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21 October, 2019 00:00 00 AM
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Osteoporosis: An epidemic with dire consequences

Dr Wrishi Raphael
Osteoporosis: An epidemic with dire consequences

Osteoporosis, which literally means porous bone, is reduced bone mass per unit volume thus predisposing the person with it to an increased risk of fracture. It also refers to the increased bone fragility that accompanies ageing and many illnesses. Following the menopause, women begin to lose calcium from their bone at a much faster rate than men, presumably as a direct response to low levels of oestrogen. Osteoporosis is a common phenomenon among menopausal women around the world but in our country it is slowly affecting younger age groups.

In Bangladesh, the manufacture of garments is the industry which earns the most foreign remittance and employs 1•6 million female workers. Due to the indoor lifestyle and low dietary intake of calcium, research shows that they are at risk of low vitamin D and bone mineral status.

Two hundred female garment workers (aged 18–36 years) were randomly selected. The high prevalence of low Vitamin D and low bone mineral density among these subjects are indicative of higher risk for osteomalacia or osteoporosis and fracture [Source: British Journal of Nutrition (2008), 99, 1322–1329, the study was conducted in 2008 by Centre for Nuclear Medicine, Mitford Hospital Dhaka ].

What used to be a cause of concern for menopausal females is slowly taking a turn for the worse for a large number of young women in our country; a catastrophe which must be averted at any cost simply because these girls have a huge impact on the country’s economy.

 

What we must all remember is that osteoporosis is commonest in post menopausal women, treatable and potentially lethal as it is capable of causing fractures. Since it does not produce any pain until fractures occur, it is almost asymptomatic.

As General Practitioners, we should be wary of bone diseases like osteoporosis in elderly females as bony lesions in the X Ray can also be caused by Multiple Myeloma (tumor of bone marrow which effects plasma cells).

Investigations

Plain radiography is of limited value. Osteoporosis is not detectable until 40-50% of bone is lost.

25-hydroxy vitamin D (most useful test). Normal range is 25-80 ng/ml.

Plasma calcium, phosphate and alkaline phosphatase are all usually normal.

Consider tests for Multiple Myeloma in an osteoporotic area.

Treatment

The goal of treatment is to prevent osteoporosis or reduce further loss. H RT (long-term use is not recommended but weighing potential benefits versus harms with the patient is always a good idea)

OR

Bisphosphonates (decrease bone absorption)-can be used alone or combined with other agents. [Potential side effect osteonecrosis of jaw and oesophagitis]

Other drugs include Raloxifene, Strontium Ranelate.

Recommendations for prevention

Adequate dietary intake of calcium:

1000 mg per day (premenopause)

1300 mg per day (postmenopause)

1000 mg for men 50-70; 1300 >70 years

Dairy food is the main source of dietary calcium. Calcium-rich foods include low-fat calcium-enriched milk (500 mL contains1000 mg), other low-fat dairy products (e.g. yoghurt or cheese), fish (including tinned fish such as salmon with the bone), citrus fruits, sesame and sunflower seeds, almonds and hazel nuts.

Life style modifications include

Exercise: moderate exercise against gravity-walking (brisk walking for 30 minutes four times a week).

Lifestyle factors: stop smoking and limit alcohol and caffeine intake.

Vitamin D deficiency and sun light: there is evidence we need significant exposure to sunlight of the face, arms and hands to produce natural vitamin D (e.g. 5-15 minutes a day in our country is enough)

Adequate nutrition: keep

BMI >18.

Refraining from the use of sunscreen, regularly spending 10–15 min outdoors in the sunshine (especially during lunch time), adequate calcium intake, proper nutrition and exercise are strongly recommended to combat both primary and secondary risk factors for low Bone Mineral Density in female workers of our RMG Sector.

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Editor : M. Shamsur Rahman

Published by the Editor on behalf of Independent Publications Limited at Media Printers, 446/H, Tejgaon I/A, Dhaka-1215.
Editorial, News & Commercial Offices : Beximco Media Complex, 149-150 Tejgaon I/A, Dhaka-1208, Bangladesh. GPO Box No. 934, Dhaka-1000.

Editor : M. Shamsur Rahman
Published by the Editor on behalf of Independent Publications Limited at Media Printers, 446/H, Tejgaon I/A, Dhaka-1215.
Editorial, News & Commercial Offices : Beximco Media Complex, 149-150 Tejgaon I/A, Dhaka-1208, Bangladesh. GPO Box No. 934, Dhaka-1000.

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