Osteoporosis, the silent disease.

Osteoporosis, the silent disease.

Osteoporosis is considered the most widespread disease of the skeletal system and represents one of the most serious and urgent public health emergencies of the XXI century. It has been defined as a "silent disease" because it progresses for several years before any symptoms become apparent. For these reasons preventive measures need to be put in place that protect bone tissue and to ensure skeletal strength.

Oedipus and the Sphinx

Posture is the mirror of man. Even the myth of Oedipus and the Sphinx agrees. According to the tale, the Sphinx denied access to the city of Thebes. Whoever wished to go that way would have to solve a riddle, otherwise the person would be eaten or thrown off the cliff. The question was always the same: "What animal walks on 4 legs in the morning, 2 legs in the afternoon and 3 legs at night?" Oedipus answered correctly that it is Man, because as a child he walks on all fours, as a young man and as an adult he walks on two legs, as an old man he walks with a stick. The ancient Greek wisdom effectively captures the common thread that unites the parable of life, referring to the progressive evolution of posture that changes from the stable quadruped of the newborn, to the unstable biped of an adult, to the insecure and curved posture of the elderly. These three ages of Man correspond to the ceaseless struggle between the phenomena of formation and destruction of bone tissue, with the prevalence of bone mass production in the first stage of life dominated by growth, followed by a balance between synthesis and resorption during adult life and the prevalence of destruction in old age.

Osteoporosis and menopause

The prevalence of the loss of bone mass undergoes a significant acceleration in women after the menopause, as there is no longer the protective role of oestrogen on the skeleton, while in men it gradually evolves, more regularly with age. You can slowly see a reduction in the height of the vertebrae that results in a decreased stature, associated with a progressive curving of the back. The constant reduction of bone mass makes the bone tissue more fragile against mechanical stress and continuous micro-traumas that the skeletal system is subjected to, making it more predisposed to fractures even in the event of trivial traumas.

Although phenomena such as the reduction in stature, a curved back, back pain and fractures are more clearly visible after the age of 65, bone resorption occurs mainly in the first years after menopause, when there is no longer the protective effect of oestrogen against bone resorption. The spine, femur, wrist and ribs are the parts most exposed to the risk of osteoporotic fractures that occur due to trivial traumas with serious consequences.

Preventive measures

To prevent the potential consequences of osteoporosis, drugs and nutritional supplements recommended by your doctor are certainly important, but you must also change your behaviour, as described below.

  • Let your doctor know of any suspicious signs of osteoporosis and particularly of a significant reduction in stature, the accentuation of a curved posture, back pain that worsens during the day due to the progressive load on increasingly fragile bones but which improves with rest.
  • During the menopause, measure bone mass with the MOC test and assess bone loss with specific medical tests, in order to detect possible bone loss and take preventive measures.
  • Constantly follow an exercise routine on a daily basis, such as walking at a brisk pace, as the main way to maintain skeletal strength in people of all ages, especially when bone mass is reduced.
  • Limit prolonged periods of immobilisation as much as possible, as they facilitate the resorption of calcium from the bones.  For the same reason, the prolonged use of a brace should be reserved for the most critical conditions, to prevent losing muscle tone and making osteoporosis worse.
  • Physical activity does not necessarily need to be intense physical exercise but it needs to be done on a regular basis. It is proven, in fact, that when an exercise programme is followed in a discontinuous manner, all of its positive benefits are slowly lost.
  • People diagnosed with osteoporosis should particularly avoid posture, exercises or activities that involve bending and torsion of the spine. The bending and torsion movements of the spine produce a high stress load, especially when lifting weights or handling loads with the risk of causing fractures of the dorsal and lumbar vertebrae.
  • Vitamin D, which is formed in the skin due to the action of ultraviolet rays of sunlight (UV-B), is essential for the absorption of calcium in the intestine and for proper bone mineralisation. People with minimal exposure to the sun, menopausal women and the elderly are often vitamin D deficient, so taking a nutritional supplement is often recommended.
  • Remove possible obstacles along the usual routes inside and outside the home. Provide and add accessories, especially in the bathroom, to ensure support and to prevent falls.
  • People with osteoporosis should avoid climbing on chairs, stools or unstable ladders, without the presence of another person, in order to prevent falls.
  • Make sure that the home is well lit to avoid obstacles. In particular, do not get up during the night without switching on the light.
  • Use glasses as prescribed by your doctor and have regular eye tests, especially if your vision has worsened.
  • Wear shoes or slippers with rubber soles and closed heels to walk comfortably and safely.
  • Do not overuse sleeping pills and anti-anxiety drugs in order not to compromise alertness and reactivity, in the event of a loss of balance.

 

By Bruno Brigo, doctor, specialised in Internal Medicine and Rehabilitation, author of several books on Integrative Medicine.

02/24/2014
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