Childhood habits play a role in healthy bones

By Maria Endah Hulupi

JAKARTA (JP): An active life and adequate calcium intake since childhood helps build healthy bones and prevent osteoporosis later in life.

"Healthy bones require a life-long process which should be practiced since childhood," said Siti Annisa Nuhonni from the rehabilitation center at Cipto Mangunkusumo General Hospital.

She explained that adequate calcium intake from the early phase of bone growth, in this case childhood, increases bone mineral density (BMD) -- which means forming strong bone structure -- while an active life helps stimulate bone formation and at the same time reduce bone resorption.

"Parents need to encourage their children to play or just be active. Because walking or running are very good for bone growth," Nuhonni said at a seminar jointly held by New Zealand Milk and the Indonesian Osteoporosis Association (PEROSI).

Another speaker was Bambang Setiyohadi from the rheumatology unit at Cipto Mangunkusumo General Hospital who said that bone density normally decreases gradually as a person ages. However people with strong bones can delay and slow the process of having porous bones.

He explained that bones undergo constant formation and resorption of unwanted ones. Under normal conditions, osteoblast (a bone-forming cell) rebuild bones which have been corroded by osteoclast (a bone-destroying cell), so there is no deficit of bone density.

But in the case of osteoporosis, due to little physical activity and poor diet, osteoblast cannot cope with the activities of osteoclast, leading to a decrease in bone mass with decreased density and enlargement of bone spaces.

This process will lead to thinning bones, in some cases no thicker than a sheet of cloth so the bone fractures easily, especially when carrying heavy objects. Three parts that are prone to fracture are the vertebrae, radius and pelvis.

"There are no clear symptoms of osteoporosis. Usually the sufferer feels pain only after microfracture. Some indicators of people having osteoporosis are a loss of height or a dowager's hump due to multiple fracture of small bones in the vertebrae," he said.

People at high risks are smokers, alcoholics, people under prolonged immobilization due to illness, underweight people and those who are on a drastic weight loss program. Women are particularly prone to osteoporosis because they naturally have thin bones, while hormonal changes during menopause can aggravate the problem.

Bambang said the amount of estrogen, which helps control the activities of osteoclast, decreases significantly during menopause.

While with men, osteoporosis is more common in the 60s or 70s. However, a drop in testosterone, which also reduces libido, increases the risk too.

"People at high risk are advised to increase their calcium intake, especially women on hormone replacement therapy," Bambang said.

Daily calcium requirement is 1,300 milligrams daily for those between nine and 18 years old; 1,000 milligrams per day for ages 19 to 50; 1,500 milligrams for people over 51, pregnant women and lactating women.

Daily calcium intake should not exceed 2,500 milligrams. Excess calcium is discharged through sweat, urine and stools. But a daily intake of more than 2,500 milligrams leads to constipation, while more than 4,000 milligrams will affect renal function.

Dairy products and anchovies, a cheap and popular diet among Indonesians, are good sources of calcium. But adequate vitamin D also plays an important role in calcium absorption. Good sources of vitamin D are fish liver oil, egg yolk, milk and sunshine.

A high salt diet, caffeine, alcohol and smoking should be avoided because they hamper calcium absorption.

Simple physical exercise, such as stretching while at the office and walking or jogging in the morning for at least 45 minutes every day, stimulates the formation of bone mass in the vertebrae.

But Nuhonni said weight bearing exercises that focus on putting pressure on the vertebrae is the best way to prevent osteoporosis.

"That's why people in the villages have better posture and are less prone to osteoporosis because they walk to places and their daily activities, such as carrying loads on their heads or backs help train and strengthen their vertebrae," she said.

Nuhonni also stressed the importance of having the right posture, such as a straight back and bent knees when lifting objects from the floor, is not only healthier but also more comfortable.

While to reduce the possibility of fracturing a bone, external factors should be emphasized too. These include better lighting at home, furniture and fixtures arranged so that movement in and around the house is not hampered. Antislip mats in the bathroom and other wet areas as well as clean and dry floors will help reduce the possibility of bone fracture due to falls.