Why bone health is important?

Bone is a living tissue that is constantly breaking down and being replaced. Throughout life, our body balances the loss of bone with the creation of new born. We reach our highest bone mass at about age 25.

Bone loss can cause osteopenia (low bone mass) and then osteoporosis, a condition in which bones become weak and are more likely to break (fracture). Fractures can cause serious health problems, including disability and premature death. Getting enough vitamin D and calcium is important in keeping our bones healthy and reducing our chances of developing osteopenia or osteoporosis.

Why are vitamin D and calcium important to bone health?

Vitamin D helps your body to absorb calcium. Calcium is necessary for building strong, healthy bones. Without enough vitamin D and calcium, bones may not form properly in childhood and can lose mass, become weak, and break easily in adulthood. Even if you get enough calcium in your diet, your body will not absorb that calcium if you don’t get enough vitamin D.

What is vitamin D?

Vitamin D is a fat-soluble vitamin, which means it is stored in the body’s fat. People normally get vitamin D through exposure to sunlight, which triggers vitamin D production in the skin.

Vitamin D is found naturally in very few foods. Good food sources are egg yolks and some types of fish such as salmon. Vitamin D is also available in nutritional supplements.

You  probably don’t get enough vitamin D if you:

• Spend little time in the sun or use a strong sun block
• Have very dark skin
• Are over age 50, when the body is less able to make and use vitamin D efficiently
• Have certain medical conditions such as diseases of the digestive system that interfere with fat and vitamin D absorption
• Are very overweight, because vitamin D can get “trapped” in body fat and be less available for the needs of the body.

What is calcium?

Calcium is a mineral with many functions. Most of the body’s calcium is stored in the bones and teeth where it supports their structure. Calcium mainly comes from the foods you eat.

Good  sources of calcium include dairy products (milk, cheese, yogurt); calcium-fortified products (foods and beverages with added calcium); fish with bones; and green, leafy vegetables. Like vitamin D, calcium is also available in supplements.

You may need extra calcium if you:

• Are a post-menopausal woman
• Eat few or no dairy products
• Have a digestive disease that interferes with nutrient absorption

Recommended Daily Intake of Vitamin D and Calcium for Adults

Vitamin D                                         Calcium

Under age 50              400 to 800 International              at least 1,000 milligrams (mg)
Units        (IU)

Over age 50                 800 to 1 000 IU                      at least 1 200 mg

• Regular Physical Exercise - Preferably outdoor. There is no exercise better than the other. Remember exercising is more important what exercise you are carrying out.

• Diet rich in Calcium.

• Supplemental Calcium - at least 1 Gm, most tablets available in the market are of 500 mg, so you need two of them.

• Medications to reduce bone loss - there are quite a few available in the market, your Doctor will be the best person to choose one for you.

• Medications to increase the bone formation -
  currently Parathyroid Hormone in available. Unfortunately this has to be given by injection everyday and costly.

• Treatment of secondary factors - for example using steroid for some reason or other, low sex hormone, deficiency of Vitamin D, very high Parathyroid Hormone level called Hyperparathyroidism, high Thyroid hormone called Hyperthyroidism either by itself or over treatment for under active Thyroid.

• Planned follow up - with Bone Density measurement at a regular interval.

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. Osteoporosis develops when bone resorption occurs too quickly or if replacement occurs too slowly. This can be considered as ageing process; it is more common in women as after menopause due to lack of oestrogen bone loss is faster.

What is Osteoarthritis?

Osteoarthritis is inflammation of the joint. There can be several types of osteoarthritis like Rheumatoid arthritis, Gout but commonest one is called degenerative arthritis which again is an ageing process. The main symptom of osteoarthritis is joint pain.

Can I have both together?

Yes they can and they do in most of the cases. But Osteoporosis does not lead to Osteoarthritis. In long standing severe Osteoarthritis as the joint and muscle are not used properly, the surrounding bones can become weaker and develop osteoporosis of the bones around the joint.

What are the differences in symptoms?

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.

On the other hand osteoarthritis always will have pain; people will come to see Doctor for the pain. The movement of the joint affected will be come restricted. Some of them may require joint replacement.

What is osteoporosis?

Osteoporosis is a disease in which bones become fragile and more likely to break. If not prevented or if left untreated, osteoporosis can progress painlessly until a bone breaks. Osteoporosis per se is not the major illness, but it is the complications of the disease that are the major cause of concern.

Which are the bones most commonly prone for fractures?

These broken bones, also known as fractures, occur typically in the hip, spine, and wrist.

What are the various risk factors for developing osteoporosis?

What happens to bone mineral density with age?

Bone mineral density increases until around age 25 and then levels off until age of 45-50yrs. During the first six to eight years of menopause, there is a sharp decline in bone mineral density. The higher a woman’s overall bone density, the less she will be affected when she loses bone density at menopause. Men looses bone slowly after age of around 50yrs.

What are the various investigations done to detect osteoporosis?

Bone mineral density using a DEXA (Dual energy X-Ray absorptiometry) scan will help us detect osteoporosis. It is safe, non-invasive and painless, and is the most reliable diagnostic tool used to check bone density throughout the body. DEXA measures bone density in the hip bone , hand bone and lumbar spine; areas susceptible to loss of bone density and fracture. The test is easy and requires no special preparation patient’s part.

There are some blood tests like bone markers available now which sometime helps in management.

BMD machine

Understanding the Results of Bone Mineral Density Tests: T-score and Z-score
Bone mineral density (BMD) tests are performed to determine whether a patient has osteoporosis or osteopenia, a low bone mass that puts her at risk for osteoporosis. To make this determination, the technologist will calculate the patient’s T-score. The World Health Organization (WHO) established the criteria for determining the T-score.

By determining a patient’s T-score, we can determine whether a woman has or is at risk for osteoporosis:

We can measure a person’s Z-score with a BMD test. The Z-score compares the patient’s BMD with somebody o same age and sex. The Z-score is not used to confirm a diagnosis of osteoporosis because a favorable BMD measurement (compared to the average BMD measurement for the patient’s age group) does not mean the patient is not at risk for osteoporosis.

What can be done to lower the risk of osteoporosis?
Two very important things: be physically active and take adequate calcium. If a person picked the one thing that would have the greatest impact on his/her life and lower the risk for a number of late effects and common adult health problems, it would be to make a lifetime habit of being physically active. Regular exercise, at least five times a week for about 30-45 minutes, makes a huge difference in the strength of our bones.

What are the various treatment options available for osteoporosis?

The various treatment options available are

1. Bisphosphonates. This group of drugs can inhibit bone breakdown, preserve bone mass, and even increase bone density, reducing the risk of fractures. Side effects include nausea, abdominal pain, and the risk of an inflamed esophagus. This is usually taken once a week, in empty stomach with one L of water and also to keep upright for an hour.
   

2. Raloxifene This medication belongs to a class of drugs called selective estrogen receptor modulators. Raloxifene mimics estrogen’s beneficial effects on bone density in postmenopausal women, without some of the risks associated with estrogen, such as increased risk of uterine cancer and, possibly, breast cancer. Hot flashes are a common side effect of raloxifene.

3. Calcitonin A hormone produced by thyroid gland, calcitonin reduces bone resorption and may slow bone loss. It may also prevent spine fractures, and may even provide some pain relief from compression fractures. It’s usually administered as a nasal spray or by injection. Because calcitonin isn’t as potent as bisphosphonates, it’s normally reserved for people who can’t take other drugs.

4. Teriparatide This powerful drug, an analog of parathyroid hormone, treats osteoporosis in postmenopausal women and men who are at high risk of fractures. Teriparatide is given once a day by injection.

5. Strontium - Strontium is a mineral found along with calcium in most foods. Strontium supplements decrease bone resorption and also stimulate bone-building osteoblast activity and new bone formation in women with osteoporosis.

Who should take Calcium supplements?
All people with an increased risk of osteoporosis should take Calcium supplementation.

Calcium supplementation is available in various forms. The RDA for calcium intake is based on the amount of elemental calcium in the supplement taken. The most commonly available is the Calcium carbonate; 500mg of this contains only 200mg of elemental Calcium. Hence at least 1gm of this is needed to give you approximately 400mg of elemental calcium.

There are other supplements which are available which contain vit.D along with calcium. While taking these supplements, a word of caution about the blood level of Calcium, as they tend to go up and cause other problems.

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