As a national survey on osteoporosis gets underway, experts stress the need for awareness programmes
In the claws of a silent bone-eater
By Esther Williams
Osteoporosis can sneak up on you. The silent disease is dangerous as there are no warning signs or symptoms. A fracture in the hip, spine or forearm resulting from a sudden strain or a simple fall is often the first indication that you have osteoporosis. But by then, it may be too late for effective treatment.

Contrary to common belief, osteoporosis is not inevitable with age. "It is a preventable disease and not a condition of ageing," said Sri Jayawardenepura University's Senior Lecturer Dr. Udul Hewage.

He was addressing a gathering at the launch of the National Osteoporosis Survey by the Ruhuna Medical Faculty's Centre for Metabolic Bone Diseases.

Osteoporosis is a bone disease that results in its softening, eventually increasing the risk of fractures caused by the fragile state of the bones. Around the world, osteoporosis has increased mortality, morbidity, the health care burden to society and the risk of complications.

Small-scale studies carried out in Sri Lanka show a high prevalence of osteoporosis among postmenopausal women. While it has been established that low calcium intake, low body weight, lack of exercise, smoking and excessive intake of alcohol or caffeine can lead to osteoporosis, backache, changed curvature of spine, hunched appearance and reduction in height are considered non-specific symptoms. It has to be noted that absence of proof is not absence of disease. Needless to say, the condition should be diagnosed early for it to be prevented and treated effectively.

It is worth noting that bone mineral is acquired only until a person reaches the age of 30 and not after that. A rapid decline is seen in bone density after 50. It is, therefore, important to build one’s calcium reserves before one reaches 30.

The National Osteoporosis Survey has been launched to determine the prevalence of the disease in Sri Lanka. It has been established that osteoporosis is a disease affecting older men and women, an age group that is expected to grow in future in this country.

Ruhuna University’s senior lecturer Dr. Sarath Lekamwasam, who is heading the project, said the survey, the first of its kind, would help them obtain data on age related changes in bone density; age at which bone density reaches its height; how bone mineral density (BMD) changes with age; proportion of people with low BMD; association of age, weight, age of menopause, smoking and alcohol with BMD and association of milk consumption with BMD.

The first phase of the research will target a 5000-sample base representing different demographic and geographic strata. Research together with analysis of the findings is expected to take 9-12 months.

In the next few months, a mobile clinic manned by well-trained personnel will visit earmarked areas to collect data. A bone-scanning machine (AccuDXA system) will be used for the BMD tests. The equipment is not available in most hospitals in the country.

The process is fairly simple as demonstrated during the launch of the survey on October 7. A person's middle finger of their non-dominant hand is placed in the slot of a machine. Fingers are easy to measure, as they are rich in trabecular bone, which is the most affected by osteoporosis. Within a few minutes a report is produced showing levels of calcium in the area being measured.

In addition, those being tested are required to fill in a questionnaire stating details pertaining to their age, menstruation, children, physical activity, milk intake, etc. Those found with low levels of calcium will be provided with referral letters to their GPs and contact numbers for further treatment. They will also be advised on lifestyle modifications. The entire process would take less than 20 minutes. Announcements will be made to keep people informed of the tests being done in their localities.

Identifying age, female gender, sedentary lifestyle, diet and steroid therapy as risk factors and outlining measures to prevent osteoporosis, Professor Devaka Fernando of the Sri Jayawardenepura University said the government, food industry and media had to play an important role in preventing the disease through awareness and other programmes.

Considering the rate of mortality and the health burden it represents, the government should make osteoporosis a priority in health policy, set recommendations for calorie intake, educate children in schools and provide incentives to health-food industries and fitness institutions, he said.

Prof. Fernando feels that the food industry should act in a more socially responsible manner and the media be more vigilant for hard evidence on medical issues before presenting information to the public.

New Zealand Milk Lanka Limited (NZML), the marketers of Anlene, is sponsoring the survey, as part of their corporate social responsibility commitment. Speaking at the launch, an NZML official said their studies had revealed a high prevalence of osteoporosis and low levels of awareness in the country. "It is our key responsibility to educate the public and support the study to tackle the disease," he said.

What is a BMD test?
The only way to determine your bone health and fracture risk for osteoporosis is to have a bone mineral density test (BMD). A BMD is a safe painless test that measures the amount of mineral or density/thickness in a specific area of bone.

The more mineral (calcium) you have, the greater your bone density or bone mass is. BMD testing is more sensitive than normal X-rays, its accuracy reported to be quite high - ranging from 85% to 99%.

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