosis especially among vegetarians who are more likely to suffer from its deficiency,” says Dr Joshipura, senior consultant orthopaedic surgeon and medical director, Apollo Hospitals, Ahmedabad.

Get tested. Anybody above 30 could discuss taking a bone density scan with their doctor. (It costs about Rs1800. If you have health insurance, this may be covered only if you are admitted to hospital.) Dr M.R. Rajasekar, head of orthopaedics at the Government Stanley Medical College Hospital, Chennai, recommends that adults aged 50 and older be screened every year. “If the screening reveals osteoporosis or osteopenia, go in for biannual screening to monitor the efficacy of the treatment regimen you are prescribed,” he advises.

Source: Published by Charu Bahri for Readers Digest.