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Osteoporosis is characterised by a decrease in bone mass, and damage in bone tissue and skeletal structure. This leads to extremely fragile, brittle and weak bones that are highly prone to fractures. Not many know that osteoporosis is a public health problem, and is estimated to affect more than 200 million people globally.
In India, the prevalence of osteoporosis is reported to be between 6.9 percent to 18.3 percent in different studies, with a higher prevalence being reported among postmenopausal women.
Although a common condition, what makes osteoporosis dangerous is the fact that the condition progresses silently without any symptoms. Moreover, it remains undiagnosed until a fracture happens. Sometimes, the bones become so weak that they may break even without falling or coughing.
About 40 percent of women and 20 percent of men with osteoporosis are likely to suffer from fractures during their lifetime. Mortality, following an osteoporotic fracture, is high and reported to be about 15-30 percent in different studies. Besides, fragility fractures are associated with pain, discomfort, disability and poor quality of life in most patients.
The non-modifiable or unchangeable risks include being of female gender, progressing age, small body frame, hormonal disorders and positive family history. Many other medical conditions such as celiac disease, kidney or liver disease, cancer, etc may also increase the risk of osteoporosis. The modifiable or lifestyle factors include a diet poor in calcium, lack of sunlight exposure, sedentary lifestyle, excessive caffeine, alcohol consumption and smoking.
Thus, lifestyle plays an important role in maintaining healthy bones and preventing the risk of osteoporosis and related complications.
In India, caffeine-containing food is consumed regularly in the form of tea or coffee, multiple times every day. Many other edible items like chocolate, soda, and energy drinks also have caffeine in varying quantities. Caffeine intake over 300 mg per day increases the amount of calcium excreted in urine, and thus increases the risk of osteoporosis. For example, a study has shown a high risk of fragility fractures among women who consume four or more cups of coffee per day, especially in those having less than 700 mg calcium intake per day.
High caffeine intake, low calcium and dairy intake, along with soda consumption and smoking all negatively affect bone marrow density (BMD). Though recent research shows that restricting caffeine to <300 mg per day may not increase the risk of fractures, this is relative.
That’s because persons having multiple other risk factors such as less calcium intake, vitamin D deficiency, excessive alcohol intake or smoking will be more prone to osteoporosis, despite consuming less caffeine.
It is prudent to have one’s health check-up done regularly along with BMD and vitamin D levels, especially in older age groups to avoid any complications like hip fracture and spine fractures — common complications of osteoporosis.
Most people are familiar with the many benefits of exercise, such as improving muscle strength and endurance, reducing the risk of heart disease and stroke, and preventing obesity.
Perhaps, not as well understood is the importance of regular physical activity in building and maintaining healthy bones. Inactivity causes loss of bone. Physical exercise is considered an effective means to stimulate bone osteogenesis (new bone formation) in osteoporotic patients. Exercise can prevent or slow bone loss, maintain muscle mass to preserve and strengthen surrounding bone, and decrease the risk of falling. An effective exercise program for bone health should be 30 minutes of weight-bearing activity, four or more days a week.
Weight-bearing aerobic exercises like walking, stair climbing, or jogging. However, walking alone does not appear to improve bone mass.
Strength and resistance exercises: These are carried out with loading (lifting weights) or without (swimming, cycling). For this sort of exercise to be effective, a joint reaction force superior to common daily activity should be incorporated. These exercises are extremely site-specific, and can increase muscle mass and BMD, only in the stimulated body regions.
To reap the benefits of exercise, one needs to add flexibility and balance training.
It is also important to end all exercise sessions with stretching.
Osteoporosis is a progressive bone disorder, and lifestyle plays an important role in its development. Along with regular exercising, a balanced, calcium-rich diet, adequate vitamin D, and a healthy lifestyle (avoiding excessive alcohol and nicotine) are equally important for healthy bones.