Make No Bones About It


EDITOR’S Rx


Come to think of it, we’re doing our bones a lot of injustice. Sometimes, we’re overly concerned with our heart, brain and kidneys and we could be easily convinced (though we don’t necessarily follow them) of preventive measures to avoid getting diseases in these vital organs. But when it comes to the bones, we don’t seem to appreciate much that it also matters to care for them, till we get a fracture, or later on feel so weak and frail because of poor bone health.

Bones literally and figuratively form the framework of the entire body. It contours the bodily structure, protects the internal organs, anchors the muscles and keep them coordinated as they contract, and stores calcium to preserve bone health. It is therefore imperative to keep our bones strong and healthy starting from childhood and adolescence all throughout adulthood.

For those who might not have been conscious of bone health in their younger years, no worries; it’s never too late during adulthood to take steps to build and preserve bone health.

It’s well established that the skeletal system is one of the most dynamic bodily systems—the bones continuously change all throughout one’s lifetime. New bone formation occurs continuously as old bone breaks down. This doesn’t stop even in old age, although it considerably slows down. New bone formation is faster than its breakdown in the young, hence, building up the bone mass. Bone build-up peaks at age 30, after which bone remodeling then occurs characterized by a gradual decrease in bone mass. In effect, one has a tendency to develop osteopenia—the reduction in bone mass—as one grows older.

Many get confused between osteopenia and osteoporosis which are two different entities, although they’re caused by the same pathophysiologic process. Osteopenia and osteoporosis are two points in the deterioration of bone health. In a way we may consider osteopenia as the midpoint between healthy bones and the pathologic state called osteoporosis, wherein the bone really becomes weak and brittle.

In sedentary people, the bone mass reduction can be accelerated leading further from osteopenia to osteoporosis. So those who have achieved a high bone reserve mass at age 30 will be least likely to develop osteoporosis later on, but like we said, ones bone world does not come to an end if one wasn’t bone conscious in one’s younger years. However, he or she needs to make up to cover for lost time. And one can do that by the following:

• Increasing one’s calcium from the diet (For adults ages 19 to 50 and men ages 51 to 70, the daily recommended dietary allowance (RDA) is 1,000 mg of calcium, increasing to 1,200 mg a day for women after age 50 and for men after age 70.)
• Exercising regularly
• Avoiding tobacco completely and alcohol in excess
• Maintaining ideal body weight—preferably a BMI of >19 to 23 (For Asians).
• Making sure one’s hormones are normal (thyroid, estrogen in premenopausal women, testosterone in men)
• Avoiding certain medication —like corticosteroids, aromatase inhibitors to treat breast cancer, selective serotonin reuptake inhibitors, methotrexate, some anti-seizure medications, like phenytoin and phenobarbital, and proton pump inhibitors— unless really necessary.

Just a thing about the calcium in our body. We need vitamin D to absorb calcium from the diet. So, vitamin D supplementation may help, too, to prevent osteoporosis. For adults (19 to 70 years of age), the RDA is 600 international units (IUs) a day. The recommendation increases to 800 IUs a day for adults age 71 and older. We normally prescribe 1,000 to 2,000 IUs per day. Checking the serum vitamin D level once or twice a year can guide one as to the optimal supplementary dose. As a bonus, vitamin D is also good for cardiovascular health.

As for exercise, one should include weight-bearing exercises. We just recommend light weights for our senior patients. Climbing stairs when making rounds in the hospital for doctors can be an acceptable substitute, which one can easily do daily or at least several times a week.

So, preserving one’s bone health is not as difficult and complicated as it may seem to be. One just has to will it, and make no bones about it.

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