How To Have Healthy Bones

As I said before, I am simply exploring how to be healthy and I want to start with our bones. By exploring I mean that I shall be looking at the views and opinions of the experts and I shall also include the experiences and stories of people who have issues with their bones.
This section deals with the most important element of our body - the framework that holds the muscles, flesh and vital organs together. So it is of paramount importance that we have optimum bone health.

When we discuss exercise most individuals immediately think of losing fat and toning or gaining muscle. It is true that with regular exercise you will lose inches and gain strength in muscles but the importance of exercise on a regular basis really offers many more important health benefits then being able to fit into your skinny jeans or being able to flex an impressive looking bicep.

Another extremely important benefit from exercise which is often over looked until problems begin to occur is bone health. Most individuals do not give their bones much thought until they or a loved one is face with the reality of failing bones which can be detrimental because it will ultimately lead to immobility.

All of us reached our maximum bone mass in our twenties and if prevention is not a focus it is down hill from that point on. The important thing to remember is it is never to late to start.

Although there has been a focus on women's bone health in recent years with the discussion of osteoporosis men are not immune to the adverse affects of bone loss. Women are prone to increased bone loss or osteoporosis during and after menopause caused by the loss of estrogen; at the same time men as they age will also experience increased bone loss associated with the loss of testosterone. Although women in general are more prone to bone disorders such as osteoporosis men are by no means off the hook.

With that being said most bone loss actually occurs from disuse atrophy. Bone tissue is the same as any other tissue in the body; if you do not use it you will lose it. Your body does not waste energy maintaining something that is deemed important or necessary such as muscle or bone that is not worked. It is also important to recognize that the loss of muscle directly affects the health of your bones.

Maintaining lean muscle mass is essential to keeping our bones healthy because this lean muscle puts good stress on our bones that in turn causes them to strengthen or in other words signals the body that our bones are important and need to be maintained. The best way to do this is to incorporate resistance training into your life two or three times a week.

Weight training does fall into the resistance training category however if lifting weights does not appeal to you there are many different options that can be done inside or outside of your home. Resistance training includes any activity that works and strengthens your muscles which in turn put the much needed stress on your bones. The possibilities are endless your workout can include any of the following: Pilates, using resistance bands, using the now popular exercise ball, yoga or simply using your own body weight. Try doing a lunge or yoga pose; when you do you will see that you do not need a fancy gym or tons of equipment to get a workout. The important thing is to find an activity or activities that you enjoy, embrace it and make it a part of your life.

Other important steps that you need to take in order to ensure you have healthy bones are; quit smoking, avoid excess drinking and ensure you are getting adequate amounts of calcium, vitamin D and vitamin K2 in your diet. You are not getting your daily requirements of the necessary mineral and vitamins then take supplements.

Healthy bones are not always our top priority but by making a few changes to our lifestyle we can help assure we will not only live longer but can enjoy independence and mobility far into our twilight years.


Saturday, December 12, 2009

Brittle Bones






The Doctor Says
By Dr MILTON LUM
Methods to diagnose low bone density are available. So don’t wait till you get a fracture to know that you are suffering from osteoporosis.

MOST people with osteoporosis have no symptoms initially because the loss of bone density is gradual. Some people never have symptoms. As the bone density continues to decrease, it leads to a fracture or gradually develops into a bony ache and deformities.
The fractures are usually at the ends of long bones and in the middle or lower spine. If several spinal bones fracture, an abnormal curvature of the spine (dowager’s hump) may result, causing muscle pain and deformity. There may also be loss of height. The long bones may fracture after a minor fall or strain. Hip fractures are a major cause of disability and independence in senior citizens. Wrist fractures are not uncommon in post-menopausal women. In addition, fractures take a longer time to heal in people who have osteoporosis.
It is not uncommon for osteoporosis to be diagnosed after a fracture has occurred. The doctor will take a history; carry out a physical examination and institute laboratory and imaging investigations. A diagnosis of primary osteoporosis is made after excluding secondary causes of bone loss.
Fractures take a longer time to heal in people who have osteoporosis.
When there is a low trauma fracture, the presumptive diagnosis is osteoporosis. The objectives of investigations are to confirm the diagnosis, assess fracture risk and to exclude secondary causes of osteoporosis.
The laboratory investigations are done to establish baselines or to exclude secondary causes of osteoporosis. They include a full blood count; serum calcium, phosphate, albumin, alkaline phosphatase; and renal function tests.
Other laboratory tests include hormone assays such as: thyroid function, sex hormones; serum protein electrophoresis; urinary proteins; bone marrow biopsy, if indicated.
Biochemical markers of bone turnover are not used in diagnosis but they are useful in monitoring treatment response.
A plain x-ray is not the best way to assess bone density. Osteoporosis is only apparent in a plain x-ray after more than 30% bone loss has occurred. However, x-rays may be taken of the affected area in patients with symptoms; in asymptomatic patients with a suspected vertebral fracture; height loss without other symptoms, or those who have pain in the spine.
Bone mineral density (BMD) provides an accurate measurement of bone mass. BMD measurements are usually considered in: women above 65 years and men above 70 years; presence of risk factors like oestrogen deficiency; prolonged absence of periods; family history of hip fracture, low body mass index, anorexia nervosa, prolonged immobilisation, hyperthyroidism, hyperparathyroidism, malabsorption and steroid therapy; x-ray evidence of osteopenia and/or spinal deformity; previous low trauma fractures of the hip, spine and/or wrist; height loss; and abnormal spinal curvature.
There are different methods of measuring bone density: dual energy x-ray absorptiometry, single energy x-ray absorptiometry, quantitative computed tomography and quantitative ultrasound.
The dual energy x-ray absorptiometry (DEXA) machine sends a thin beam of x-rays through the bones through two energy streams. There are two distinct energy peaks: one is absorbed mainly by soft tissue and the other by bone. The soft tissue amount is subtracted from the total with the remainder being a person’s BMD. All DEXA machines have software computing the data and displaying them on a monitor. The amount of radiation used is less than 10% of a routine chest x-ray.
The DEXA test, which is painless, takes about 10 to 30 minutes, depending on the equipment used and the parts of the body examined. There is usually focus on the spine and hip because these are the sites where most osteoporosis related fractures occur.
The DEXA results are in the form of two scores: the T score is the bone density expressed in standard deviations from the mean in healthy young adults of the same gender, while the Z score reflects the individual’s bone density compared to other people in the same age group of the same size and gender.
DEXA is currently the most accurate diagnostic method. It provides an accurate estimate of fracture risk. It cannot tell whether one will have a fracture but it will give the likelihood of getting a fracture. If the reading is low, one should not worry, but, instead set oneself a plan to improve the bone density.
Single energy x-ray absorptiometry (SXA) is used to measure the BMD of the radius bone in the forearm and the calcaneum in the foot. A single x-ray beam and a water bath to simulate a uniform soft tissue thickness are used to measure BMD. Its predictive value for spinal and hip fractures is less than that of DEXA. It is useful for identifying those who are at very low fracture risk and require no further assessment.
Quantitative computed tomography (QCT) is based on the differential absorption of ionising radiation by calcified tissue. It is an alternative technique used to measure the BMD of the spine, and can be used in adults and children. It is the only technique that can distinguish between cortical and cancellous bone. Its limited availability, relatively higher radiation dose, high cost and possible interference by osteophytes restrict its use.
Quantitative ultrasound (QUS) measures the speed of sound and broad band ultrasonic attenuation of an ultrasound beam passed in between two transducers. The role of QUS in diagnosis and treatment monitoring is currently not well defined, due to the diverse techniques, limited standardisation and comparable normal values. However, it is a low cost portable screening tool.
QUS may be used to predict future osteoporotic fractures in perimenopausal and immediate postmenopausal women, and senior citizens. Those with low QUS values for the ankle bone (calcaneum) are referred for BMD measurements of the spine.
When a person receives treatment for osteoporosis, the response is monitored by methods that include regular clinical assessments, DEXA of the spine every one to two years and two separate baseline measurements of biochemical markers e.g. osteocalcin, bone specific alkaline phosphatase and a repeat measurement two to three months after treatment was started, and yearly thereafter.
Dr Milton Lum is a member of the board of Medical Defence Malaysia. This article is not intended to replace, dictate or define evaluation by a qualified doctor. The views expressed do not represent that of any organisation the writer is associated with.
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