Osteoporosis makes your bones as fragile as dry twigs

By Frederick Womakuyu

AS she waited for a taxi to Mukono, Nancy Nabulo felt sharp pain in her left hip. The 40-year-old who had always been healthy suddenly could barely stand. When she visited a doctor, she learned that several of her vertebrae had fractured.

The radiologist studying her x-rays thought he was looking at the bones of a 70-year-old woman.

Nabulo faces a potentially crippling, even lethal affliction she had never thought about; osteoporosis or porous bones. Dr. John Tumusiime of Medecins Sans Frontiers, says more than 300 cases of osteoporosis have been reported in Uganda over the last five years and the majority of the victims do not seek medical help and resort to prescriptions of pain killers.

Although it strikes both sexes, women are most affected because of reduced estrogen production during early menopause. “Unfortunately, there are no early symptoms — the disease steals silently into victims’ lives until their bones are as fragile as dry twigs,” Tumusiime says. “Women of all ages remain ignorant of it,” says Dr. Peter Wasike of Arua Hospital.

“They may think of cancer and heart disease as threats and be unaware of the risk of osteoporosis, which is greater.”

He said according to cases reported in most hospitals, more than 90% of women failed to link osteoporosis with hip , vertebral and wrist fractures the disease causes each year.

Mary Wetaka, resident of Mbale, is proof of the bigger implications of osteoporosis. Now 77, Wetaka has had the disease since her early 50s.
She says recovering from recent heart surgery from South Africa was quicker and less painful than recovering from the spinal fractures.

“The heart surgery slowed me down, but a broken hip could put me in a wheel-chair or hospital,” she says. “My fear is that I will be trapped in a body that can no longer support me.”

Although there is no cure for osteoporosis, it is preventable and controllable. Experts say the following steps should be taken to prevent it:

Know the facts
The bone is naturally dynamic tissue, continually torn apart, and then rebuilt. During childhood and adolescence, bone builders form more new tissue than bone-eaters take away.

But after age 30, bone eaters begin to out-number bone builders and loss exceeds again.

“Your skeleton is like a bank account,” says Dr. Helen Namutebi of Nsambya Hospital. “You put in bone deposits during your first 30 years or so, and then you start to withdraw. The bigger your account, the more you have to draw on for the rest of your life.”

Personal factors also play a role in osteoporosis. Thin, small-framed women are more susceptible than their large sized counter parts.
Namutebi adds that smoking and excessive alcohol consumption are toxic to bone.

Smoking presents a double risk for women because it also lowers estrogen levels. Caffeine — two or more cups of coffee a day — has been shown to increase the chances of osteoporosis. In addition, the use of certain medications, such as corticosteroids, can reduce calcium absorption.

Eat calcium
A diet rich in vitamin D, helps the small intestines absorb calucium and is a vital element in preventing the disease.
Most doctors recommend that calcium comes from diet rather than supplements because calcium-rich foods provide other nutrients as well.

Low-fat or non fat milk, yoghurt, cheese and dark-green vegetables are good sources. Vitamin D is found in many dairy products and is also manufactured by skin exposed to a modest amount of sunlight 10 to 20 minutes a week.

Be active
Regular exercise helps prevent osteoporosis by stimulating bones to thicken. When muscles attached to it strain and contract, a bone responds by building denser tissue.

To increase bone mass, doctors recommend activities such as walking, running, tennis, dancing and low-impact aerobics.
“Exercise,” says Tumusiime, “may delay osteoporosis fractures by 10 or 15 years.”

Estrogen replacement therapy (ERT)
In the first five years after menopause, the average woman loses up to 5% a year of her total bone density, then about one percent a year after that. Since decreased estrogen is one cause, many doctors recommend ERT for preventing or treating osteoporosis.

Namutebi says: “ERT started at the time of menopause decreases the incidence of subsequent bone fractures by as much as 50%.” Even in women with established osteoporosis, ERT helps.

Get tested
Dual-Energy X-ray Absorptiometry (DEXA), is one of several methods for measuring bone density but only limited to a few hospitals like Mulago.

Carol Namatunga, a medical attendant at Aparland Clinic in Kampala, begun breaking bones in her early fifties. First it was a vertebra when she slipped walking home,a year later, she tripped while carrying saucepans in her home and broke an arm.

Six months later , she broke her hip. A DEXA test showed advanced osteoporosis.
Namatunga now knows she must avoid situations that may cause her to fall. She also pursues a regime of calcium and ERT.

Tumusiime says a break-through is coming. A recent study by scientists in the US, tracked down a gene that determines how well the body absorbs and uses calcium to create new bone tissue.

The gene encodes the vitamin D receptor so a childhood blood test may some day identify those who are short on receptors.

“Knowing which young people are at risk will let us deal with their intake of calcium and vitamin D, as well as the exercise they get,” says Namutebi.