Is a healthy lifestyle the prescription for osteoporosis?

Is a healthy lifestyle the prescription for osteoporosis?

It has been estimated that more than 200 million people are suffering from osteoporosis worldwide. According to the International Osteoporosis Foundation, worldwide, 1 in 3 women over 50 years and 1 in 5 men of the same age will experience osteoporotic fractures in their lifetime. In India, around 36 million people are currently living with osteoporosis, majorly undiagnosed until the person has a fracture. Every fracture is a sign of another impending one.

We’ve come a long way in the we treat osteoporosis. As recently as 1970, there were hardly any therapy options available for osteoporosis. A few physicians were recommending estrogen to their female patients, but even then, there was no real consensus on what dosage was suitable for individual patients. In 50 years, our understanding has grown by leaps and bounds in how to treat this condition. However, there is one pillar of osteoporosis management that is still being overlooked and must be addressed sooner than later. That is, the preventive approach to osteoporosis.

Advancements in diagnosis and treatment
Today, we have both a macroscopic and a microscopic understanding of how bone remodelling takes place over a person’s lifespan and the factors that influence it, for better or for worse. Dual energy x-ray absorptiometry and an interpretation of those numbers have revolutionized skeletal imaging and how we diagnose osteoporosis. Bisphosphonates, parathyroid hormone, selective estrogen receptor modulators, menopausal hormone therapy, calcitonin, monoclonal antibodies and other drugs now offer us physicians the opportunity to tailor treatment for our patients, depending on their degree of bone loss, age, gender, overall health and even their personal preference for a specific drug format over another. However, as we all know, none of these drugs completely cure osteoporosis and all come with their own side effects.

Challenges faced in treatment and patient dropout
Moreover, there is a common challenge that we all face and that is poor patient adherence to therapy. This has been well documented in academic publications as well, with one study reporting that up to 30% of patients suspend their osteoporosis treatment within a year, while another study put the number even higher at about 40%. Yet another study has demonstrated that the longer the time after initiation of treatment, the higher the percentage of those having discontinued treatment. There could be many reasons for this – the occurrence of adverse events, the fear of adverse events, or in some cases, the inability to realize how serious this condition can become. So, no matter how good treatment may have become, patients still do not take their medication, and for those patients, the 50 years of revolutionary drug discovery in osteoporosis has absolutely no significant value.

Inclusion of preventive approach in treatment
This is why I really believe that we need to expand our vision when it comes to managing osteoporosis to also include the preventive approach. Instead of focussing only on preventing fractures once a person has developed osteoporosis, we need to put far greater emphasis on how adults can minimize bone loss in the first place. No one is suggesting that bone loss can be stopped altogether. However, we need to lay greater stress on the value of a good diet and the right exercise to minimize bone loss. Diet needs to be sufficient in essential bone nutrients like calcium, vitamin D and magnesium. People also need to realize the importance of weight-bearing and resistance training exercise such as walking, trekking, skipping rope and working out with resistance bands. In fact, the National Osteoporosis Foundation’s Clinician’s Guide to Prevention and Treatment of Osteoporosis “strongly endorses lifelong physical activity at all ages, both for osteoporosis prevention and overall health”. I also believe that exercises that enhance balance are just as important for people of all ages.

For many other conditions such as diabetes and cardiovascular disease, we are seeing a shift in the conversation and the rise of ‘health advocates’, from doctors to fitness bloggers to even gym instructors, talking about the need to prevent a medical condition by living a healthy life. The pillars – a healthy diet and regular exercise – are equally beneficial to prevent osteoporosis. I believe it is time for us to start to tilt the osteoporosis narrative in favour of the preventive approach.

[“source=economictimes”]

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