By the time your 60th birthday rolls around, many of the critical decisions that will determine your state of health will have already been made. For instance, the strength of your bones. You can only add on critical bone mass up to the age of 25. The changes that occur in the body as part of the normal aging process leave the elderly particularly vulnerable to a number of orthopaedic problems. While your actual age, general wellbeing, levels of physical activity and medical history will determine much, careful management is also vital.

Studies estimate that by 2020 approximately 20% of Sri Lankans will be over 60 years, and susceptible to medical problems that cover the range from bowel cancer to heart disease. Orthopaedic issues will be particularly taxing. “We can expect around 16,000 hip fractures and a need for around 30,000 knee replacements a year,” estimates Consultant Orthopaedic Surgeon Dr. Pradeep Fernando.
Sri Lanka is already seeing more and more cases of osteoarthritis and osteoporosis, he adds, explaining that as a person ages they are more likely to injure themselves seriously in an accident as a result of osteoporosis related ‘fragility’ fractures. This month we speak to Dr. Fernando on some of the problems the elderly must cope with.

Stiffness and pain brought on by exercise are among the first symptoms of osteoarthritis, says Dr. Fernando. It’s one of the reasons the condition is sometimes referred to as ‘wear-and-tear’ arthritis. To understand why this happens you must first know a little bit about how your joints function. Cartilage at the end of the joints serves as a sort of lubricated surface, allowing for the joint to flex and bend without the rough ends grating on each other. Cartilage also serves as a shock absorber, bearing the brunt of jarring movements on the body. However, this coating can break down or thin out – leaving the bones exposed and causing damage to the joints.

Though the effect of the condition can be felt in any joint of the body, it most commonly affects the joints in your hands, neck, lower back, knees and hips. There is no cure, says Dr. Fernando, explaining that over time, the damage begins to have an accumulative effect on the joints, leading to the thickening of the bones. The already inflamed joint begins to become increasingly painful and difficult to move, earning the disease a spot on the list of degenerative conditions.

Obesity, age or an injury to the cartilage can leave you vulnerable to osteoarthritis, says Dr. Fernando. The condition also manifests in specific ways in different cultures – in countries like Sri Lanka, more patients develop osteoarthritis in the knee, while in America or the U.K, patients are more likely to struggle with damage to the hip.

Treatment in such cases is focused on slowing the relentless progress of the disease, relieving chronic pain and improving the function of the joints. For patients who are in their 50s and 60s, knee and hip replacements are both viable options.

They are not recommended for younger patients because despite the steep price tag, the replacements have a relatively limited lifespan. Once worn out, redoing the operation is more expensive, more complex and less effective, says Dr. Fernando. It is why patients, regardless of their age, are encouraged to lose weight. Depending on the severity of the problem, a doctor might also prescribe drugs that stimulate cartilage formation while slowing down cartilage destruction.

The good news is that you can still lead a normal life even if you have osteoarthritis. You need only be more aware and careful about avoiding further injury, while maintaining your ideal weight. Lifestyle changes should include a carefully planned exercise regime.

The other ‘osteo’ (derived from ‘osteon’, Greek for bones) is osteoporosis, a condition marked by brittle bones. For many patients, the first time they realise they have the problem is when they’re in hospital being treated for a fracture or a broken bone. This is because the condition has been steadily, quietly worsening, as a patient’s bones become increasingly brittle and fragile.

When unnoticed and left untreated, the progress can lead to the point where bones break at the slightest injury, says Dr. Fernando, adding that once more the hip and wrist are vulnerable points, as is the spine.
While a wrist fracture is extremely debilitating, making it hard for patients to go about their daily lives, a hip fracture is more serious, often requiring hospitalization and major surgery.

The recovery process can be demanding, robbing patients of independence as they often find it difficult to walk unassisted. For many, this results in prolonged or permanent disability. Vertebral fractures in the spine are perhaps the most serious. Intense and chronic back pain, and in some cases deformity, can result from an injury to these bones.

When it comes to treating the problem, it’s not always ideal to simply set the bones in a cast and then immobilise them, says Dr. Fernando, explaining that metal devices that hold the bone together but still allow for some activity might actually accelerate the healing process and improve mobility in the long run. It is critical of course that a patient’s condition is accurately diagnosed and that osteoarthritis and osteoporosis are identified.

Women, particularly over the age of fifty, are more vulnerable to osteoporosis. Young women up to 18 years of age should aim for 1,300 mg of calcium daily while women under the age of 50 need a little less – at least 1,000 mg per day. Post-menopausal women closing in on 60, however, need up to 1,200 mg a day.
A bone density test is the best way to check how your bones are faring. Remember, osteoporosis in particular can be prevented.

Supplements and weight bearing exercises can reduce the drop off in bone density. Calcium deficiency can worsen the condition significantly, so pregnant women and breastfeeding mothers must take particular care.

Keep those bones strong

1. Get the calcium you need:

Your bones need calcium and while a supplement is a good idea, Dr. Fernando recommends you try to get as much as you can through a diet rich in calcium. Good natural sources include dairy products such as milk, cheese and yoghurt and certain leafy greens. Canned fish with their soft bones will work for non-vegetarians and tofu for vegetarians.

2. Add enough Vitamin D 

Your body needs Vitamin D to absorb calcium from the food you eat. The ‘sunshine vitamin’ is produced by your body when exposed to sunlight – not a problem here in Sri Lanka. Once again, fish and eggs are a good source.

3. Make smart lifestyle choices

It’s important to remember that even aside from calcium and Vitamin D, a good diet is essential to maintaining good bone health. Other nutrients like Vitamin K, Vitamin C, magnesium, zinc and protein help build strong bones, too.

4. Do weight bearing exercises

When you run, dance, lift weights, climb stairs or even simply go for a walk, your skeletal system must go to work – and that’s good for it. Being active can help slow down bone loss even as it improves your strength and balance, reducing the likelihood of accidental injury.

5. Quit smoking and drink only moderately:

It is established by now that smoking lowers the amount of oestrogen in your body and since that hormone helps slow bone loss it is a critical ally in fighting osteoporosis. Limit yourself to no more than one alcoholic drink a day – more can interfere with your body’s ability to use the calcium you eat.

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