Calcium intake, exercise help reduce risk of osteoporosis

Maria Endah Hulupi, The Jakarta Post, Jakarta

While strolling along the dairy aisle at supermarkets, people will easily spot high-calcium milk for adults to prevent osteoporosis. You may ask why more people are so concerned of late about osteoporosis. Everybody will eventually get older, and naturally, the bones will become weaker.

It is true, but one would do well to listen to the experts' opinions prior to the World Osteoporosis Day which will fall on Oct. 20.

"Osteoporosis is a common problem for middle-aged people but it is better to prevent it from an early age," said Johanna Rumawas, a nutritionist from the University of Indonesia, in a recent seminar jointly held by the Indonesian Osteoporosis Association (PEROSI) and New Zealand Milk, producer of the high calcium milk Anlene.

People with strong bones can reduce the thinning process of natural bones as they get older but those with thinner bones are more prone to fracture due to falls or the carrying of heavy objects.

Taking an adequate amount of calcium from calcium-rich sources -- particularly dairy products, tofu and anchovies -- since the early phase of growth is important for strong bones and high bone mineral density (BMD).

Vitamin D -- available in egg yolk, saltwater fish, liver and sunshine -- is also needed for the body to absorb calcium.

So far, there is no available data on the number of Indonesians suffering from this silent illness. However, doctors believe the figure is relatively high as the average calcium intake among Indonesians is only 254 milligrams per day. Compare that figure to the international recommended intake at 1000 milligrams for adults and 1500 milligrams for pregnant and post menopausal women, and the difference is astounding!

Rumawas said people with low calcium diets needed to fulfill the daily requirement by taking calcium supplements.

Other sources said it is important to ensure adequate intake of calcium for healthy teeth, proper function of the heart, muscles and nerves. Otherwise, the body will extract the mineral from bones.

A balanced diet alone is not enough and must be assisted with an active lifestyle or at least 30 minutes of daily exercise to help stimulate bone formation and also reduce the bone resorption process, said a rheumatologist from the Cipto Mangunkusumo General Hospital (RSCM) Bambang Setiyohadi.

Human bone, Bambang explained, is a dynamic organ that undergoes constant formation. This process is carried out by bone-forming cells osteoblast, which rebuild the bones corroded by the bone-eating cell osteoclast.

Due to poor calcium intake and inactive lifestyles, the bone forming process can not cope with the activities of osteoclast and in turn leads to decreased bone density and enlargement of bone spaces, making them susceptible to fracture.

And as osteoporosis has no outward symptoms, a person will only suffer pain after microfractures occur.

Bambang identified bones that are prone to fracture include the wrists, hip and spine. The latter can become unnaturally curved, also known as Dowager's Hump.

People at high risk of osteoporosis are Caucasians, people with small figures, smokers, alcoholics, people under prolonged immobilization due to illness, underweight people, those who are on a drastic weight loss program, people taking steroids (and other medications, including for epilepsy) and women.

Bambang explained that women are particularly prone to osteoporosis because they naturally have thin bones, while a significant decrease in estrogen during menopause can aggravate the problem. However, it can be controlled by hormone replacement therapy.

"Estrogen helps control the activities of osteoclast," he explained, adding that rapid resorption process continues 10 years after menopause.

As for men, a drop in testosterone levels also increases their risk as the hormone also helps control the activities of osteoclast.

The best exercises for strong bones are walking, jogging and aerobics (including dancing) as they stimulate bone formation.

It is also important to avoid alcohol, reduce coffee intake and high salt food as these items have roles in affecting the bone formation, hampering the calcium absorption or encouraging calcium excretion from the body.

RSCM rehabilitation center's Siti Annisa Nuhonni warned that prevention must be prioritized.

She explained that people with normal bones needed to prevent osteoporosis, those with osteoporosis needed to be extra careful to prevent bone fracture due to falling or other accidents, while those with fractured bones needed to prevent crippling effects due to prolonged immobilization.

"It can be aggravated by psychological problems because at this stage, the elderlies, weakened by bone fractures, may feel that they are nothing but a burden for the other family members," she said.

Nuhonni also stressed the importance of maintaining proper posture by standing and sitting straight and by bending knees when carrying objects from the floor because it was not only more comfortable, but such a position was also less stressful to bones.

As for fall prevention, it is advisable to rearrange things that may hamper movement, such as cables, toys and rugs, to make sure that all rooms are well illuminated, to install hand rails, to put anti-slip mats in the bathroom and other wet areas, to keep floors clean and dry.