WOMEN AFTER FORTY : SOME BONY ISSUES

                                    Dr. Arvind Dubey

Decreasing bone density is a very important and very common health hazard of  women after forty-forty five years of age. It is painful and crippling. This is called, "OSTEOPOROSIS" or "POROUS BONES" which is never considered a disease but a normal routine for women or as a discredit of being a woman, especially in rural India.

Why should you at all fear osteoporosis?

Besides a painful and crippling condition, chances of bone fractures increase considerably in osteoporosis. Even a minor fall or a vigorous hug may Cause a fractured bone which heals very slowly or some times not at all or with long term disability and accelerated death rate. It causes marked changes in posture as humped back is considered a stereotype of ageing especially in our country. Deformed skeletal framework pushes or shifts various organs result into a spectrum of difficulties ranging from constipation to breathing problems. There may be chronic low backache, restlessness, arthritis, and leg cramps etcetera.

Cause of the problem

What you are suffering today is the culmination of slow process started decades back. We usually visualize bone as a solid rigid inactive mass but in fact it is an active living tissue, constantly being recycled. Inner part of bone always breaks down and outer surface is always in the process of reformation. The delicate balance of these two processes in response to the demand of the body, which is maintained in the youth, becomes disturbed. More calcium is withdrawn from the bones than deposited and these become soft and weak. Actual cause of this misbalance is not known. It may be hormones, a genetic predisposition, nutrition, physical activity, life style factors or probably all in combination.

Bone loss wit advanced age  occurs due to changes in a woman's hormone levels.
Image Courtsey- Wikipedia

Female hormone, oestrogen, may be cited as a cause because when its production stops due to ovarian atrophy, the process enhances. In nutri­tion Calcium and vitamin D, C & E deficiencies have been blamed as even in a healthy adult deficiency of these can cause osteoporosis

Who is at risk?

Any one who is having the fo1lowing may be at the risk of developing speedy osteoporosis. Judge yourself over these 1ines­-

• Any member of your family had or having bone disease?
• Are you short stature and thin built?
• Are you fair skinned?
• Have your ovaries been removed before 45 years of age?
• Are you childless?
• Have you been confined to bed for a longer period?
• Are you having diabetes, kidney or liver disease?
• Are you having an under active thyroid?
• Are you sedentary?
• Do you smoke?
• Do you diet or fast frequently?

                 If your answer for any one of the above questions is yes then you are at the risk of developing osteoporosis.

What to do?

However you may sufficiently delay it and decrease its intensity but how? Read further and follow it in your life.

Take extra calcium in your diet: Calcium is essential to bone health. The daily allowance of calcium for a woman prior to menopause is 1000 milligrams per day and after menopause is around 1,500 milligrams per day. Take plenty of dairy products, turnips, fish (especially those which are eaten with bone), dates etc. Ragi is a very good source of calcium. This can be taken into CHAPATI or in some other form. Calcium supplementation in the form of medicinal preparations may be cheap and desirable alternative to many of the women. Take about 1 to 1.5 grams of elemental calcium per day (according to your menopausal status) and at least 50,000 units of vitamin D per week. This vitamin D will help you in depositing this calcium in the bone properly. As proper ratio of calcium to phosphates affects the amount of calcium absorbed by bones. So reduce your intake of high phosphate food drastically, namely all processed or canned meat, processed cheese, instant soups, puddings, pastries and soft drinks. For adequate absorption and metabolism of calcium, you will need vitamin C and magnesium. The whole business may look to you rather confusing, so it’s better to consult your doctor for it.

Change your life style: The speed with which your bones break down depends on the way you treat your body. These are few recommendations for change in your life style­-

·       Remain active as inactivity increases bone breakdown. Even after fracture, start moving as early as permitted by your doctor.

·       Cut down intake of meat in your diet as it has been seen that heavy meat eaters have twice more chances of developing osteoporosis than vegetarians. Eat more cereals, grains, beans, vegetables, nuts etc.

·       Avoid foods containing excess fats (optimum amount of fat intake is necessary- beware of slimming courses which insist on non-fat milk). So avoid saturated fats which are solid at room temperature viz. ghee, butter, lard and some vegetable oils such as coconut or palm oil.

·       Minimize your intake of concentrated sugars which produce acidity in the blood and consequently more calcium Comes out of bones.

·       Reduce intake of foods with high phosphate concentration (see above)

·       Stop smoking and boozing as both of these reduce amount of “Oestrogen” in blood so enhances bone dissolution.

·       Limit intake of coffee and tae.

Make exercise a routine: Like muscles bones grow stronger with use. Bone density in well nourished women depends directly on how much the bone is stressed. Though exercise should be started earlier but it’s never too late. No matter how old you are, exercise can strengthen your bones. The best exercise for bone strengthening are those that put a load or stress on your bones such as jogging, aerobic dances, skipping roaps or brisk walking. Simple dancing or swimming can be a good exercise. To get full benefit exercise should be done for 20 to 30 minutes at a pace fast enough to accelerate your pulse rate moderately. While exercising, beware it should not be over­ done because if overdone the exercise may increase bone destruction at the place of its formation.

Beware of self medication: Steroids (used erroneously for increasing muscle bulk and almost always present in magic or so called “rapid cure preparations” of nonqualified quacks) intake results in severe blood loss bone loss.  So please do not go for magic pills. Drugs for acidity (antacid) which especially contain Aluminum in them, may contribute to osteoporosis, when taken regularly. The drugs for hypertension which increase amount of urine, increase bone destruction or calcium removal in urine. So when you are on above said drugs take calcium and vit. D supplementation and consult your doctor on this point too.

CAN HORMONAL THERAPY BE AN ANSWER?

Bone resorption hastens as your ovaries are nonfunctional and you do not have its hormones. So it is very likely to be concluded that these hormones, especially Oestrogen might be a protector of the bone. But it is still debatable. It has been claimed that Oestrogen though decreases bone dissolution but it does not increase bone formation, which eventually usually decreases. As therapy is withdrawn the bone loss resumes. Simultaneously it places a woman at the risk of Cancer of uterus, breast & liver, high blood pressure, gall bladder disease, diabetes etc. So this hormone replacement therapy is not a desirable alternative for women with a family history of uterine or breast cancer, diabetes, liver diseases, gall bladder stones, migraine and uterine tumors.

It does not mean that no women should take Oesrogen even if she is a high risk candidate for osteoporosis. Current researches suggest that when the Oestrogen is taken in combination with another hormone called progesterone (this combination is found in almost all the faintly planning pills); risk of the cancer is reduced. But in any case this therapy should be started and continued under strict medical supervision.

So do not long for a magic pill for your day to day aches and pains due to osteoporosis which you can take at bedtime and on next fine morning find yourself cured. You have to Change a lot in your nutrition, your life style etcetera but choose the way you can pursue life long, not that which you can tolerate as a discomfort for a short period.