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Osteoporosis
Osteoporosis, or brittle bone
disease, can begin as early as nine years old (HealthWorld, p.1). Commonly
viewed as a menopausal disease, research now shows that it, in fact, affects men
just as much as women (Smith, p.1). This silent disease reminds us that like
everything else, one’s health can often benefit from mindful living and a
healthier way of eating.
According to the International
Osteoporosis Foundation, every 30 seconds, someone in Europe has a fracture as a
result of osteoporosis. In the U.S., 28 million people are affected by 300,000
hip fractures and 500,000 spinal fractures annually due to osteoporosis
(Swnyecz, p.1). Although the occurrences are mainly in Europe and North America,
projections warn of a three-fold increase worldwide from 1.7 million in 1990 to
6.3 million by 2050 (WHO p.1, 2). In India, for example, where metabolic bone
disorders were relatively unknown, the past two decades have born witness to
hyperparathyroidism becoming the most prevalent non-communicable disease
(Zargar, p.1).
The Glandular System and
Hyperparathyroidism
The normal parathyroid hormone release maintains calcium levels. However, in
hyperparathyroidism, excessive release removes calcium from bones - causing
osteoporosis. The human skeleton consists of two types of bone:
1-
cortical
– the strong outer shell representing 75% of bone mass and
2-
trabecular – spongy, but supporting
the cortical bone representing 25% of the bone mass.
The trabecular is the site of bone
building and the site where osteoporosis emanates from (Swnyecz, p.1). Bone
builds-up density during childhood and teenage years releasing calcium deposits
in equal amounts in early adulthood. In a person’s mid-thirties, more calcium
deposits are released than stored and this process accelerates when estrogen
production decreases at menopause (Fitz-Patrick, p.1). With a weakened skeletal
system, stress fractures can occur during normal activity - like in the feet
whilst walking. Repeated fractures can cause chronic pain, loss of height or a
humped-back (Focus, p.1, 2). Some fractures can even go undetected for years.
Men start at a higher bone density
and lose calcium at a slower rate than women, however, it is unknown what
constitutes normal estrogen levels in men. It was the Canadian Multi-Center
Osteoporosis Study (CaMOS) who found spinal fractures to be equal for both men
and women. The study involved 10,000 Canadians randomly selected. There were
interviewed and received Bone Mineral Density (BMD) scans and x-rays.
Their progress was followed for five years. Jonathan Adachi, a rheumatologist
and a director of CaMOS commented, “We used to think this was a disease of
women. In men, we just weren’t looking” (Smith p.1).
Dr. Nikolai Khaltaev, head of the
World Health Organization (WHO) Osteoporosis Program states, “Early detection
is the key. With BMD it is easy to identify those at risk and to suggest
preventative course of action. We know that BMD declines quite sharply with age
in women but we also know what should be done by way of prevention” (WHO,
p.1). Diagnosis involves going under a dual energy x-ray absorptiometry (DEXA)
and a CT bone density test, which calculates BMD (Swnyecz, p.2). The Lebanese
Osteoporosis Society and the Lebanese Red Cross launched a nationwide BMD
screening program in Lebanon. Four small foot ultrasound densitometers were used
in the preliminary tests of 2000 people and one large DEXA to carry-out complete
diagnosis on 1333 individuals (Osteofound, p.1, 2).
The ‘DEXA’ Machine in Beirut
Scientists now know that
osteoporosis is widespread across all ages and sexes. Doctors now know, as well,
that parathyroisism is one cause. However, there are many other causes of
osteoporosis - including many that are unknown.
One cause of osteoporosis is
prescription or over-the-counter drugs. It was in 1932 that Harvey Cushing made
the connection between osteoporosis and the overproduction of natural cortisol
from the adrenal glands. In 1954, Curtiss described a compression of the spine
in four male patients who were given cortisone. Bisphosphonate is actually used
in the treatment of osteoporosis as it increases BMD and reduces fractures
because it binds strongly to calcium. However, bisphosphonates behave like a
category of steroids known as glucorticoids – which induce osteoporosis,
causing excessive bone reabsorption. Oral bisphosphonates, in addition, causes
esophagitis, gastritis and diarrhea in some people (Greenspan, p. 1-3). The
consequences are reflected elsewhere.
In the case of asthmatics,
bronchodilators contain low doses of corticosteroids - though with minimal
affect for light sufferers. In the case of debilitating asthma, long-term
corticosteroid therapy actually increases the risk of osteoporosis whilst the
recent dry-powder formulas could cause higher systemic corticosteroid levels.
Corticosteroids prevent bone formation and biopsies have revealed unfilled
reabsorption cavities, reduced osteoid, thinned trabeculae and a decreased
production of new bone. This is in fact despite adequate vitamin D levels.
Long-term use (three months) of corticosteroidss therefore results in vertebral
and rib fractures, multiple fractures in the chest wall and decreased bone
density at the hips and the forearms (Niewoehner, p.1 –4).
Another cause of osteoporosis is
thyroxin therapy. In a study of 19 women who suffered from thyroid gland
carcinoma, their histories revealed that they had received total thyroidectomy
and thyroxin suppressive therapy over a period of less than six to nine years.
Their BMD was tested over four years. The study revealed that women who begin a
long-term thyroxin therapy in their premenopausal period were likely to develop
low-density bone mass by the beginning of their menopause (Sijanovic, p.1). Some
treatments for prostrate cancer also increase the risk of osteoporosis.
Prostrate cancer patients who had taken the hormone therapy – leuprolide –
incurred bone loss (Zamora p.1).
Earlier treatments had focused on increasing bone quantity, but now the focus is
on reducing the rate of bone turnover by decreasing bone reabsorption, quality
and risk of fractures (Swnyecz, p.3). Apart from the Food and Drug
Administration (FDA) approved drugs bisphosphonates, raloxifene and calcitonin,
Hormone Replacement Therapy (HRT) is also recommended to increase bone
mass (Medscape, p.7). HRT Testosterone therapy was shown to increase BMD in the
lumbar spine by 5% over 12 months in a study that involved astmatic men with
hypergonadism (Niewoehner, p.6).
Comprehensive prevention of osteoporosis, however, is multi-layered. Dr. Ibrahim
Syed highlights the role of taraweeh prayers
because of the repeated isometric and isotonic gentle exercises in Ramadan. Our
blood glucose levels are high after breaking fast, and the length and repeated
movements of taraweeh utilizes the circulating glucose which is
metabolized in carbon dioxide and water using up the high levels of blood
glucose and plasma insulin. The repeated movements also strengthen the muscles,
tendons, increases joint flexibility, BMD and the cardio-vascular system is
improved. This increases the flow of blood and nutrition (Syed, p.1 –5). WHO
also recommends physical activity as well as time outdoors, a balanced diet and
a daily intake of 80 – 1500mg of calcium daily for both children and adults
(WHO p.2). Sun exposure produces vitamin D in the body, which increases
absorption of calcium. As one rises at the end of one rakat of prayer or
bends down into sujud (prostration) one is bearing ones weight upon ones
upper and lower limbs. A study found that menopausal women who did weight
bearing exercise (walking, dancing, climbing and hiking) for 22 months
experienced a 6.1% increase in bone density on the lumbar spine.
Calcium containing foods include
sesame seeds (tahina and zata’ar bread), cheese, broccoli, milk, yogurt, green
leafy vegetables and firm tofu. However, milk products must be fresh (the same
way the Prophet Mohammad drank them) to provide the full benefit of the calcium.
Long life milk, or milk products that have been sitting at the grocers for
longer than a few days have little benefit. Calcium supplements are also an
option for some women. However, women with a history of kidney disease should
seek advice from their doctors first before taking calcium supplements
(Fitz-Patrick, p.2).
In addition, people taking calcium
should also make sure they get enough vitamin D to provide for proper absorption
of the calcium. Without vitamin D, calcium is often of little benefit. Vitamin D
can be found in fortified milk, egg yolks, liver and saltwater fish oil.
However, although supplemental calcium and vitamin D can counter the affects of
corticosteroids, they cannot eliminate these steroids (Niewoeher p.6).
Once a person decides to be
mindful of their calcium intake, they must also make sure they do not eat or do
anything to deplete the calcium in their system as well. One should avoid
antacids as they can inhibit absorption of calcium supplements (Swnyecz, p.4).
Those with osteoporosis should also avoid forward bending and excess twisting of
the spine has this could result in a compression fracture. Extension exercises
are recommended (Swnyecz, p.3).
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