Strong bones

By DR MILTON LUM

Eat right to maintain healthy bones.

Keeping healthy with a positive lifestyle has a significant impact on health. As bone mass peaks in our 30s, the higher the bone mineral density (BMD) attained at this time, the less likely is the risk of osteoporotic fractures. So we should try to get as high a BMD as we possibly can in the first three decades of our lives.

Many women have no hesitation about taking a healthy diet when pregnant but may not do so after the baby is born. They can do themselves a lot of good if they continue taking a healthy diet, whether pregnant or not.

Lifestyle changes will lower their risk of health problems as they get older. The perimenopause is a good time to pay more attention to health if one has not been doing so.

It is essential to remember that prevention is better than treatment – it is easier to prevent loss of bone density than to restore it once it is lost.

Healthy diet

A balanced diet high in grains, fruits and vegetables, with adequate water, vitamins and minerals but low in fat contributes to good bone health. The intake of sweet and fatty food should be limited. Fat intake should be less than 30% of daily calorie requirement.

Women at the perimenopause and beyond should pay attention to their diet as cardiovascular disease and osteoporosis are affected by diet.

There is a positive relationship between calcium consumption and bone mass at all ages. When calcium intake is consistently high in childhood and adolescence, bone mass achieved in the 30s would be higher. An increased calcium intake enhances the effects of other treatments like vitamin D and hormone therapy.

The recommended daily consumption of elemental calcium varies at different ages. It is important that these levels be achieved so that there is maximum impact on bone health. The recommended intakes are:

* Infant – 300mg in breast-fed and 400mg in bottle-fed

* Children – 500mg (one to three years), 600mg (four to six) and 700mg (seven to 10)

* Adolescents (10 to 18) – 1,000mg

* Adults – 800mg (up to 49) and 1,000mg (above 50)

* Pregnant and during breast- feeding – 1,000mg.

Calcium is found in leafy green vegetables, calcium-rich dairy products, tofu, dhal, mussels, ikan bilis, sardine, baked beans, and calcium-fortified foods and juices. If this is insufficient, calcium supplements (calcium carbonate, citrate, calcium lactate and calcium gluconate) may be used.

Calcium absorption is increased by vitamin D, which can be found with 15 minutes or more of daily exposure to the sun and in fortified foods like milk, tuna and liver or vitamin D supplements. If one does not go outdoors, is immobile or has a deficient diet, a daily intake of 800IU of vitamin D supplement is necessary. This is particularly relevant to women, as a recent study found that 49% of postmenopausal Malaysian women were vitamin D-deficient. An adequate intake of protein and energy is important particularly in children and senior citizens.

Exercise

Physical inactivity is a risk factor for many conditions. Exercise can help one lose weight and protects against cardiovascular disease and prevents osteoporosis as it maximises peak bone mass, decreases age-related bone loss as well as maintains muscle strength and balance.

If one is not used to strenuous activity, it would be prudent to check with the doctor before commencing an exercise programme, especially if one is above 40 years or overweight.

In a good workout, one needs to exercise at the target heart rate for at least 30 minutes three times a week. The doctor will be able to provide advice on the target heart rate, which is dependent on age.

If there is difficulty in fitting exercise into one’s schedule, there are things that can be done to be more active, such as walking (rather than driving) and taking the stairs (instead of the lift).

Excessive dieting and a low body weight (body mass index less than 19kg per sqm) are associated with low bone mass and increased risk of fracture. Weight gain is not due to menopause. As one ages, metabolism slows so that the body takes a longer time to burn up the food taken. This means that taking the same amount of food like what one did when younger would increase the weight.

It would be best not to exceed the weight for one’s height. If one has to lose weight, discuss the matter with the doctor and dietitian. A healthy rate of weight loss is 0.5 to 1kg per week. Do not go on crash diets.

Alcohol exerts a greater impact on women than men as their bodies contain less water to dilute the alcohol and the enzyme that digests alcohol is less in women. Alcohol interferes with calcium absorption and bone growth. A drink or two a day may be all right. Larger amounts have been associated with many health problems.

Preventing falls

It is important to eliminate factors in the environment that can result in falls, thereby reducing the risk of fractures. Various conditions can increase the chances of falling. They include poor eyesight and/or balance, decreased muscle strength, excessive alcohol intake, diseases of the nervous system, muscles and the skeleton, certain medicines like anti-hypertensives, sedatives, and home conditions like slippery floors, steps and poor lighting. In general, falls can be avoided by regular exercise, reducing alcohol intake, avoiding sedatives and correcting eyesight problems.

There is ample evidence that hip protectors reduce the risk of hip fractures due to falls. To avoid falls indoors, keep rooms free of clutter, keep floors smooth but not slippery, install grab bars and use a rubber bath mat in the tub or shower. To avoid falls outdoors, wear rubber-soled shoes, avoid walking on slippery surfaces and use a walker or cane for added stability.

Hormone therapy, bisphosphonates and other medicines have proven effective in the prevention of osteoporosis. A healthy lifestyle and regular clinical examinations are important in maintaining health. Routine examinations can detect problems early and give the patient and doctor an opportunity to discuss ways to avoid problems later in life.

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.