How to avoid the brittle bone problem

Tantri Yuliandini, The Jakarta Post, Jakarta

"You're not in any danger yet, you're still young, but you should eat more calcium-enriched foods just to make sure," a nurse tells a woman in her late 20s after she had her bone density measured at a mall recently.

The young woman's T-score -- the comparison of her bone density with that of a young adult reference -- was minus two on the Ultrasound Bone Densimeter operated by pharmaceutical company PT Aventis Pharma, placing her in the osteopenic range, or having low bone density.

The World Health Organization has set the T-score as the criteria for diagnosing osteoporosis. In brief, a T-score of more than minus one is normal, between minus one and minus 2.5 is osteopenic and less than minus 2.5 is osteoporotic.

The densimeter measures T-score taken from the heel -- an important bone of the body, along with the spine and femur, that bears the body's weight and contains a high proportion of trabecular bone.

Osteoporosis is a disease in which bones become fragile and more likely to break. It is also a "silent disease", meaning that if left untreated it can progress painlessly until a bone breaks, typically in the hip, spine or wrist.

Bambang Setiyohadi of the Rheumatology Department at the Cipto Mangunkusumo General Hospital in Central Jakarta said complications that usually occur after a fracture could increase a person's risk of death.

"A 50-year-old woman's lifetime risk of dying from a hip fracture is equal to her risk of dying from breast cancer and greater than her risk of dying from endometrial cancer," he said.

A hip fracture almost always requires hospitalization and major surgery. It can impair a person's ability to walk unassisted and may cause prolonged or permanent disability. Spinal or vertebral fractures could cause loss of height, severe back pain and deformity.

Early detection of osteoporosis is therefore important, because although there is currently no cure steps can be taken to help prevent and/or treat the disease.

The Ultrasound Bone Densimeter is considered an effective tool for the early detection of osteoporotic fracture.

"But it is not absolute and a thorough check-up using a more reliable Dual Energy X-ray Absorptiometry (DEXA) is still needed to determine osteoporosis," James Hajadi, Aventis medical director, said recently.

However, unlike the more expensive DEXA scan, the Ultrasound Bone Densimeter is much cheaper and easier to operate. A person simply places her heel into the unit and after a minute a reading is printed out.

In the United States, osteoporosis is considered a major public health threat for some 44 million people, with women making up about 80 percent of cases, according to the National Osteoporosis Foundation on its website nof.org.

The prevalence of the disease in Indonesia, as is frequently the case, is relatively unknown.

In order to provide a preliminary overview of osteoporosis in Indonesia, Aventis, supported by German investment company Deutsche Investitions-und Entwicklungsgesellschaft (DEG), conducted Ultrasound Bone Densimeter screenings in Jakarta, Bandung, Semarang, Surabaya and Medan from January to September 2002.

The screenings were carried out on 101,161 people in places where people usually congregate, such as hospitals, malls, places of worship and exhibitions.

The results showed that out of the total number of people screened, some 35 percent were normal, 36 percent showed signs of osteopenia, while 29 percent suffered from osteoporosis, James said.

"The number of people suffering from osteoporosis greatly increases with age," he said.

He said that in the below 50 age range of the survey, osteoporosis occurred in only 14 percent of patients, while that figure rose to 28 percent in the 50 to 60 age range and 47 percent in the 60 to 70 age range.

Older people, especially women, are more likely to develop osteoporosis. Also more at risk of osteoporosis are those whose current bone mass is low, who are thin or have small frames, have a low lifetime calcium intake, an inactive lifestyle, smoke cigarettes, use alcohol excessively or have a family history of the disease.

Those who suffer from an estrogen deficiency as a result of menopause (especially early or surgically induced), abnormal menstrual periods or anorexia nervosa are also more at risk.

But bone is not a lifeless structure, it is a living tissue that can be healed and affected by diet and exercise. Until the age of about 30 the body builds and stores bone efficiently, then as part of the natural aging process the bone begins to break down faster than new bone can be developed.

Building strong bones during childhood and adolescence is the best defense against developing osteoporosis later in life. It is also important to eat a balanced diet rich in calcium and vitamin D, to perform regular weight-bearing exercises and to lead a healthy lifestyle with no smoking or excessive alcohol intake.

i-box:

Who should take a bone mineral density test?

The only sure way to determine bone density and fracture risk for osteoporosis is to have a bone mineral density (BMD) test. Your doctor can help you determine whether you should have a BMD test. A doctor may order a BMD test for: * all postmenopausal women under the age of 65 who have one or more additional risk factors for osteoporosis (in addition to being postmenopausal and female) * all women over the age of 65 regardless of additional risk factors * postmenopausal women who present with fractures (to confirm diagnosis and determine disease severity) * women who are considering therapy for osteoporosis if BMD testing would facilitate the decision * women who have been on hormone replacement therapy (HRT/ERT) for prolonged period

Source: The National Osteoporosis Foundation