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Osteoporosis: the silent epidemic

Sticks, stones—and osteoporosis—can break your bones.

By Bernice Varona


“I thought osteoporosis was something that affected old ladies,” Allan, 54, recounts, remembering the first time he learned he had the disease. “I collapsed in agony while lifting furniture at home one day, and the doctors saw that my vertebrae were spongy and damaged. It took them several months to diagnose me with spinal osteoporosis. The doctors told me I had the bones of an 80-year-old.”

Osteoporosis is a disease in which bone density and quality are reduced. As the bones become more porous and fragile, the risk of fractures increases. This silent disease usually doesn’t have any symptoms until the time the patient develops fractures at the hip and spine, like in Allan’s case. This is the reason why osteoporosis is also considered a silent epidemic.

Deteriorating living tissue

People with osteoporosis experience rapid bone loss, compared to those with normal bone growth. Our bones are made out of living tissue and are constantly changing throughout our lives. From the moment of birth until young adulthood, our bones develop and strengthen until they reach their most dense state, or peak bone mass, in our early 20s. After this peak, the bone removing cells begin to increase and a gradual loss of bone mineral continues for the rest of one’s life. How weak one’s bones get as we age hinges on the peak bone mass achieved in early adulthood and the rate of subsequent bone loss. Those with osteoporosis have a faster rate of deterioration that results in fractures that could be debilitating.

According to the Osteoporosis Society of the Philippines Foundation, Inc., it’s predicted that about 4 million Filipinos will be at high risk of osteoporosis by 2020, and this number may surpass 10 million by 2050. The disease isn’t just confined to women. Around the world, one in three women and one in five men are at risk of osteoporotic fractures, with the risk increasing with age in both men and women. Results from bone health examinations conducted among 250,000 Filipino men from 2011 to 2012 showed that 43 percent of men between ages of 26 to 65 are at risk. Osteoporosis is considered one of the most common and debilitating chronic diseases worldwide.

Decline of bone mass

“I never considered myself to be at risk for osteoporosis because I was active when I was young,” says Allan. “But when I started working, I was more sedentary with the occasional drinking and smoking. These may have contributed to my getting the disease.” Risk factors for osteoporosis include:

• high alcohol intake;

• smoking;

• little physical activity;

• low body weight;

• long-term enforced bed rest;

• age of 60 years and above;

• family history of osteoporosis;

• history of getting fractures from minor bumps and falls;

• chronic disorders such as anorexia nervosa, Crohn’s disease, chronic liver disease, primary hyperthyroidism, post-transplantation, arthritis, and more; and

• disruption of estrogen and its bone-protective effect, such as during hormonal changes like menopause and amenorrhea in women.

In diagnosing the disease, a doctor will review the patient’s medical history for fractures and predisposition due to heredity, and make him or her undergo a bone mineral density (BMD) test. There are many kinds of bone mineral density tests, but the most accurate is the dual energy X-ray absorptiometry (DXA). DXA is a low radiation X-ray capable of detecting low percentages of bone loss. Osteoporosis is diagnosed when a person’s BMD is equal or more than 2.5 standard deviations below the T-score—the reference measurement derived from bone density measurements in a population of healthy young adults, as defined by the World Health Organization.

Halting or slowing the problem

Treatment options for osteoporosis may be tailored to fit a patient’s medical needs and lifestyle. In the Philippines, virtually all drugs used to treat osteoporosis are available such as estrogen or progesterone preparations, all the biphosphonates, strontium ranelate and parathyroid hormone. Calcium and vitamin D supplements are also prescribed to help maintain bone density and muscle function, as well as ensure maximum effectiveness of the drug therapy. Some may undergo pain management therapy to deal with chronic pain due to the disease. Women who undergo hormone replacement therapy (HRT) also show a beneficial effect on their bones, although this option must be weighed against side effects, including potential cardiovascular compromise.

Allan admits that the disease has affected how he does his daily activities. “Because of my bone weaknesses, I have to limit any physical activity that could put me at risk of fractures. This includes sports where there is impact, and also carrying heavy loads which may damage my spine. I also experience chronic pain, but I am able to manage. I am one of the luckier ones as I [can] still walk and move around. Some sufferers of osteoporosis are not able to do much because standing and sitting is difficult.”

What else can we do to proactively prevent this silent epidemic? Find out in the October issue of HealthToday.

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