Lack of healthy atmosphere in the community is also contributing to increase in osteoporosis-Prof.Umar Farooque

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World Osteoporosis Day symposium at DIMC

Lack of healthy atmosphere in the community
is also contributing to increase in
osteoporosis - Prof.Umar Farooque
Pathophysiology, risk factors, prevention & treatment
of osteoporosis discussed by various speakers

KARACHI: Osteoporosis occurs after certain age in both men and women though women are affected the most but lack of healthy atmosphere in the society is also contributing to increase in the prevalence of osteoporosis. This was stated by Prof. Umar Farooque Pro-Vice Chancellor of Dow University of Health Sciences. He was speaking at a meeting organized by the Department of Orthopaedics at Dow International Medical College, DUHS at its Ojha Campus on October 23rd 2013 to commemorate the World Osteoporosis Day.
He further stated that we must give importance to prevention as certain diseases can be prevented by creating public awareness and osteoporosis is one of them. Provision of better service to the community is a part of the mission of DUHS and in future we should organize such meetings in the community so that the message is conveyed to them directly. Every effort, Prof. Umar Farooque said, should be made to educate the people to consume healthy balanced diet, improve their life style, do regular exercise and ensure that they expose themselves to sunlight. Is it not surprising that though we have so much sunshine but still over 80-90% of our people are deficient in Vitamin D.? We have become a lazy nation. We do not want to walk any more but at the same time walking is also not possible due to security concerns and we also do not have enough parks. We need to look into all these issues and by ensuring healthy diet, proper nutrition, proper exposure to sunlight and regular exercise, we can reduce the prevalence of osteoporosis to a great extent, he added.

Prof. Masroor Ahmad Principal DIMC presenting a memento to Prof. Umar Farooque
Pro VC DUHS who was the chief guest at the symposium on osteoporosis organized
on October 23, 2013 at DUHS Ojha Campus. Also seen in the centre is
Prof. Mujahid Humail Head of the Department of Orthopaedics at DIMC.

Earlier Prof. Mujahid Humail Head of the Dept. of Orthopaedics at DIMC in his presentation on pathophysiology and risk factors of osteoporosis said that besides providing structural support, bones perform many important functions like providing strength to the body, blood cell formation and they also contribute 10% in cardiac output. He discussed in detail the normal bone metabolism, bone formation and resorption and pointed out that bone health is related to nutritional, physical activity, genetics as well as hormones. It helps to maintain healthy skeleton. Whenever the equilibrium between bone formation and resorption is disturbed, destruction of bone leads to osteoporosis. Women lose bone at an accelerated rate in first ten years after menopause 2-5% per year. When holes in bones become bigger, it makes them fragile and osteoporosis takes place. There are no symptoms till fracture takes place. Most fractures occur in hip, spine and wrist and almost 80% of women suffer from osteoporosis. It is said that one in four women and one in eight men will develop osteoporosis after the age of fifty years. Osteoporosis continues to rise in elderly population. It is also reported that more women die of osteoporotic fractures than from breast cancer and ovarian cancer combined. It is also reported that in men osteoporosis is under diagnosed, under reported, unrecognized and inadequately researched.
Speaking about the risk factors, Prof. Mujahid Humail mentioned lack of calcium, vitamin D deficiency, lack of physical activity, early surgical menopause, Low Body Weight, past menopause, smoking, over use of certain medications besides primary hyperthyroidism. Use of alcohol, smoking, low BMI, poor nutrition, repeated falls and insufficient exercises are some of the risk factors which can be prevented and modified but one cannot do anything with other risk factors like age, gender, genetics, rheumatoid arthritis etc. Almost 90-95% of patients go home after surgery without bone density test. We did a study in Karachi comparing children of well to do families and poor families which showed that children in the higher socioeconomic set up had low BMD because they use lot of junk food as compared to poor children who do lot of exercise and get normal food. He emphasized that we must ensure good bone mass early in childhood to prevent osteoporosis from developing later in life.

A view of the Walk organized on World Osteoporosis Day at DIMC-DUHS Ojha Campus on World Osteoporosis Day.

Prof. Masroor Ahmad Prof. of Medicine and Principal DIMC talked about how to approach a patient with osteoporosis. Defining osteoporosis Prof. Masroor Ahmad said that it is low bone mass and micro-structural deterioration of bone tissue with consequent increase in bone fragility and susceptibility to fracture. It is relatively easy to diagnose and treat. Disease may be more serious than osteoporosis itself. Fragility is seen more in vertebra, ribs, hip and wrist. There is increased mortality from hip and vertebral fractures.
While managing these patients one must ask whether this patient is suffering from osteoporosis? What is the cause and what is the risk of fracture. Take careful history and do proper clinical examination. Do conventional radiology. If need be then go for DXA scan, CT scan, qualitative ultrasound which are the other investigations. Take history of medication, delayed bone healing, life style, immobility, pain, loss of height, history of fragile fracture etc. Routine radiology can detect osteoporosis with minimum 30% loss of bone mass. DXA is the gold standard for diagnosis and it can predict the risk of fracture. It can also be used for monitoring response to treatment. Its radiation is just 10% but even then do not do it in pregnant women. T. Score of 2.5 or less is considered osteoporosis but remember this test also has got some limitations. There are primary and secondary types of osteoporosis. All women over sixty five years of age should have BMD test and early if they have some risk factors. Milk and sunshine is essential to prevent it. Speaking about relative risk for fracture, Prof. Masroor said that fracture risk doubles with every SD decrease in BMD.
Prof. Shakil Baig from Baqai University of Medical Sciences talked about prevention and treatment of osteoporosis based on evidence based guidelines. He pointed out that in order to reduce the risk factors, stop the medications if it is the cause of osteoporosis. Stop smoking, fall prevention, physical activity and exercise besides ensuring optimal nutrition like supplements of calcium and vitamin D. Yogurt and milk has enough calcium and vitamin D. Ensure regular use of milk besides thirty minutes exposure to sunlight daily will be extremely useful. Thin lean people should increase their weight to avoid the risk of fractures. Among the drugs, he mentioned use of biphosphonates, calcitonins, estrogen agonist/antagonists, anabolic therapies, rankle inhibitors. Be careful of osteonecrosis of the jaw while using biphosphonates. Raloxifene is also quite safe and effective in osteoporosis. One must also ensure compliance to drugs and ask the patients to have an annual assessment, he added.
Prof. Rumina Tabassum Prof. of Obstetrics and Gynaecology at DIMC discussed menopause and osteoporosis. Surgical menopause occurs when ovaries are removed during hysterectomy. Menopause age is about fifty one years but in Asia it may be even less. She was of the view that ovaries should be conserved if possible for hormonal functions. Premature menopause occurs before the age of forty five years; its frequency is reported to be 1% in women less than forty years. She opined that post menopause women with risk factors should go for screening. To prevent osteoporosis she suggested regular exercise, calcium and Vitamin D supplements, use of vegetables and fruits, use of proteins and Vitamin A.
Prof. Mujahid Humail in his introductory remarks welcomed the speakers and the participants. He also thanked all those who helped in the organization of this symposium. In the end, Prof. Umar Farooque presented mementoes among the speakers and the organizers from the Dept. of Orthopaedics which included Dr. Asif and Dr. Kamran Hafeez as well.
The symposium was preceded by a walk while free consultation and Bone Mineral Density Test facilities were also made available for patients after the symposium.