Dr Praveen Ramachandra
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Patient Education on Bone Health

Bones play different roles in the body — providing structure, protecting organs, anchoring muscles and storing calcium.

Importance of bone health

Bones are continuously changing — new bone is made and old bone is broken down. When a person is young, body makes new bone faster than it breaks down old bone, and bone mass increases. Most people reach their peak bone mass around age 30. After that, bone remodeling continues, but a person lose slightly more bone mass than he gains.

How likely a person to develop osteoporosis — a condition that causes bones to become weak and brittle — depends on how much bone mass he attains by the time he reaches age 30 and how rapidly he loses it after that. The higher peak bone mass, the more bone a person has "in the bank" and the less likely he is to develop osteoporosis as he becomes older.

Factors which affect bone health

A number of factors can affect bone health such as:

·        The amount of calcium in your diet. A diet low in calcium contributes to diminished bone density, early bone loss and an increased risk of fractures.

·        Physical activity. People who are physically inactive have a higher risk of osteoporosis than do their more-active counterparts.

·        Tobacco and alcohol use. Research suggests that tobacco use contributes to weak bones. Similarly, regularly having more than two alcoholic drinks per day increases the risk of osteoporosis, possibly because alcohol can interfere with the body's ability to absorb calcium.

·        Gender, size and age. You're at greater risk of osteoporosis if you're a woman, because women have less bone tissue than do men. You're also at risk if you're extremely thin (with a body mass index of 19 or less) or have a small body frame because you may have less bone mass to draw from as you become old. Also your bones become thinner and weaker as you age.

·        Race and family history. You're at greatest risk of osteoporosis if you're white or of Asian descent. In addition, having a parent or sibling who has osteoporosis puts you at greater risk — especially if you also have a family history of fractures.

·        Hormone levels. Too much thyroid hormone can cause bone loss. In women, bone loss increases dramatically at menopause due to dropping of estrogen levels. Prolonged periods, absence of menstruation (amenorrhea), before menopause, also increases the risk of osteoporosis. In men, low testosterone levels can cause a loss of bone mass.

                                                                                         

                                                                                                     Fig 1: Factors which affect bone health

·        Eating disorders and other conditions. People who have anorexia or bulimia are at risk of bone loss. In addition, stomach surgery (gastrectomy), weight-loss surgery and conditions such as Crohn's disease, celiac disease and Cushing's disease can affect body's ability to absorb calcium.

·        Certain medications. Long-term use of corticosteroid medications, such as prednisone, cortisone, prednisolone and dexamethasone, damages the bone. Other drugs that may increase the risk of osteoporosis include aromatase inhibitors to treat breast cancer, selective serotonin reuptake inhibitors, methotrexate, some anti-seizure medications and proton pump inhibitors.

 Steps to keep your bones healthy

Some simple steps to prevent or slow down bone loss are as follows:

·        Include plenty of calcium in your diet. For adults ages 19 to 50 and men ages 51 to 70, the recommended dietary allowance (RDA) is 1,000 milligrams (mg) of calcium per day. The recommendation increases to 1,200 mg per day for women after age 50 and for men after age 70. Good sources of calcium include dairy products, almonds, broccoli, kale, canned salmon with bones, sardines and soy products, such as tofu. If you find it difficult to get enough calcium from your diet, ask your doctor about supplements.

·        Pay attention to vitamin D. A person’s body needs vitamin D to absorb calcium. For adults ages 19 to 70, the RDA of vitamin D is 600 international units (IUs) a day. The recommendation increases to 800 IUs a day for adults age 71 and older. Good sources of vitamin D include oily fish, such as tuna and sardines, egg yolks and fortified milk. Sunlight also contributes to the body's production of vitamin D. If you are worried about getting enough vitamin D, ask your doctor about supplements.

                                                                                           

                                                                                                            Fig 2: Factors which keep the bones healthy


·        Include physical activity in your daily routine. Weight-bearing exercises, such as walking, jogging, tennis and climbing stairs, can help to build strong bones and slow down bone loss.

·        Avoid substance abuse. Don't smoke and avoid drinking more than two alcoholic drinks a day.

·        Enlist your doctor's help. If you're concerned about your bone health or your risk factors for osteoporosis, consult your doctor. He or she may recommend a bone density test. The results will help your doctor gauge your bone density and determine your rate of bone loss. By evaluating this information and your risk factors, your doctor can assess whether you might be a candidate for medication to help slow down bone loss.