It is common for older people to often experience pain in their bones and attribute it to their age. Awareness about osteoporosis and other related bone, muscle and joint disorders that can lead to pain, severe disability and premature death is hence, severely limited. Osteoporosis is characterised by low bone mass and loss of bone tissue that leads to weak and fragile bones. Patients suffering from the disease have an increased risk for fractured bones particularly in the hip, spine, and wrist. However, most of them are unaware of their condition until their first fracture while in certain cases it goes untreated even after a fracture.
The leading cause of osteoporosis is a lack of certain hormones, particularly estrogen in women and androgen in men. In certain cases, it can also be genetic which can accelerate the bone deformation process.
Combating the silent disease
Women, especially those older than 60 years of age, are frequently diagnosed with osteoporosis. Menopause is accompanied by lower estrogen levels and increases a woman’s risk of osteoporosis. The most common complaint that patients have is of difficulty in walking and performing daily household chores. This can be particularly challenging for women for whom household chores are an integral part of life. Mrs Shahid, a 55-year-old, who has been battling with osteoporosis after her menopause faces great difficulty in walking due to her weak bones. “After menopause, I realised that I couldn’t go out on a morning walk like I used to. I had a limp in my walk and my bones felt weak,” she says. An X-ray revealed that she was suffering from osteoporosis. “I thought I will never be able to walk again. But with regular physiotherapy for a month and a calcium and vitamin D rich diet, I was back on my feet.” Shahid admits that she still has to exercise extra care and avoid tasks that will hurt her bones.
Despite the wide prevalence of osteoporosis, no proper cure has been found yet. “We usually give painkillers for pain management and disease modifying drugs to slow the process of deformation of joints,” says Dr G N Valicha, a federal government health officer. He explains that the pain can be minimised through anti-inflammatory drugs, proper intake of calcium and vitamin through food or supplements.
Calcium is essential for the proper functioning of critical organs such as the heart and brain. To keep them functioning, the body reabsorbs calcium that is stored in the bones to maintain blood calcium levels. “If calcium intake is not sufficient or if the body does not absorb enough calcium from the diet, then the body will start producing bones of decreased mass and density. Thus, the bones may become brittle and fragile bones and break easily,” says Valicha. Moreover, meat that contains hormones and antibiotics like chicken and beef should be avoided and instead a diet that is rich in fruits and vegetables should be consumed.
He further explains that the loss of bone usually occurs over an extended period of time, often a few years. Usually, a person will sustain a fracture before they find out that they suffer from osteoporosis but by that time the disease may be in its advanced stages and the damage may be serious.
Since osteoporosis is incurable, it spreads over time as you grow old and sometimes extreme pain management strategies are needed to relieve the patient. Dr Aruna, who has been struggling with osteoporosis for the past 17 years, has been on regular painkillers and anti-inflammatory medicines. During bouts of severe pain, her doctors have even prescribed her anti-cancerous medicines. “The stage [of the disease] that I am at has deformed my joints. Hence, walking, sitting and getting up have become an issue. Exercising and lifting heavy things is also difficult.” During high humidity, her condition gets even worse. For patients like Aruna, survival without medicines is close to impossible.
Osteoporosis is often considered to be a condition limited to frail elderly women. However, the damage from osteoporosis begins much earlier in life. Because peak bone density is reached at approximately 25 years of age, it is important to build strong bones by that age, so that they remain strong later in life.
A stronger Pakistan
Pakistan, which has a significant proportion of elderly, now faces a major osteoporosis threat, according to the medical fraternity. Currently, 9.91 million people in Pakistan suffer from the disease. According to a report published by the International Osteoporosis Foundation (IOF) in 2006, women in Pakistan have a daily calcium intakes of 300 to 500 milligrams range which is less than the ideal intake of 1000 milligrams. Even though, calcium and vitamin D supplements are readily available there is no programme to educate people of its importance.
Recently, societies such as The Osteoporosis Society, The Menopause Society, and The Pakistan Endocrine Society have made major efforts towards creating awareness among health professionals, through national seminars as well as for the public through seminars and World Osteoporosis Day activities. Information material, including the IOF literature is available in Urdu but dissemination is limited.
Even though things have taken a positive turn in the past few years with media playing a key role in creating awareness about diseases such as osteoporosis, a lot more needs to be done to ensure a stronger, healthier Pakistan.
Around the world one in three women and one in five men over the age of 50 will suffer an osteoporotic fracture. In fact, a bone will break every three seconds because of this disease.
While there is no clear data on the number of (osteoporotic) hip fractures per year, estimates based on a large ultrasound study conducted throughout Pakistan by International Osteoporosis Foundation suggested that there are 9.91 million people diagnosed with osteoporosis of which 7.19 million are women and 2.71 million are men. These numbers are estimated to rise to 12.91 million in 2050.
Dr Sundeep Sahitia, residential medical officer at Dow Medical College recommends the following precautionary measures in order to avoid osteoporosis:
• Exercise daily as it increases mobility.
• Avoid smoking.
• Ensure a nutritious diet with adequate calcium.
• Proper sunlight exposure.
According to Dr Sahitia strange myths are associated with osteoporosis, which need to be debunked. Some of the most common ones are:
1. Some patients often associate the pain with food consumed at odd times like taking curd in the night while others relate it to black magic.
2. They assume that the pain will subside when they take more physical rest.
3. Some patients do not believe that that the disease can be caused through smoking and therefore don’t make an attempt to avoid smoking.
“Osteoporosis requires constant battle of wills. There is pain, there are strange myths and there is the static life that people fear. The only solution is proper diet, physical activity and proper guidelines,” says Sahitia.
Published in The Express Tribune, Ms T, August 10th, 2014.