UHS Medical Times 1
Newsletter |May 2017
OSTEOPOROS S Osteoporosis
is sometimes called a “Silent Disease” because you can’t feel your bones getting weaker – often the first indication of osteoporosis is when a bone breaks. While Osteoporosis can strike at any age, it occurs mostly in adults age 50 and over. According to the International Osteoporosis Foundation, 60% of adults are at risk of breaking a bone. One in three women and up to one in five men will break a bone in their lifetime due to Osteoporosis. But eating a healthy diet and exercising regularly can help slow or stop the loss of bone mass and help prevent fractures. Source:
International Osteoporosis Foundation
3 WHAT IS OSTEOPOROSIS? As defined by the World Health Organization, Osteoporosis is a generalized skeletal disorder of low bone mass (thinning of the bone) and deterioration in its architecture, causing susceptibility to fracture.
“Break Free from Osteoporosis” is a campaign to create public awareness about effective ways of building bone strength, maintaining healthy weight and preventing Osteoporosis.
Newsletter from University Hospital Sharjah
The components of the word 'Osteoporosis' literally mean 'porous bones' - 'osteo' is for bones, and 'porosis' means porous - helpfully describing this condition that results in reduced bone density and increased fragility of the bones. The thinning of the bones in Osteoporosis, combined with the formation of weaker bone crystals, puts people at a higher risk of fractures.
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NORMAL BONE
OSTEOPOROSIS
There are two types of Osteoporosis: Type I Osteoporosis (Postmenopausal Osteoporosis) generally develops in women after menopause when the amount of estrogen in the body greatly decreases. This process leads to an increase in the resorption of bone (the bones loses substance). Type I Osteoporosis is far more common in women than in men, and typically develops between the ages of 50 and 70. The process usually results in a decrease in the amount of trabecular bone (the spongy bone inside of the hard cortical bone). The decrease in the overall strength of the bone leads primarily to wrist and vertebral body (in the spine) fractures.
Type II Osteoporosis (Senile Psteoporosis) typically happens after the age of 70 and affects women twice as frequently as men. Type II Osteoporosis involves a thinning of both the Trabecular Bone (the spongy bone inside of the hard Cortical Bone) and the hard Cortical Bone. This process often leads to hip and vertebral body fractures.
FAST FACTS ON OSTEOPOROSIS Here are some key facts about Osteoporosis:
Osteoporosis is a bone disease affecting the bone structure and strength of bone, raising the risk of fractures. Postmenopausal women are most likely to develop the condition, but it also affects men and younger people across all genders. Some risk factors for osteoporosis are modiďŹ able, such as smoking and poor nutrition.
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Osteoporosis is often considered a silent disease as there are no clear outward symptoms caused by the loss of bone density (although bone pain may occur in some people).
Fractures are most likely in the spine, hip and wrists.
Diagnosis is made directly via a special X-ray-based scan, and sometimes through ultrasound.
Treatments include drugs that prevent or slow down bone loss, exercise programs, and dietary adjustments, including extra calcium, magnesium and vitamin D.
It is important for people with osteoporosis to take measures to avoid falls so as to reduce the risk of fractures (which can prove fatal).
OSTEOPOROSIS IN
U.A.E
The three most prevalent rheumatic conditions that affect women in the UAE are
Osteoporosis, Osteoarthritis, and Vitamin D Deficiency. Vitamin D deďŹ ciency greatly increases the risk of developing osteoporosis and about
78% of the
three women in the UAE over the age of 50 is prone to fractures incurred through osteoporosis and could experience osteoporotic fractures.
UAE population suffers from it. One in
The prevalence of osteoporosis, a condition marked by brittle and fragile bones that are prone to fracture, is
set to double in the UAE by 2040 unless adequate precautions are taken.
The disease, which is often silent until the patient experiences a debilitating fracture, is more common in older individuals, because the creation of new bone tissue cannot keep up with the removal of old and dying bone tissue. And the UAE population, which is still fairly young, will age over the next two decades.
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WHAT CAUSES OSTEOPOROSIS Osteoporosis occurs when there is an imbalance between new bone formation and old bone resorption. The body may fail to form enough new bone, or too much old bone may be reabsorbed, or both. Two essential minerals for normal bone formation are calcium and phosphate. Throughout youth, the body uses these minerals to produce bones. Calcium is essential for proper functioning of the heart, brain, and other organs. To keep those critical organs functioning, the body reabsorbs calcium that is stored in the bones to maintain blood calcium levels. If calcium intake is not sufďŹ cient or if the body does not absorb enough calcium from the diet, bone production and bone tissue may suffer. Thus, the bones may become weaker, resulting in fragile and brittle bones that can break easily. Usually, the loss of bone occurs over an extended period of years. Often, a person will sustain a fracture before becoming aware that the disease is present. By then, the disease may be in its advanced stages and damage may be serious. The leading cause of osteoporosis is a lack of certain hormones, particularly estrogen in women and androgen in men. Women, especially those older than 60 years of age, are frequently diagnosed with the disease. Menopause is accompanied by lower estrogen levels and increases a woman's risk for osteoporosis. Other factors that may contribute to bone loss in this age group include inadequate intake of calcium and vitamin D, lack of weight-bearing exercise, and other age-related changes in endocrine functions (in addition to lack of estrogen). Other conditions that may lead to osteoporosis include overuse of corticosteroids (Cushing syndrome), thyroid problems, lack of muscle use, bone cancer, certain genetic disorders, use of certain medications, and problems such as low calcium in the diet.
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OSTEOPOROSIS PREVENTION Although we often think of our bones as being static, these tissues are constantly under construction, with old damaged bone replaced by new bone to maintain bone density, and the integrity of its crystals and structure. However, as we age, the rate of bone breakdown can outstrip bone-building, with a peak in bone density in the late twenties, and a gradual weakening after the age of 35 or so in some people, this natural weakening is more pronounced, leading to Osteoporosis and a higher risk of fractures. Type I Osteoporosis (Postmenopausal Osteoporosis) can be significantly influenced by several preventive measures. Most of these measures are in the hands of the individual and should be started as early in life as possible. An individual’s peak bone mass is typically achieved by the age of 30. The amount of bone that is obtained at one’s peak, and how much is retained thereafter, is influenced by several factors, including:
1 - GENETICS AND OSTEOPOROSIS
It is important for individuals to know their genetic predisposition to osteoporosis. Genetics plays an important role - it is estimated that about 75% of an individual’s peak bone mass is influenced by genetics. There are genes that code for Vitamin D receptors and for estrogen receptors that both significantly affect peak bone mass. If one is genetically predisposed to osteoporosis, then exercise, diet and regular bone mass testing are even more important.
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2 - EXERCISE AND OSTEOPOROSIS
Weight bearing exercise (which refers to activity that one performs while on their feet that works the bones and muscles against gravity) and muscle contraction combined have been shown to effectively increase bone density in the spine. It is recommended that an individual perform 20 to 30 minutes of aerobic exercise 3 to 4 times weekly to increase bone mass. However for people with osteoporosis or low bone mass, care must be taken when exercising especially with regard to posture and body mechanics. Activities that require twisting of the spine or bending forward from the waist (such as conventional sit-ups or toe touches) may be dangerous. Individuals already diagnosed with osteopenia or osteoporosis should discuss their exercise program with their physician to avoid fractures.
SIGNS AND SYMPTOMS OF OSTEOPOROSIS
Bone loss that develops slowly, leading to osteoporosis, does not cause any symptoms or outward signs.
As such, a patient may only discover that they have osteoporosis due to an unexpected fracture after a minor fall.
A slip or strain - or even a simple cough or sneeze - may result in a fracture. Typically, breaks occur in the hip, wrist, or in the spinal vertebrae.
Breaks in the spine can lead to altered posture; with compressed vertebrae creating the stooped appearance often seen in older people (this excessive curvature of the spine is called kyphosis).
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OSTEOPOROSIS DIAGNOSIS
The gold standard for diagnosis of Osteoporosis is dual energy X-ray absorption scan (DEXA scan). The test is performed by passing low energy X-rays through a bone (e.g. spine, hip or wrist). The test takes about ten minutes, is painless, and is associated with very limited radiation exposure. The values generated by the test can then be compared to both: Young adult population: called a "T score," this test measures the variance between the patient and the young adult baseline. A score above -1 is considered normal; a score between -1 and -2.5 is considered osteopenia; and a score below -2.5 is considered osteoporosis. For each -1 standard deviation in T score there is a 3 times increased risk of hip fracture and a 2.5 times risk of spine fracture. Age- and gender-matched control groups: a "Z score" measures the variance between the patients’ and control groups’ amount of bone. The control group consists of other people in the patient’s age group of the same size and gender. An unusually high or low score may indicate the need for additional tests.
DEXA SCAN AT UHS
Using statistical analysis, the DEXA scan diagnostic study can indicate if someone is at increased risk of sustaining a fracture. According to the National Osteoporosis Foundation, bone mineral density testing is recommended in the following situations:
All women over age 65 Postmenopausal women under age 65 who have multiple risk factors At menopause, if undecided about hormone replacement therapy Abnormal spine X-rays Long-term oral steroid use Hyperparathyroidism (over-active parathyroid gland)
An osteoporosis diagnosis distinguishes whether or not osteoporosis is a primary problem or is secondary to another problem. Therefore, a thorough history and physical examination, as well as the appropriate diagnostic tests, need to be obtained. It is important to distinguish primary from secondary because the treatments are often different.
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WHO IS AT RISK FOR OSTEOPOROSIS? Women over the age of 45 or 50 are considered at higher risk for developing Type I Osteoporosis. Individuals who are at higher risk for Osteoporosis should be especially attentive about taking preventive measures and getting tested for early signs of Osteoporosis. Certain risk factors are linked to the development of Osteoporosis and contribute to an individual’s likelihood of developing the disease. Many people with Osteoporosis have several risk factors, but others who develop the disease have no known risk factors. Some risk factors cannot be changed, but you can change others.
Risk Factors You
CAN’T Change:
Gender: Your chances of developing osteoporosis are greater if you are a woman. Women have less bone tissue and lose bone faster than men because of the changes that happen with menopause.
Age: The older you are, the greater your risk of osteoporosis. Your bones become thinner and weaker as you age.
Body Size: Small, thin-boned women are at greater risk. Ethnicity: Caucasian and Asian women are at highest
risk. African American and Hispanic
women have a lower but significant risk.
Family History: Fracture risk may be due, in part, to heredity. People whose parents have a history of fractures also seem to have reduced bone mass and may be at risk for fractures.
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Risk Factors You
CAN Change:
Sex Hormones:
Abnormal absence of menstrual periods (amenorrhea), low estrogen level (menopause), and low testosterone level in men can bring on osteoporosis.
Anorexia Nervosa: Characterized by an irrational fear of weight gain, this eating disorder increases your risk for osteoporosis.
Calcium and Vitamin D Intake: A lifetime diet low in calcium and vitamin D makes you more prone to bone loss.
Medication Use: Long-term use of certain medications, such as glucocorticoids and some anticonvulsants can lead to loss of bone density and fractures.
Lifestyle: An inactive lifestyle or extended bed rest tends to weaken bones. Cigarette Smoking: Smoking is bad for bones as well as the heart and lungs. Alcohol Intake:
Excessive consumption of alcohol increases the risk of bone loss and
fractures.
Other factors that increase the risk of osteoporosis include diseases or drugs that cause changes in hormone levels, and drugs that reduce bone mass. Diseases that affect hormone levels include hyperthyroidism, hyperparathyroidism and Cushing's disease.
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OSTEOPOROSIS TREATMENT Early detection of low bone mass Osteopenia) or Osteoporosis is the most important step for treatment to be effective. If Osteopenia or Osteoporosis is diagnosed, a person can take action to stop the progression of bone loss. Knowing the risk factors for Osteoporosis in order to begin effective prevention or treatment is important. Once the appropriate medical history, physical exam and diagnostic tests have been obtained and a diagnosis of primary Osteoporosis has been made, treatment is warranted. Treatment for Osteoporosis typically includes education on diet/nutrition, exercise (if no fractures) and medications. The goal of Osteoporosis treatment is to prevent fractures. First, education regarding the appropriate calcium and Vitamin D intake, as well as overall nutrition, is necessary. As appropriate, exercise and fitness is also important to help maintain bone density and reduce the risk of falls. Calcium is the major nutrient needed to form new bone cells and is vital for bone health. Getting plenty of calcium and vitamin D in the diet can help slow bone loss. Calcium-rich foods include:
MILK
Dairy Products
Dark Green Vegetables
Enriched Grains and Breads
Soy Products
Most cereals and orange juices are now available with added calcium as well. Vitamin D helps your body absorb the calcium it needs. Bones store more than 99% of the calcium in the body. Just as the bones change throughout the lifetime, so do the calcium needs: Children ages 4 to 8 need at least 1,000 milligrams of calcium a day (2-3 servings of dairy per day). Children ages 9 to 18 need at least 1,300 milligrams of calcium a day (4 servings of dairy per day). Adults ages 19 to 50 need at least 1,000 milligrams of calcium a day (3 servings of dairy per day). Women over age 50 and men over age 70 need at least 1,200 milligrams of calcium a day (3-4 servings of dairy per day).
While calcium is critical it cannot build bones alone. It works with other nutrients -vitamin D, vitamin K, Potassium, Fluoride, Magnesium - to increase bone strength. Vital at every age for healthy bones, exercise is important for treating and preventing Osteoporosis. Not only does exercise improves bone health, it also increases muscle strength, coordination, and balance, and it leads to better overall health.
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Here are a few key reasons why exercise is important for individuals with Osteoporosis:
To Build Muscle Strength: Strength training improves muscle mass and strength.
To Prevent Falls: Performing challenging balance exercises can improve balance and coordination, which helps prevent falls, and this in turn may prevent fractures.
To Protect the Spine: Spine fractures are often caused by forces, or “loads,� on the vertebrae that are greater than they can withstand. Exercises that target the muscles that extend your back can help improve posture, reducing the risk of spine fractures.
Benefits of
Regular Excercise
To Slow the Rate of Bone Loss: Exercises aimed at increasing muscle strength (i.e., strength or resistance training), combined with weight-bearing aerobic physical activity, help to prevent bone loss as we age.
Other Benefits: Whether or not you have osteoporosis, regular exercise improves health in many ways. People who exercise regularly have lower rates of depression, heart disease, dementia, cancer, diabetes and many other chronic diseases. Exercise can improve your physical fitness, strength, energy levels, stamina and mental health.
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Newsletter |May 2017
TEAM AT UHS QUALIFICATIONS Dr. Sukhbir graduated from Armed Forces Medical College, Pune University, India with certificate of equivalence to MRCP from JRCTB (UK). He completed his Postdoctoral Fellowship in Rheumatology, from the All India Institute of Medical Sciences, New Delhi, India. He is a Fellow of the Royal College of Physicians (FRCP), Edinburgh – UK and American College of Rheumatology (FACR), USA.
EXPERIENCE
Prof. Sukbhir Singh MD, MBBS, FRCP (UK), FACR (USA) Consultant Rheumatologist
Professor Sukhbir Uppal’s expertise extends for more than 32 years including 28 years experience as a Consultant Physician and 21 years experience as Consultant Rheumatologist. His previous positions have included Consultant Rheumatology, Mubarak Al Kabeer Hospital, Kuwait and Associate Professor of Rheumatology at Kuwait University. He is a highly experienced Senior Consultant in Rheumatology skilled in the evaluation and management of arthritis and all other rheumatic disorders. His being an academic professor for several years, as well as his active membership with professional organizations and involvement in clinical trials, ensures that he is at the forefront of advances in Rheumatology.
He is abreast of latest developments in the fields of rheumatology and medicine, attending all important international conferences for advancing knowledge and skills, especially the annual American (ACR) and European (EULAR) Rheumatology conferences. Dr. Sukhbir has several publications to his credit, and regularly contributes to professional conferences and meetings. His contributions to the field of Rheumatology have received recognition through several awards which have been conferred on him in recent years.
SPECIAL INTEREST
Rheumatoid Arthritis Systemic Lupus Erythematosus (Lupus) Gout Psoriatic Arthritis Inflammatory Arthritis Connective Tissue Diseases Osteoporosis Systemic Sclerosis Inflammatory Muscle Disorders Metabolic Bone Disease Chronic Musculoskeletal Pain Disorders Osteoarthrit
LANGUAGE KNOWN
Arabic, English, Hindi, Punjabi and Urdu
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