People don’t really think much about bone health when, in fact, they should. It’s only when one gets fractured or is diagnosed with a bone ailment that bone health becomes an immediate concern.
With the Philippines transitioning to an aging society, bone health has become a primary issue for a growing number of senior citizens, especially women.
According to the Osteoporosis International Foundation, one in three women and one in five men aged 50 years and over will suffer an osteoporotic fracture. Osteoporosis causes bones to become weak and fragile, so that they break easily – even as a result of a minor fall, a bump, a sneeze, or a sudden movement. Fractures caused by osteoporosis can be life-threatening and a major cause of pain and long-term disability.
Experts, however, say one does not monitor bone health only when one’s hair turns to grey.
In an interview with the Good Life, Dr. Vandana Garg, orthopaedic surgeon and Medical and Scientific Affairs Director of Haleon for Southeast Asia and Taiwan, and Dr. Charles Villamin, an orthopaedic surgeon based in the Philippines, say that bone mass reaches its peak at age 30 and thereafter begins to decline.
“You know, physiologically, the bone mass peaks around 30. Around that age, that’s where you have the highest bone mass. After that, it’s all downhill,” says Garg.
‘You can’t restore it to the original condition. That’s why early prevention is very, very necessary,” she points out.
“It’s common among the aging population… women are protected by estrogen all throughout their lives and during menopause it drops down and this protective hormone reduces the bone density of these patients, which makes them susceptible to fragility fractures or bone fractures,” says Dr. orthopedic surgeon Charles Villamin, who teaches at the University of Santo Tomas and practices at St. Luke’s Medical Center.
“It’s a very common disease, a silent disease. But ultimately when the bone breaks, it’s catastrophic for the patient and also for the entire family due to financial burdens,” he points out.
If not addressed, the decline in bone health becomes pronounced at age 50, particularly for menopausal women, who are at risk of having osteoporosis and other musculoskeletal conditions such as knee pain and back pain.
According to the Philippine College of Endocrinology Diabetes and Metabolism (PCEDM), “fractures of the spine, hip, and wrist are the most common fractures associated with osteoporosis. Hip fracture is a major cause of morbidity and occurs more frequently among the older age group. It is a source of disability, leading to loss of independence, and a major economic burden.”
“Besides fracture, which is the most serious complication of osteoporosis, it can also limit your mobility and cause instability during daily activities….Loss of mobility results in loss of independence and leads to a feeling of isolation and depression. Pain caused by fractures may be so severe that they become debilitating and decrease their quality of life,” adds PCEDM.
In the Philippines alone, osteoporosis carries an annual cost of USD647.7 million from healthcare, premature deaths, and productivity losses. According to a study of the International Osteoporosis Foundation,
l Less than half of hip fracture patients ever walk the same way again.
l Up to one in four die within a year of their fracture.
l Among survivors, 40% can’t walk unaided and 60% require daily help.
Calcium: Building block of bones
Villamin says studies show that 97 percent of Filipinos are calcium deficient because of their lifestyle and diet and many are lactose intolerant.
“Processed food is cheaper right now,” he says. “They’re consumed by more people both in urban and rural areas.”
In order to keep the bones sturdy after it reaches its growth peak and correct the calcium deficiency, the Osteoporosis Foundation prescribes five steps:
1. Exercise – Exercise regularly – keep your bones and muscles moving. Weight-bearing, muscle-strengthening and balance-training exercises are best.
2. Nutrition – Ensure your diet is rich in bone-healthy nutrients. Calcium, vitamin D and protein are the most important for bone health. Safe exposure to sunshine will help you get enough vitamin D.
3. Lifestyle – Avoid negative lifestyle habits. Maintain a healthy body weight, avoid smoking and excessive drinking.
4. Know your risk factors – Find out whether you have risk factors. Bring these to your doctor’s attention, especially if you’ve had a previous fracture, have a family history of osteoporosis, or take specific medications that affect bone health
5. Get Tested – Get treated if needed. If you’re at high risk you will likely need medication and lifestyle changes to help protect yourself against fractures.
Dr. Villamin further breaks the steps down, saying that the elderly should engage in low-impact exercises, like walking, swimming, yoga, zumba and ballroom dancing.
Weight training is also suggested because “muscles need weight, need pressure to be strong.”
“If you don’t use it, you will lose the strength of your muscles,” says Villamin.
“As for food, meat, eggs, dairy products and vegetables are a rich source of calcium,” he adds.
Dr. Garg, howeve,r offers a cautionary tale: “In today’s world, we want to stay indoors more in the air con, you know, or even if we go out, we put lots of sunscreen or cover ourselves with a cap or umbrella, we cover our skin.
“So we are not, you know, able to get that enough vitamin D, which is also very important for calcium absorption,” she adds.
“Then if your diet is not giving you enough of these nutrients, then you need to top up. And the top up has to be an external source, like a supplement like Caltrate, you know?”
Dr. Garg points out the need for more information about the right kind of food to be able to have the amount of calcium in one’s body.
Bone Density Measurement Tests
One effective method for early detection is through Bone Mineral Densitometry or Dual Energy X-ray Absorptiometry (DEXA) testing, a non-invasive method that measures bone density, says Dr. Villamin.
‘It’s mostly required when a woman reaches menopause age, and for older men.” he says. “If you have low body weight or poor nutrition, if you have a sedentary lifestyle, you have smoking habits, you are a heavy alcohol drinker, you have medications that would lower the density like steroids, you might want to have a bone mineral densitometry.”
And if the test shows that one has low bone density, then the central bone mineral density test could give a more accurate picture of the condition of one’s bones, says Dr. Villamin.
Improved detection of individuals at high risk of osteoporotic fractures is crucial to ensure that they receive the treatment they need to reduce this risk, according to a recent report by impact.economist.com.
The report, Health drives wealth: the economic impact of health inclusivity, points out that in 2019, only 29% of women at high risk of osteoporosis fractures were receiving treatment. Worse, even after an older person suffers a fracture, 80% are still not assessed or treated for osteoporosis, it added.
The study further states that “improving bone health through better access to osteoporosis detection and care to reduce osteoporosis-related fractures of the hip or spine…results in an annual economic benefit of US$31bn in healthcare savings and productivity gains.
