One of the major health concerns related to bone health is osteoporosis in which the density of bone decreases and causes damage to the bone tissue, as a result the bones become fragile and got fractured even with a mild stress. In this condition, the loss of bone is more than its formation. It is a silent disease because it is nearly asymptomatic until you got a fracture. The most common sites of fractures are hips, wrist and vertebrae. The condition when your bones are weak but are still strong enough that they wouldn’t break easily during a fall is known as osteopenia. In initial stages, osteoporosis has no symptoms but in advance stages they might include pain, posture change ie stooped posture, decrease in height and weak bones . Osteoporosis is further categorized into primary and secondary osteoporosis. Primary osteoporosis is most common and affects mostly women as compared to men and is caused due to either age related factors (senile osteoporosis) or in some cases due to some unknown factors (idiopathic osteoporosis). The secondary osteoporosis is due to any drug usage or disease process which causes loss of bone mass and ultimately weakens the bones.
Globally more than 8.9 million fractures are caused by osteoporosis per year.Almost 1 in 3 women and 1 in 5 or 8 men having age over 50 years are suffering from this serious issue. When we talk about America and Europe, the osteoporotic fractures include 2.8 million disability-adjusted life years which is even higher than that of hypertension and rheumatoid arthritis. In Pakistan, a survey was conducted in 2011 with the mean age of the population 50.3 ± 9.9 years. It shows that the prevalence of osteoporosis was 16.4% out of which females were 20.3% and males were 11.8% whereas the prevalence of osteopenia was 45.8%. Following graph shows the Burden of diseases estimated as disability-adjusted life years (DALYs) in 2002 in the America and Europe combined.
Level of vitamin D and sedentary lifestyle, high phosphorus and low calcium diet also leads to osteoporosis. The pathophysiology behind it is that if our diet is based on high phosphorus (P) and low calcium (Ca) foods then our blood Phosphorus levels will get higher than Calcium after absorption from GIT. Our body tends to maintain a balance between Ca and phosphorus. If our blood phosphorus levels are elevated as compare to Ca then the parathyroid gland secretes parathyroid hormone (PTH) which maintains serum Ca homeostasis .PTH acts on the bones and causes release of calcium .As a result we loss Ca from the bones and they become weak thus contribute towards osteopenia and then to osteoporosis in older ages.
We have conducted a primary research to check the average consumption of Calcium and Phosphorus by adult university going females of age group 20-25 years. We have taken 24 hr. dietary recall of 20 university going females from different cities and then we evaluate their average Ca and Phosphorus consumption by using USDA (United States Department of Agriculture) food composition tables. For our selected age group ie 20-25 yrs, the Recommended Dietary Allowance (RDA) of Ca is 1000mg/day and of phosphorus is 700mg/day. According to our results, the average consumption of Ca among all girls is 691.61 mg/day thus meeting 69.1% of daily requirement. On the other hand, the average consumption of Phosphorus is 2501.92 mg/day which is almost 3.5 times higher than the required amount. This high amount of phosphorus in diet is mainly due to Colas and other drinks with phosphate additives.
The risk factors of osteoporosis are:
(1) Non-modifiable factors like gender female, older age , race, family history, and small body frame size
(2) Hormonal levels such as low sex hormones like estrogen after menopause, too much thyroid hormone and over reactive parathyroid and adrenal glands.
(3) Dietary factors such as low vitamin D and Ca intake, high phosphorus intake, eating disorders, Malabsorption and Maldigest ion due to GIT disorders
(4) Long term use of certain medications like corticosteroids, phenytoin, proton pump inhibitors, heparin etc.
(5) Medical conditions like celiac disease, IBD, CKD, cancer, multiple myeloma, rheumatoid arthritis etc.
(6) Lifestyle choices like being physically inactive, excessive alcohol consumption, tobacco use etc.
To diagnose osteoporosis, various tests are available and out of all we prefer DEXA scan (Dual Energy X-ray Absorptiometry) which is measures the bone mineral density (BMD). In osteoporosis the common sites of fracture are hip, spine and wrist so in DEXA scan we measures BMD of these bones in order to diagnose osteoporosis . Other test performed are BMD test and ultrasound measurements of bone. The labs in Pakistan offering these tests are Agha khan university hospital, Chagatai lab, Shaukat khanum lab, Islamabad diagnostic center etc. The cost of these test ranges within PKR 3000-8000.
There is no standard treatment for osteoporosis. The best way is to manage it by safe exercise options, fall prevention and use of medications. If you have osteoporosis then start managing your disease as soon as possible as it prevents your bones from further bone loss.
For prevention of osteoporosis certain factors play their role such as:
(1 )Adequate intake of Vitamin D and Ca rich food sources ie yogurt, cheese, tofu, egg, liver etc.
(2) Weight bearing exercises such as brisk walking, jogging, tennis, net ball or dance
(3) Lifestyle changes ie quit smoking, taking adequate sun exposure, limit caffeine and soft drinks etc.
(4)Adequate intake of docosahexaenoic acid, vitamin K, strontium, and magnesium
(5)Intake of isoflavones, present in soybean, as they show skeletal benefits
(6) Supplementation of Ca (1000mg/day) and Vitamin D (800-1000 units/day) is recommended especially for those who are using one or more bone drugs.
In short, there is a high prevalence of osteoporosis in Pakistan particularly among females so, there is a need to take certain interventions regarding its prevention and reversal . Adopting better lifestyle choices right from early childhood help in making the strong foundation for our bones. We have to modify our lifestyle in terms of both dietary choices and exercise regime in order to prevent ourselves from osteoporosis so that we can live a healthy and physically active life.
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- Nagi D, Butt Z, Farooq F, Aamar A. Frequency of osteoporosis in anambulatory setting in Lahore using quantitative calcanealultrasound. J Pak Med Assoc 2013; 63: 965-8
- Habib, Sara, Romaina Iqbal, Muhammad Shahid, and Aysha Habib. “Growing prevalence of osteoporosis in Pakistan: Call for action.” J Pak Med Assoc 65, no. 2 (2015): 230-1.