The 206 bones (or 208, depending on who's doing the counting) that form your skeleton serve you in a staggering number of ways. They give your body form and protect vital soft internal organs like your heart, lungs and brain. They are also known to play a role in regulating specific hormones and storing valuable minerals; and in their red marrow, the long bones produce essential red blood cells.
Despite all this, we tend to neglect our bones - to the great detriment of our health.
While tumours and osteonecrosis (bone death) are uncommon conditions, osteoarthritis and osteoporosis are on the rise in Sri Lanka. Trauma from accidents, associated with broken bones, is one of the leading causes of hospital admissions. By 2020, 20% of Sri Lankans will be over 60 years, putting them at risk for osteoarthritis and osteoporosis and 'fragility' fractures. "It is an epidemic in slow motion," warns Dr. Pradeep Fernando, Consultant Orthopaedic Surgeon. Here are some common bone-related ailments.
Osteoarthritis: Painful joints
The first symptom of osteoarthritis might simply be pain, says Dr. Fernando, explaining that this "mechanical" pain is brought on by exertion and relieved by rest. Stiffness in the joints is also common. It is one of the most common forms of arthritis and it causes pain, swelling and reduced motion in your joints. It can occur in any joint, but usually it affects weight- bearing joints such as your hips and knees. It can also affect the spine. Over time, the damage to the surface of the joint results in the surrounding bone growing thicker. Joints, already inflamed because of earlier damage, become increasingly painful and difficult to move. Hence, osteoarthritis is considered a degenerative disease.
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Osteoarthritis is associated with a breakdown in the cartilage in your joints. This slippery coating covers the ends of bones in joints, allowing for smooth movement and extension/contraction of limbs. Healthy cartilage also serves as a shock absorber, protecting the body against jarring movement. When you begin to lose cartilage or it thins out, it brings your bones into often agonising contact. Over time, as they continue to rub against each other extensive damage to the joint can occur.
Obesity, age and injuries can all place you at risk for osteoarthritis, says Dr. Fernando. Sri Lankans most commonly experience osteoarthritis in the knee, while studies in the west indicate that people there are most affected in the hip. For those in their 50s and 60s, knee replacement is a viable alternative, but for younger patients treatment is somewhat more complex.
Currently, knee replacements are expensive affairs with only a limited lifespan. Once a replacement has worn out in a young patient, redoing it is much more expensive, the process complex and the results are nowhere near as good, says Dr. Fernando. To reduce the pain, obese sufferers with osteoarthritis must lose weight. A doctor might also prescribe drugs that stimulate cartilage formation and slow down cartilage destruction.
Osteoarthritis will not prevent you from leading a normal life. A carefully chosen and monitored exercise regime, protection of joints and prevention of further injury along with maintenance of an ideal weight are all recommended.
Osteoporosis: Brittle bones
Osteoporosis often catches people by surprise and in fact most patients will not realize they have the condition until they come into a hospital with a fracture or broken bone. Osteoporosis is normally years in the making, as bones grow increasingly fragile and brittle. If not prevented or if left untreated, it can progress stealthily and painlessly until a bone breaks. Once again the hip and wrist are vulnerable points, as is the spine.
A hip fracture in particular can be serious, requiring hospitalization and major surgery. Patients might find it difficult to walk unassisted and the condition can even result in prolonged or permanent disability. Vertebral fractures in the spine as can also have serious consequences such intense back pain and deformity.
Osteoporosis is more common in women than in men and is most often seen in those over fifty. A bone mineral density test is the best way to check the condition of your bones. Preventing the disease is essentially about keeping your bones strong - a diet rich in calcium and Vitamin D and plenty of exercise are recommended.
The catch is that you can do most to buffer your bones against osteoporosis before you turn 25. After that, it is no longer a matter of adding bone mass, but trying to maintain it. This is no less crucial, however. Supplements and weight bearing exercises can reduce the drop off in bone density. Calcium deficiency can accelerate the drop off, and so pregnant women and breast feeding mothers must take particular care.
Broken bones
The single most common problem with regard to bones is trauma, says Dr. Fernando. Road accidents and the like have made trauma the highest cause of death for those under 45, he explains. Since we're talking about a productive age group, the cost to society is also high.
Setting breaks and fractures and then immobilising them is not always the best solution, says Dr. Fernando, explaining that operating and using metal devices to hold the bone together actually allows for quicker healing and greater mobility. All this is a moot point, of course, if the injury is neglected or misdiagnosed. If it is wrongly set, even a clean break might lead to chronic discomfort or even permanent disability.
In the end, your bones may be the toughest part of your body, but they need care and attention if they are to serve you well all your life. In times like these, this is the one investment you'll never regret making.
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