Osteoporosis is low bone density, also called brittle bone. Bones become thinner and brittle; a small injury can make the bone break.

How do we develop this?

Throughout the life, old bone is removed (resorption) and new bone is added (formation) to the skeleton. During childhood and teenage years, new bone is added faster than old bone is removed. As a result, bones become larger, heavier, and denser. Bone formation continues at a pace faster than resorption until maximum bone density is reached at around the age of 25 years. After that age, bone resorption slowly begins to exceed bone formation. Bone loss is most rapid in the first few years after menopause. Osteoporosis develops when bone resorption occurs too quickly or if replacement occurs too slowly.

Why do we stoop forward with Osteoporosis?

Loosing height is very common and used to be considered as normal. Now we know we stoop forward because we loose height and back bones (vertebra) get crushed due to weakness. This is called Osteoporosis or brittle bone disease. This is due to low bone mass and an increased susceptibility to fractures, especially of the hip, spine and wrist.

What are the symptoms of Osteoporosis?

Osteoporosis is a silent disease. People may not know that they have osteoporosis until their bones become so weak that a sudden strain, bump or a simple fall causes a fracture. Collapsed vertebral fracture may present with severe back pain and loss of height.

How do we diagnose Osteoporosis?

X-ray is not a good test for osteoporosis, by the time X-ray will detect it will be too late. Also X-ray can not quantify Osteoporosis. We need to see the bone density; this is done by a test called DEXA Scan. This is painless, does not require injection, and takes around 30 minute to finish.

Is it common with us in India?

Osteoporosis in India has gained relatively little attention until recently. It is likely 30-40% of people above the age of 50 years in India have it. Also this is happening around 10 years earlier than people in the west. In the west women are more affected but it seems in India it is equally common in men.

What are causes for short stature?

Most common cause for short stature is nutritional deficiency. Other causes are genetic or familial short stature, constitutional short stature or late bloomer, chronic diseases and hormonal deficiency. Among hormonal deficiencies they are thyroid and growth hormone (GH) deficiency. Rare causes are Turner syndrome, growth retardation inside mother’s tummy and emotional deprivation.

What is Hypothyroidism?

Hypothyroidism means thyroid hormone deficiency. It can occur at any age from newborn baby to old age. When a newborn baby develops hypothyroidism it is called congenital hypothyroidism. It is one of the preventable causes of mental retardation. Earlier the diagnosis and treatment better is the outcome. Earlier diagnosis has been achieved with the introduction of newborn screening for congenital hypothyroidism.

Symptoms of congenital hypothyroidism are prolonged jaundice, constipation, excessive sleep, poor feeding, large tongue hoarse voice, etc.

Symptoms in infancy and childhood are growth failure, constipation, dry skin, excessive sleep, etc.

What is newborn screening for hypothyroidism?

Newborn screening means one drop of blood is collected by heel prick of the baby on 4th or 5th day of life and this sample is sent for thyroid hormone analysis.

What is the treatment for hypothyroidism?

The goal of treatment is to achieve normal serum thyroxine level rapidly to attain normal growth both physically and mentally. The treatment for hypothyrodism is oral thyroxine tablet, dose depending on the weight of the child. It should always be under the guidance of a Paediatrician or Endocrinologist. Also child needs to be regularly monitored for growth and development. Response to treatment is monitored by estimating serum thyroxine and TSH levels.

What is IUGR ( Intrauterine growth retardation)?

Low birth weight or small for dates or babies weight is inappropriately low for duration of the pregnancy. This inappropriate low weight indicates that growth of the baby in womb has been unsatisfactory and this is why it is called intra uterine growth retardation or IUGR

Is there treatment for short stature?

Yes, there is treatment for short stature. Initially good balanced diet with exercise, thyroid deficiency screening and treatment of chronic diseases are tried with regular growth monitoring. If all these factors are corrected and growth is not adequate then tests are done to rule out growth hormone deficiency. Growth hormone deficiency is treated with growth hormone.

What are the signs of GH deficiency?

Children with GH deficiency are short with normal body proportions and intelligence. Bone development may be delayed causing child to look younger than his actual age. There may be under development of mid facial structure and frontal bossing of the skull. They are often obese / overweight as GH controls fat deposition.

What is growth hormone deficiency?

Growth hormone is a hormone that regulates growth. GH deficiency occurs when pituitary gland (master gland, a small pea sized gland at the base of brain) fails to produce adequate amount of GH in the body.

How do you diagnose Growth hormone deficiency?

After all other possibilities of short stature have been ruled out, tests are done for growth hormone deficiency. First analyse growth rate in the growth chart, second, thorough physical examination, X-ray of hand and wrist to see bone development and compare it with height and chronological age. Confirmation is by giving the child a substance that releases growth hormone burst in normal children. If the release is sub optimal it confirms growth hormone deficiency.

What is the set back with Growth hormone?

COST. It is an expensive medicine. Hence it is not reachable by everybody. It needs to be given for a minimum period of one year and the cost increases if the child is older and heavier.

Why adult cannot grow taller?

Adults cannot grow as their bones are fused. Once puberty is reached the sex hormones, oestrogens in girls and testosterone in boys cause fusion of bones. Once bones are fused we cannot grow anymore.

Thyroid is the name of a gland that is situated in front of the neck. Normally you may not be able to see the gland unless you are very thin. The function of the thyroid gland is to produce thyroid hormone.

Hormones are the chemical substances that are produced by different glands in the body and are carried to various organs through blood.

What way thyroid is helpful?

Thyroid hormone is one of the life-saving hormones. It has a number of effects on body’s function. The main one being to control the metabolic rate, i.e., the amount of energy used by the body to maintain vital processes such as breathing, circulation and digestion. Too much thyroid hormone makes the body to work too fast, whereas too little allows the body to slow down. Thyroid hormone also has important function of being involved in the maturation of brain and physical growth in babies both before and after birth. Deficiency of thyroid hormone certainly can affect height in the growing children.

What controls the thyroid gland?

The pituitary gland is a pea-sized gland that is found at the base of the brain. One of the hormones that the pituitary gland produces is called thyroid stimulating hormone (TSH). TSH stimulates the thyroid gland to release thyroid hormone.

• If the level of the thyroid hormone in the body is low, pituitary gland tries to cope by giving more TSH and this stimulates the thyroid gland to produce more thyroid hormone.

• On the other hand, if thyroid hormone level is high, pituitary stops giving TSH and the thyroid gland stops releasing thyroid hormone until it is again required.

What is the need for treatment?

Thyroid hormone is absolutely necessary for normal body functions. So if you have under-active thyroid you need to be on thyroid hormone. When you are taking less than the optimum treatment, you will yourself find that you are becoming slow. Also, your blood level of cholesterol (fat in the blood) increases with under active thyroid, which as you would know, is not good for heart and brain.

In the same way, excess thyroid hormone in the blood puts pressure on different organs in the body, particularly on the heart and brain. Heart is made to work more by the excess thyroid hormones and may lead to heart failure, particularly in the elderly. Long standing overactive thyroid can make the bones weak and the muscles thin.

Who is at risk of developing Thyroid disease?

Family history of thyroid is the main risk factor. If you have a family history and you have symptoms suggestive of under- or overactive thyroid, it is worth seeing your doctor for a physical examination and blood test. Remember thyroid disease is 10 times more common in women than in men.

How often do you need to monitor when you are on treatment?

Once we know the exact dose of thyroid hormone for treating under active thyroid, test need not be done for more than once a year. The good practice is to repeat the test every year to make sure that you are not under- or overtreated. For overactive thyroid you will require frequent monitoring, may be every six weeks until your thyroid settles. Your treating physician will be the best person to tell you that.

What is Goiter?

A big thyroid gland for whatever reason is called goiter. A big gland not necessarily is overactive; it can work normally or can work less. A goiter which puts pressure on the structures in the neck or is very big, may be best dealt with operation.

Is Goiter and Cancer same?

No, certainly not. Thyroid cancer is not common. There are certain clinical pointers are there which tells us whether thyroid cancer is high on the card or not. If yes, we can perform a simple test called FNAC to see a few cells under the microscope.

Once a diagnosis of cancer is made, thyroid gland is removed and radiotherapy is given. We use thyroid hormone after operation for not only replacing the hormone you will be deficient after operation but also for reducing the chance of recurrence of the cancer. Periodic monitoring is necessary, so people with thyroid cancer should be followed up life-long.

Is there is any good news?

The good news is that in most of the cases we can treat thyroid very effectively and completely. Under active thyroid disease is very common and totally treatable. Its’ true that you need monitoring throughout your life, but if you have under active thyroid, there is absolutely no reason for not feeling like anybody without thyroid problem.

There is very little bad news with thyroid problem. Even thyroid cancer is one of those cancers which are very much treatable and you can have a normal life for decades unless the cancer has spread too much before the diagnosis is made.

What diet I need to change?

There is no need to worry regarding diet in thyroid disease. As told before, our salt and water is iodinated now and you do not need to take extra iodine. If you have a goiter, it is advisable to avoid spinach and broccoli as sometime they can make the goiter bigger.

2. Are hormone diseases treatable/curable?

Most of them, yes. We need to understand why the hormone level is high or low by different tests mainly blood tests. In most the cases treatment is much simple than it is thought. The word CURE can be used in not many cases in medical science, so we prefer the word CARE.

3. Do I need to take medication for whole life if I have wrong hormone?

This depends on the exact diagnosis. If this is due to deficiency of a hormone and we are replacing the deficient hormone then in most of the cases the answer is yes, the classic example is Primary hypothyroidism where the thyroid gland fails to secrete thyroid hormone we need to replace the thyroid hormone. This is like natural therapy, body is deficient and we are giving it from outside.

4. Are hormone problems genetic?

Well, not as a routine. Some of the problems in the field of Endocrinology has connection with genes no doubt.

5. Is steroid harmful?

We have a lot of misconception about the word STEROID. Remember there are different steroid hormones. We have natural steroids in our body, they are life-saving. Taking excess of them with the misconception of extra benefit can be harmful.

6. Who is at risk of developing Thyroid disease?

Family history of thyroid is the main risk factor. If you have a family history and you have symptoms suggestive of under- or overactive thyroid, it is worth seeing your doctor for a physical examination and blood test. Remember thyroid disease is 10 times more common in women than in men.

7. Is Goiter and Cancer same?

No, certainly not. Thyroid cancer is not common. A big thyroid gland for whatever the reason is called goiter. There are certain clinical pointers are there which tells us whether thyroid cancer is high on the card or not. If yes, we can perform a simple test called FNAC to see a few cells under the microscope.

8. If I have thyroid problem, is my baby at risk?

Baby in mother’s womb needs good thyroid balance of the mother, thyroid hormone problem is a common cause of miscarriage. Also for growth of the baby depends on mother’s thyroid balance. It is very rare to have thyroid problem in the baby for mother’s thyroid issue, so there is nothing much to worry from that point.

9. Can early puberty be treated?

Definitely yes, and it should be treated. There are a lot of myths about pubertal changes, early puberty may not be beneficial in a number of ways, most importantly inability to handle it and peer matching. Also we need and treat the reason of early puberty.

10. Is there treatment for short stature? Why an adult cannot grow taller?

Yes, there is treatment for short stature. Initially good balanced diet with exercise, thyroid function screening and treatment of chronic diseases are tried with regular growth monitoring. If all these factors are corrected and growth is not adequate then tests are done to rule out growth hormone deficiency. Growth hormone deficiency is treated with growth hormone.

The long bones in the hands and legs consist of three portions from birth. We grow taller as the bones grow in childhood. Once puberty is reached the sex hormones, oestrogens in girls and testosterone in boys cause fusion of bones. Once bones are fused we cannot grow any more. This is why adults cannot grow taller. In general girls grow till around 18 months after starting cycles and boys till around 18 years.

The incidence of Diabetes is increasing all over the world including India. There are two main types: type 1 or Insulin deficient or juvenile and type 2 or Insulin resistant or adult onset Diabetes. In type 1 Diabetes pancreas does not produce Insulin and you cannot survive without Insulin. In type 2 Diabetes, pancreas does produce Insulin but it is insufficient and/or less effective.

Public education is the key to control the epidemic of Diabetes. Here are the top 10 questions asked by the public and the answers.

How do I know I have Diabetes?

At the beginning there may not be any symptom. When blood sugar is above 180 mg%, sugar starts appearing in the urine. Sugar in the urine drags water and you pass a lot of urine and feel dry and thirsty. You may also feel tired and loose weight. Your appetite increases and peculiarly you may notice that you are loosing weight in spite of eating more. Chance of infection is higher if you have high sugar and also your healing from infection, cut or wound may be unusually delayed. Some people complain of poor eyesight.

Who are at risk of Diabetes?

Family history of Diabetes is the major risk factor. Sedentary life-style, obesity, smoking, excessive alcohol intake, high blood pressure and in case of women previous Diabetes in pregnancy or delivering big baby (birth weight more than 4Kg) are risk factors.

Can I prevent Diabetes when my risk is high?

If you have family history, you cannot do anything about that. Things in your hands are healthy eating (i.e., eating vegetables and fruits, avoiding fast food), healthy life-style (regular exercise, avoidance of smoking, moderation of alcohol, etc) and keeping your weight in accordance to your height. Certain medicines are being used recently for preventing Diabetes in people who have borderline Diabetes.

I have nobody in my whole family with Diabetes, how did I get it then?

Family history certainly is an important factor, but the fact is being Asian, we all have high-risk gene for Diabetes. Remember it is not your fault that you have Diabetes. You are just happened to be the person who got it. In India 4% of villagers and up to 15% of city dwellers have Diabetes. Not only we have more Diabetes we are getting it at an earlier age than people in the west (around 10 yr).

Can I have drink when I have Diabetes?

Yes, you can. Alcohol is not banned in people with Diabetes. As always a little alcohol is pleasant but a lot is not, regardless of Diabetes and can damage the body badly. Remember “Hypo” (low blood sugar) can occur with alcohol and you should not skip meal after a drink with the fear of calorie in the drink.

You need to know the medically allowed limit of alcohol. A small measure of Whisky, Rum, Vodka or Gin, a small glass of Beer or Wine is measured as one unit. The limit for men is 21 units and for women 14 units a week. It is better to space that rather than taking weekly quota on a day! Sweet wine or Sherry should be avoided as they have very high sugar content.

Do I need to stop eating out? Can I have ice cream? Can I take artificial sweetener?

Certainly not, as long as you are not planning to eat out everyday! You need to know what the right food is and correct amount.

Occasionally yes, but do not make a habit of eating ice cream regularly. There are certain ice cream available now with no added sugar, but do not forget they have calories.

Certainly yes, artificial sweeteners are safe. Do not put them in cooking, they break down when heated. So they will not be sweet any more.

Can I control Diabetes with Diet only?

Diet is a very important aspect in the treatment of Diabetes particularly the timing of it. At the beginning you may be successful in controlling Diabetes with diet only, but unfortunately a time will come when only diet won’t be enough, you will require medicine. This time is different for different people, for somebody this can be a few months while for others it may be a few years. It is very important to try with diet first; this will help you to understand the principles of diet and will convince you the need for treatment to control Diabetes.

Once started, do I need to take tablet for life?

This all depends on your Diabetes. If your Diabetes is very well controlled with a small dose of tablet, you may try only with diet. If that is fine, why not to control your Diabetes only with diet and life-style measures. But if you see, your control is not good with diet alone, you must accept that your body needs medicine and you should start again.

Who with Diabetes needs Insulin?

In type 1 Diabetes Insulin is a must for living. In type 2 Diabetes we advice Insulin in certain situations like pregnancy, during and after surgery, severe infection and for some reason or other when you are not able to eat. Obviously, when tablets do not work, you need Insulin for Diabetes control.

Is there any job restriction for people with Diabetes?

Diabetes should not be a selecting or refusing factor in employment arena. We need to make this clear to employers and employees. Driving is a problem if you are getting frequent hypo, as a rule people with Diabetes on Insulin are not given license to drive heavy vehicle and buses. Remember it is not your fault that you have Diabetes and there is no reason to hide it. Make sure that people around you know that you have Diabetes. Tell them about “Hypo” and what they should do in case you have a severe hypo.