Bone of Contention


COVER STORY

Osteoporosis is a lot more serious than many realize it is. The Osteoporosis Society of the Philippines Foundation bats for a well-informed public on the risks of poor bone health and frailty; and simple, doable things that can prevent it

By Gelyka Ruth R. Dumaraos


As an organ system which main role is to protect the internal organs and enable one to move and perform motor functions, the skeletal system plays a vital role from birth to aging. Thus, as one ages, it is important to maintain an active lifestyle to minimize the risk of frailty in one’s senior years.

The body’s bones continue to grow and become stronger until about the age of 30, but most bone growth occurs in the first 20 years. Adolescence is one of the most important periods for bone growth, as this is when bone density reaches its peak. Leaving adolescence with strong bones may be important for later bone health. After age 30, the loss of bone density begins. In general, the stronger the bones are as a young person, the stronger they will stay as the person ages.

Around the world, one in three women and one in five men over the age of 50 will suffer an osteoporotic fracture, the most common bone risk. In fact, the World Health Organization (WHO) reveals that a bone will break every three seconds because of this disease, creating an enormous human and socio-economic impact.

“Osteoporosis affects the quality of the bones,” Dr. Rylan Flores, noted orthopedic surgeon at the De Los Santos Medical Center says. “Unfortunately, it is called a silent disease.”

He adds that aging automatically means having osteoporosis. “It is still a disease and we will never know that we have it until we accidently break our bones due to its weakness.”

Dr. Flores, who is also a fellow of the Philippine Orthopedic Association, also points out that while men also suffer from the disease, women experience the greatest loss after menopause, around age 50. The WHO states that the bone density varies continuously throughout life, and may be affected by many aspects of a woman’s life that impact her health, such as breastfeeding and pregnancy. The hormone estrogen plays an important role in developing and maintaining strong bones. This means that hormonal birth control may also affect bone density. Hormonal contraception that contains an estrogen may help keep the bones of some women strong, but for most healthy women it probably does not make a big difference.

Increased risk

Dr. Flores says that while it is a possibility for older women to have bone risks when they reach menopause, there are other factors such as physical activity, age, diet, and some medical problems. Health problems such as anorexia nervosa, diabetes, liver or kidney disease, cancer, asthma and allergies, hyperthyroidism may also affect ones’ bones.

Osteoporosis is just one among the major health issues in the country due to a rapid increase in the aging population.

The Osteoporosis Society of the Philippines Foundation, Inc. (OSPFI) says that there are many things that can increase chances of getting osteoporosis. Some risk factors are modifiable or treatable, while some are non-modifiable and beyond one’s control.

Examples of modifiable or treatable risk factors are calcium and vitamin D deficiencies. Negative lifestyle habits such as smoking and sedentary living also impact negatively on bone health. Certain medicines can also cause bone loss. These include glucocorticoids or steroids, which some people with arthritis, asthma, and many other diseases take. Some anti-seizure medicines, drugs for endometriosis, and cancer chemotherapy can also accelerate the risk of osteoporosis.

Diet and mobilization

There are simple things one can do to keep one’s bones healthy and strong. Dr. Flores stresses the importance of proper diet, by eating foods rich in calcium and vitamin D, regular exercise, and healthy lifestyle practices in general to help keep the bones healthy.

“An 80-year-old woman, who in her age, maintains a balanced diet may be osteopenic—something that is expected with her age—is even healthier in terms of bone health than a young person who always eats fast food and other processed foods which lack enough vitamins and minerals the body needs. This young person is likely to be osteoporotic when bone screening is done,” explains Dr. Flores.

Maintaining an ideal body weight is also important. Being overweight or underweight can be a risk factor for osteoporosis. Being too thin makes one more likely to get osteoporosis, too.

The misconception of exercising as a risk to bone fractures should be debunked. In fact, keeping the bones healthy also means having an active lifestyle, Dr. Flores adds.

A regular, properly designed exercise program may actually help prevent falls and fractures, even for people with osteoporosis. Exercise strengthens bones and muscles and improves balance, coordination, and flexibility.

There is no single exercise plan that’s best for everyone with osteoporosis. The choice should be individualized and based on fracture risk, muscle strength, functional capacity or level of physical activity, fitness, gait and balance. Other health problems that have a bearing on ability to exercise, such as obesity, high blood pressure, and heart disease should also be considered.

In addition, weight-bearing exercise is advised which forces one to move against gravity, or gives resistance while moving. High-impact weight-bearing exercises are best for building bones. However, these should be limited if you have been diagnosed with osteopenia or osteoporosis.

Examples of high-impact exercises include running or jogging, high-impact aerobics, stair climbing, dancing, and sports such as tennis or basketball. One should get a clearance from one’s physician before engaging in them, especially for those with medical conditions and some cardiovascular risk.

For people who experiences bone pain, Dr. Flores highly recommends consulting a doctor to supervise bone screening. He advises: “Do not wait until you’re a senior citizen to have your bones checked. While you are young and able, treat them with care through having a healthy lifestyle. As I said, you will never know when you have osteoporosis until you break your bone.”

Public awareness

The International Osteoporosis Foundation (IOF) reveals that bone health awareness in the country was one of the lowest when compared to other Asian countries in the mid 1990s. Ten years later, awareness of the disease has moved one level higher, with the fact that many recognize the consequences of growing old and osteoporosis is one of the greatest fears of the elderly population.

In the Philippines, OSPFI leads the way in advocating for active campaigns for bone health, especially for the aging population.

“While the government has recognized osteoporosis as a major problem and has initiated measures to improve awareness about the disease, more sustained effort and structured programs are essential for substantive progress to be made,” a statement from OSPFI reveals.

OSPFI stresses that there is an urgent need to have more preventive programs which are government-aided, and also an increase in the diagnostic facilities especially in rural areas.

Currently the number of people over 60 years, in a population of 96 million, is 6-7 percent. The Philippines Osteoporosis Society has posed a Call to Action to the Philippines Government to try and address the shortfall in services for the many people suffering from osteoporosis and fractures.

OSPFI started its fight against osteoporosis in 1998 through Presidential Proclamation No. 19 which directs all local and national agencies along with the private sector to be supportive of activities of OSPFI in the annual celebration of NOAW.

The OSPFI also joins the IOF in celebrating the World Osteoporosis Day annually during which the global concern for the disease is highlighted. OSPFI has been at the forefront of the campaign for improved osteoporosis prevention and treatment; specifically, the inclusion of osteoporosis as one of the official causes of significant morbidity and mortality of elderly persons 65 years and above; heath care awareness programs, which should be closely coordinated with national osteoporosis organizations or societies; national research studies to establish baseline risk for fracture in elderly Filipino persons; drawing up strategies for the early detection of high risk individuals through the inclusion of the use of Osteoporosis Screening Tool for Asians (OSTA); and case finding strategies of measuring bone density in health care packages of adult women and men.

The OSPFI also calls on the government to support the evaluation of osteoporosisrelated fragility fractures, most especially vertebral fractures, by including baseline thoraco-lumbar radiographs and central BMD measurement in healthcare packages of all postmenopausal women and elderly men age 65 years and above.

With a concerted drive to actively campaign for bone health, the OSPFI and many other bone health advocates share this important message to everyone, that it is never too late to keep the bones healthy. And there should be no ‘bone of contention’ about it.

“There is an urgent need to have more preventive programs which are governmentaided, and also an increase in the diagnostic facilities especially in rural areas”

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