Experts at Mediclinic Dubai Mall shine light on Osteoporosis
23 October 2019| Last updated on 23 October 2019
What is this disease?
Osteoporosis is a silent disease. A normal bone is a living tissue that is constantly renewing itself, replacing old bone with a new bone. With osteoporosis, the body loses bone faster than it is replaced. As a result bones weaken, becoming thinner and more likely to break. Unfortunately we do not feel this process and osteoporosis can develop without sufferes knowing until a fracture occurs.
Does it affect women only?
Osteoporosis generally affects people over 50 years old and the risk gradually increases with age. The areas most affected by this disease and most frequent locations of fractures are the hip, spine and wrist. Fractures caused by osteoporosis are two to three times more common in women than men. It affects white Caucasians more than other races and is responsible for over a million and a half fractures annually in the USA.
There are several risk factors for this condition such as:
- Excess alcohol
- Lack of calcium and Vitamin D
- Thyroid diseases
- Family history
- Low weight
- Chronic steroid use
- Lack of oestrogen either after menopause or after surgical removal of the two ovaries
The most important complication of osteoporosis is fracture, and sometimes spontaneous fracture. If a fracture happens in the spine it will cause a collapsed vertebra and sometimes height loss or a curved back or kyphosis. A collapsed vertebra can cause severe back pain but on the other hand, pain can also be present without an obvious fracture on the spine x-ray. This is due to micro fractures and can lead to a wrong diagnosis of osteoarthritis. It is very important to think about osteoporosis and diagnose it early to prevent its complications.
Do patients know that they are affected with the disease?
We can diagnose osteoporosis by doing a radiology test to measure bone density called a DEXA scan. The test result can either tell us that the bone is normal with a low risk for fractures or can differentiate between two conditions: either the presence of osteoporosis with a high risk for fractures or a condition called osteopenia which is the very early stage of osteoporosis with a medium risk for fractures.
The DEXA test measures the bone density in two areas: the hip and lumbar spine.
Is calcium alone enough for treatment as thought by lots of women?
It is a wrong practice to use calcium alone to treat this condition as studies have showed that calcium alone does not build bone. It is important to intake an adequate amount of calcium, however for women up to the age of 50, 1000mg daily is recommended, and for women over 50 this should be increased to 1500mg, especially if they are not taking hormone replacements.
This dose of calcium can be taken partially as food such as milk and dairy products e.g an 8oz glass of milk contain 300mg of calcium. The rest of the daily required dose can be taken as a calcium pill. It is also important to combine calcium with vitamin D, which can help the absorption of calcium from the intestine. It is estimated that the daily requirement of vitamin D is 400 IU if that person is exposed to adequate sun light, otherwise the dose should be increased to 800 IU daily.
Now, let me speak about a controversial subject, which is oestrogen or hormone replacement therapy. There is conflicting data regarding the benefit of hormone replacement. It is possible now that oestrogen alone, without progesterone, can increase the risk of breast cancer and uterine cancer, but on the other hand oestrogen can prevent rapid postmenopausal bone loss and osteoporosis. Women taking hormone replacement should be under strict medical supervision and undergoing periodic mammograms and pelvic exams. Oestrogen can also cause deep vein thrombosis, increased triglyceride levels and cholecystitis.
There are several medications approved for the prevention and the treatment of osteoporosis which are not hormone replacement. Some of these are easy to take as a weekly pill or a yearly injection but of course, there are some side effects like all other medications and we have to weigh the advantages and the disadvantages of each one.
How to treat Osteoporosis?
Finally, I want to remind you that osteoporosis is a silent disease. We have to diagnose it early before it progresses to complications such as fractures, so women should seek medical advice and screening by doing a DEXA scan as early as 50 years old. Women should also adhere to the following recommendations to prevent this disease:
- Diet rich in calcium and vitamin D either by food or by tablets as outlined by your doctor
- Adequate sun exposure without over exposure
- Regular exercise
- Avoid smoking and excess alcohol
- Doing a DEXA scan as recommended by your doctor to diagnose osteoporosis or osteopenia early
Authored by Amer Helbaoui, M.D.
Consultant Internal Medicine
American Board of Internal Medicine