Osteoporosis And Brittle Bones
by Dr.Eva Bell
As oestrogen “the chemical fountain of femininity” declines in the menopausal years, complex changes occur in a woman’s body. This leads to a great deal of physical discomfort such as backache, fracture of bones and diminution of height.
Bones are never static. A continuous process of bone formation and destruction takes place. This fine balance is what keeps bones healthy. Oestrogen helps maintain this balance.
At menopause, oestrogen levels fall due to declining activity of the ovaries. There is a loss of calcium and minerals from bones, making them brittle and liable to fracture. The shell of the bones becomes thin and the matrix becomes spongy. Bone pains become excruciating and incapacitating. This condition is called osteoporosis.
Twenty percent of fractures occur at the hip (neck of the femur), twenty percent at the wrist (Colles fracture) and fifty percent are compression fractures of the spine, especially of the lumbar vertebrae, which occur spontaneously. In women above 65, the fracture rate increases by about 8-10%. The back and shoulders become hunched, leading to what is called the “Dowager’s Hump.” Thin women and heavy smokers are at a greater risk of fractures. A sudden onset of low back pain in the elderly should alert one to vertebral fractures.Other causes of osteoporosis are:
• Young women who have undergone hysterectomy and removal of ovaries can suffer from osteoporosis at an early age.
• Medical disorders like hyperthyroidism, hyperparathyroidism, chronic kidney or liver disease or rheumatoid arthritis can lead to osteoporosis.
• Prolonged drug usage like cortisone, anti-epilepsy drugs, anti-cancer drugs or heparin can bring about bone changes. Glucocorticoids consumed on a long term basis causes bone loss. About 5% is lost in the first year, and 1-2% in subsequent years. Anti-convulsant drugs also affect bone and mineral metabolism.
• Malabsorption of calcium and Vitamin D due to ceoliac disease.
• Dietary deficiencies of Calcium or Vitamin D. The normal requirement of calcium is about 1000 mgms per day. Indian diets may be low in calcium. Urban diets supply about 350mgs/ day, and rural diets, as low as 250
• Smoking makes bones weaker. The spinal ligaments become weaker, there is accelerated bone loss without simultaneous bone production, and even the intervertebral discs may degenerate.
• Sedentary life styles, alcoholism and obesity are also contributory factors.Diagnosis:
-Measurement of Bone Density. Women above fifty should be tested at least once in two years.
-Ultra sound or X-rays of bone,
-Rise of Calcium and phosphorous in blood because of resorption of bones.Management:
1. Physical activity like walking, jogging, cycling or swimming. However there should be no participation in rough and collision sports.
2. A wholesome diet containing calcium, magnesium and other minerals. Protein, nuts, grains, pulses will provide the body’s requirements of calcium and minerals. However, only about 8-10% of calcium in food is absorbed. So Calcium supplements may be required.
3. Vitamin D3 is recommended for those with severe osteoporosis. The dose must be prescribed by a doctor.
4. Hormone Replacement Therapy (HRT) is known to have beneficial effects on osteoporosis. Oestrogen slows down bone loss and prevents fractures. If started soon after menopause sets in and is continued for a few years, it preserves bone mass density and also prevents pain. However, the benefits of HRT must be weighed against its side effects. The major drawback is its ability to cause endometrial cancer, irregular bleeding or breast cancer. The risk depends on dosage and duration. A Denmark study showed that women who were treated from the onset of menopause for about three years, lost bone mass more slowly than those who were untreated. Similarly an American study showed that those who were on long term HRT were 50-60% less likely to suffer from fractures. HRT must be given only under medical supervision. Those with a family history of cancer, coronary heart disease or varicose veins are not suitable candidates.
Bone density begins to gradually fall after the age of 35. Prevention of osteoporosis should start as early as at 30 years of age, with regular physical activity, healthy diet and lifestyles free of smoking or alcohol. One must also watch one’s weight.