The num­ber of In­di­ans af­fected by os­teo­poro­sis is ris­ing. Im­prov­ing nu­tri­tion is the only way out.

India Today - - HEALTH SPECIAL -

We are de­pen­dent on our bones for ev­ery small move­ment. Bones sup­port the whole weight of our bod­ies so that we can stand up, sit down, and move around. We take th­ese for granted when we are young. But th­ese sim­ple acts of daily liv­ing be­come dif­fi­cult as we get older and our bones get weaker.

Med­i­cal ad­vances have in­creased our life ex­pectancy and also the bur­den of age- re­lated health prob­lems like os­teo­poro­sis. Os­teo­poro­sis lit­er­ally means ‘ por­ous bones’. Os­teo­porotic bones be­come weak and frag­ile, so frag­ile that frac­tures can oc­cur with mild trauma. Os­teo­porotic frac­tures in­volve very high eco­nomic and so­cial costs and have a sig­nif­i­cant neg­a­tive im­pact on the qual­ity of life of pa­tients. Women, es­pe­cially af­ter menopause, are more likely to suf­fer from os­teo­poro­sis com­pared to men.

An alarm­ing find­ing is that In­di­ans, es­pe­cially those from the low so­cio- eco­nomic group, tend to have os­teo­porotic frac­tures at a much ear­lier age com­pared to the peo­ple from the western coun­tries. Stud­ies by the National In­sti­tute of Nu­tri­tion, Hyderabad, ( NIN) have shown that the aver­age age at which women from poor so­cioe­co­nomic group suf­fer from hip frac­ture is only about 57 whereas frac­tures usu­ally oc­cur af­ter 75 in well- nour­ished pop­u­la­tions. Apart from hip frac­tures, os­teo­poro­sis can cause ver­te­bral mi­cro- frac­tures which cause per­sis­tent back pain. A large num­ber of ver­te­bral frac­tures go un­de­tected be­cause back pain is of­ten not con­sid­ered se­ri­ous enough to seek med­i­cal care.

Os­teo­poro­sis is a silent dis­ease and frac­tures can oc­cur with­out any warn­ing or sig­nal. How­ever, os­teo­poro­sis can be de­tected early by as­sess­ment of bone min­eral den­sity ( which in­di­cates strength) us­ing spe­cialised equip­ment called dual en­ergy X- ray ab­sorp­tiom­e­try ( DXA). Stud­ies by NIN and other re­search cen­tres in In­dia as­sess­ing the bone min­eral den­sity of var­i­ous pop­u­la­tion groups have shown a high preva­lence of os­teo­poro­sis. Al­though

os­teo­poro­sis af­fects peo­ple late in their lives, its seeds are sown early. When chil­dren grow, their bones be­come pro­gres­sively stronger due to in­crease in the bone min­eral den­sity through­out child­hood and ado­les­cence. Its peak is reached in the early 20s, which is known as the peak bone mass, and no fu­ture in­crease in bone mass is pos­si­ble af­ter that. Un­der- nu­tri­tion dur­ing child­hood and ado­les­cence leads to low peak bone mass in the youth and with age- re­lated loss in bone min­er­als, os­teo­poro­sis sets in.

How does one pre­vent this de­bil­i­tat­ing dis­ease? A bal­anced diet with ad­e­quate cal­cium, vi­ta­min D and pro­tein along with reg­u­lar weight bear­ing phys­i­cal ac­tiv­ity is the key to pre­vent­ing os­teo­poro­sis. In ad­di­tion, main­tain­ing a healthy weight and avoid­ing cig­a­rettes and al­co­hol help in main- tain­ing strong and healthy bones.

Cal­cium is the most im­por­tant bone- form­ing min­eral. Good sources of cal­cium in­clude dairy prod­ucts like milk, yo­ghurt and cheese; leafy veg­eta­bles like spinach and ama­ranth; pulses like chana dal and ra­jma; oilseeds, es­pe­cially se­same seeds; and spices like cumin seeds, pep­per and cloves.

More­over, the food source of cal­cium is just as im­por­tant as the amount of cal­cium in­take. Cal­cium from milk is highly bio- avail­able: A higher quan­tity of it is ab­sorbed from the gut and can be utilised for min­er­al­i­sa­tion of bones. On the other hand, cal­cium from plant sources has low bio- avail­abil­ity. It is dif­fi­cult for di­ets with­out milk to be ad­e­quate in cal­cium.

Ab­sorp­tion of cal­cium is de­pen­dent on vi­ta­min D. Re­ports from dif­fer­ent parts of the coun­try have shown that a large pro­por­tion of In­di­ans suf­fers from vi­ta­min D de­fi­ciency. This is sur­pris­ing in a sunny coun­try con­sid­er­ing that sun­light ex­po­sure is es­sen­tial for ad­e­quate vi­ta­min D. But re­ally, how many of us ex­pose our­selves to the sun for at least 15 min­utes ev­ery day? Not many. Apart from our in­door habits that pre­clude sun­light ex­po­sure, pol­lu­tion could also play a role in this de­fi­ciency. Pol­lu­tion can block ul­tra­vi­o­let rays which stim­u­late vi­ta­min D syn­the­sis in the skin.

Apart from diet, phys­i­cal ac­tiv­ity plays an im­por­tant role in de­vel­op­ment and main­te­nance of bone mass. Weight- bear­ing ac­tiv­i­ties such as brisk walk­ing, jog­ging, stair climb­ing, and danc­ing are es­pe­cially im­por­tant for im­prov­ing bone den­sity as well as im­prov­ing mus­cle strength.

As life ex­pectancy in­creases and the pop­u­la­tion con­tin­ues to grey, os­teo­poro­sis is likely to in­crease. Preven­tion of os­teo­poro­sis by im­prov­ing nu­tri­tion is there­fore of para­mount im­por­tance. Im­prov­ing cal­cium in­take would re­quire in­creas­ing the avail­abil­ity of dairy prod­ucts at an af­ford­able cost and ex­plor­ing newer, cheaper food sources of cal­cium. Strate­gies should tar­get younger age groups for op­ti­mal de­vel­op­ment of peak bone mass and older in­di­vid­u­als to re­duce age- re­lated bone loss.


Dr Bharati Kulka­rni Deputy di­rec­tor, Clin­i­cal Di­vi­sion, National

In­sti­tu­tion of Nu­tri­tion

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