Why young Mumbaikars are rushing to ortho clinics?Why are Mumbaikars as young as 30 queueingup at ortho clinics with joint pain?

क्या है युवाओं को अपनी गिरिफ्त में लेने वाला ऑस्टियोपीनिया ?

शहरी जीवन की महामारी है यह रोग। अस्थि रोगों के माहिर अब इसे जीवन शैली रोग कहने लगे हैं। अस्थियों का चूना और सीमेंट हैं विटामिन -D और केल्शियम खनिज। उम्र के तीसरे दशक तक पहुँचने पर अस्थियों का घनत्व अधिकतम हो जाता है बा -शर्ते आपकी जीवन शैली ठीकठाक रहे। लेकिन भ्रष्ट जीवन शैली के चलते २० की उम्र तक ही इन दोनों ज़रूरी तत्वों की कमी बेशी होने लगती है। 

उठने बैठने का गलत तरीका ,पुअर पोस्चर्स ,दैनिकी में कसरत का अभाव ,बंद कमरों में सिमटी दैनिकी ,समय की तंगी के चलते बिना वार्म अप हुए हाई इम्पेक्ट एक्सरसाइज़ करना ,फेशन फैड बनता अतिरिक्त धूम्र और मद्यपान ,केफीन युक्त पेयों का सुड़कते चले जाना ,कोला- कॉफी -कल्चर ,गलत अस्वास्थ्यकर खानपान (पुअर ईटिंग हेबिट्स ),दवाब ग्रस्त दैनिकी ,हारमोन असंतुलन उम्र से पहले अस्थियों और पेशियों की कमज़ोरी की वजह बन रहा है।

नतीज़ा क्या  है ऑस्टियोपीनिया (अस्थि घनत्व की  उस उम्र में कमीबेशी जिसमें  इसे अधिकतम होना चाहिए था ). ? 

चालीस मिनिट धूप  में बिताइए।  केफीन युक्त पेय केल्शियम की ज़ज्बी  को दुष्कर बनाते हैं। केशियम उलटा शरीर से बाहर जाने लगता है। लीचिंग होने लगती है इस बोन मिनरल की। 

आउट डोर गतिविधि खेल कूद ,टहलकदमी ,तैराकी ,तेज़कदमी (जॉगिंग )जो भी कर सकतें हैं ज़रूर करें। खानपान दुरुस्त करें वही दूध दही घी ,छाछ (बटर मिल्क ) भात साग ,गहरे रंग वाली पत्तेदार सब्ज़ियाँ शामिल कीजिए खुराक में। बोन मिनरल को दुरुस्त कीजिये। चूना -सीमेंट है तो दीवार सलामत है।  

Why young Mumbaikars are rushing to ortho clinics
 Why are Mumbaikars as young as 30 queueingup at ortho clinics with joint pain?

Make hay while the sun shines carries a literal meaning for Bandra entrepreneur Preet Motwani. She gets out every morning at 8.15 am to soak in an hour of bright sunlight. It wasn't like this nine months ago. The 35-year-old was fighting time to get her eight-year-old ready for school before heading to her interiors store in Andheri.


But a sever stomach infection she contracted in January, that she overcame with a light,nutritious diet and medication, left her weak, irritable and lethargic. "I was experiencing excruciating pain and spasms in my neck, which travelled down my shoulders and spine," says Motwani. This lasted a month before she decided to visit a doctor who suggested she get her Vitamin D3 and B12 levels tested. While her B12 reserves were sufficient, Motwani's Vitamin D level stood at 12.20 ng/ml, way below the normal range of 30 to 100 ng/ml). "The deficiency was responsible for the pain that was a result of weakened bones," she says. Other than the mandatory hour of sunshine, Vitamin D supplements and physiotherapy have seen her through the year.

Age dropping
Mumbai's orthopaedics and physiotherapists have reported a rise in the cases of poor bone healthcompounded by muscle weakness, as in Motwani's case. Orthopaedic surgeon and head of orthopaedics at Seth G S Medical College and KEM Hospital, Dr Pradeep Bhosale, says the situation has worsened in the last five years. "Most female patients also complain of pain in the heels, irritability and short temper," says the doctor, who sees four such cases a week. Across the city in Bandra, physiotherapist Dr Poonam Bajaj treats 30 odd patients a day, teaching them exercises that will rid them of joint and muscle pain. Medically, they use the term osteopenia or the lack of bone density mineral to describe such cases. It's a step before osteoporosis, a condition that refers to the degeneration of bones. The thinning of bones due to ageing is a natural process. Most adults reach their peak bone mass density (BMD) at 30, after which there is a gradual bone mass loss that kicks in. In fact, by middle age, the body reabsorbs existing bone cells faster than new bone cells are made, resulting in minerals, mass, and structure loss, leaving bones weaker. Brittle bones are more susceptible to fractures.

Doctors say, owing to a poor lifestyle most people don't end up reaching their peak BMD at 30. This is why they are noticing more cases of weak bones in patients in their 20s because they haven't built their reserves.

Lack of Vitamin D is the biggest culprit, with orthopaedics calling it India's 'urban epidemic'. Dr Ameet Pispati, consulting orthopaedic surgeon at Jaslok and Bhatia Hospitals, explains, "The bone has a trabecular network. Think of it as a honeycomb. Its main source of constitution are Vitamin D and calcium. They are the lime and cement of the bone's building structure." If a person is deficient in either of these, the network's foundations are affected, leaving him more prone to pain and fracture.



What's wrong? 
Doctors are not ruling out poor posture, sedentary lifestyle, and high impact workouts without warming up as factors, too. Likewise, lack of exercise, high stress, excessive smoking and drinking, a poor diet, an overdose of caffeine and colas (they increase calcium excretion and reduce absorption) and hormonal imbalances are contributors, too.

Women are especially vulnerable since they have a lower peak BMD to begin with. Besides, loss of bone mass tends to speed up as hormonal changes kick in with menopause.

Dr Fixit
The easiest and cheapest remedy, experts will tell you, is to expose yourself to morning sunlight for 40 minutes every day. Playing tennis, jogging, dancing and climbing stairs together with the right diet (see box) helps slow down bone loss. "It easier to prevent bone weakness than treat it. Once bones are weakened, it is a longterm uphill battle," says Dr Pispati.

Feed your bones
Where to get your calcium from 
Dietician and fitness expert Sheela Tanna suggests dairy products (milk, ghee, yoghurt and cheese). Go for eggs, dark green leafy vegetables and soyabean.

Replace the junk food
High sugar and fat intake leads to bone weakening. Since fast foods are deficient in calcium, Vitamin C and zinc, all necessary for bone maintenance. Instead of snacking on chips and farsan, eat fruits like orange, guava and sweet lime, rich Vitamin C. Have khakra and bread or rotis made from whole grains.

WHAT IS OSTEOPENIA

Osteopenia refers to bone mineral density (BMD) that is lower than normal peak BMD but not low enough to be classified asosteoporosis. Bone mineral density is a measurement of the level of minerals in the bones, which shows how dense and strong they are. If your BMD is low compared to normal peak BMD, you are said to have osteopenia. Having osteopenia means there is a greater risk that, as time passes, you may develop BMD that is very low compared to normal, known as osteoporosis.

What causes osteopenia?

Bones naturally become thinner as people grow older because, beginning in middle age, existing bone cells are reabsorbed by the body faster than new bone is made. As this occurs, the bones lose minerals, heaviness (mass), and structure, making them weaker and increasing their risk of breaking. All people begin losing bone mass after they reach peak BMD at about 30 years of age. The thicker your bones are at about age 30, the longer it takes to develop osteopenia or osteoporosis.

Some people who have osteopenia may not have bone loss. They may just naturally have a lower bone density. Osteopenia may also be the result of a wide variety of other conditions,disease processes, or treatments. Women are far more likely to develop osteopenia and osteoporosis than men. This is because women have a lower peak BMD and because the loss of bone mass speeds up as hormonal changes take place at the time of menopause. In both men and women, the following things can contribute to osteopenia:

• Eating disorders or metabolism problems that do not allow the body to take in and use enough vitamins and minerals
• Chemotherapy, or medicines such as steroids used to treat a number of conditions, including asthma
• Exposure to radiation

Having a family history of osteoporosis, being thin, being white or Asian, getting limited physical activity, smoking, regularly drinking cola drinks, and drinking excessive amounts of alcohol also increase the risk of osteopenia and, eventually, osteoporosis.

What are the symptoms?

Osteopenia has no symptoms. You notice no pain or change as the bone becomes thinner, although the risk of breaking a bone increases as the bone becomes less dense.

How is osteopenia diagnosed?

Osteopenia is diagnosed with a bone mineral density (BMD) test, usually done to see whether you have osteoporosis. The most accurate test of BMD is dual-energy X-ray absorptiometry (DEXA), although there are other methods. DEXA is a form of X-ray that can detect as little as 2% of bone loss per year. A standard X-ray is not useful in diagnosing osteopenia, because it is not sensitive enough to detect small amounts of bone loss or minor changes in bone density. See the topic Osteoporosis for more information on BMD testing.

The United States Preventive Services Task Force (USPSTF) recommends that all women age 65 and older routinely have a bone mineral density test to screen for osteoporosis. If you are at increased risk for fractures caused by osteoporosis, routine screening should begin sooner.1 USPSTF recommends that you and your doctor check your fracture risk using a tool such as FRAX to help decide whether you should be screened for osteoporosis. Talk to your doctor about your risk factors and when to start bone mineral density screening.

The FRAX tool was developed by the World Health Organization to help predict your risk of having a fracture related to osteoporosis in the next 10 years. You can use this tool. Go to the website at www.sheffield.ac.uk/FRAX, and click on Calculation Tool. If you have had a bone mineral density test (BMD) on your hip, you can type in your score. If you have not had that test, you can leave the score blank.

Things that increase risk include:

• Being white (Caucasian) or, to a lesser degree, being Asian.
• A family history of osteoporosis.
• Being thin.
• Long-term use of corticosteroids, such as prednisone or hydrocortisone for inflammatory conditions, or anticonvulsants, such as carbamazepine (Tegretol), phenytoin (Dilantin), or gabapentin (Neurontin) for pain or seizures.
• Eating disorders or diseases that affect the absorption of nutrients from food.
• Being inactive or bedridden for a long period of time.
• Smoking.
• Drinking excessive amounts of alcohol.
• Having a diet low in calcium or vitamin D.

Experts suggest that older men talk to their doctors about osteoporosis and, if they are at risk, have bone mineral density tests done.2 Many men don't think they are at risk for osteopenia or osteoporosis, since these are commonly considered to be conditions of older women. Because men have a higher peak bone mineral density than women at middle age, osteopenia and osteoporosis tend to happen at an older age in men. But aside from the hormonal change in women as they go through menopause, the things that put people at risk for osteopenia are true for men as well as for women. Men are also at risk if they have low levels of the hormone testosterone. Talk with your doctor if any risk factors apply to you.

How is it treated?

How is it treated?

Osteopenia is treated by taking steps to keep it from progressing to osteoporosis and, for a few people, by taking medicine. Lifestyle changes can help reduce the bone loss that leads to osteopenia and osteoporosis.

What you eat is very important to bone development. Calcium is the most critical mineral for bone mass. Your best sources of calcium are milk and other dairy products, green vegetables, and calcium-enriched products.

Your doctor may also want you to take a calcium supplement, often combined with vitamin D. Vitamin D helps your body absorb calcium and other minerals. It is found in eggs, salmon, sardines, swordfish, and some fish oils. It is added to milk and can be taken in calcium and vitamin supplements. In addition to what you take in from food, your body makes vitamin D in response to sunlight.

Exercise is important for having strong bones, because bone forms in response to stress. Weight-bearing exercises such as walking, hiking, and dancing are all good choices. Adding exercise with light weights or elastic bands can help the bones in the upper body. Talk to your doctor or a physical therapist about starting an exercise program.

In addition to diet and exercise, quitting smoking and avoiding excessive use of alcohol and cola will also reduce your risk of bone loss

There are medicines for treating bone thinning. But these are more commonly used if you have progressed past osteopenia to the more serious condition of osteoporosis. Medicines that may be used for osteopenia include bisphosphonates, raloxifene, and hormone replacement. For more information on these medicines, see the topic Osteoporosis.

How can osteopenia be prevented?

Whether you will tend to develop osteopenia is, in part, already determined. Things like whether you have any family members who have had osteoporosis or osteopenia, whether you have chronic asthma that requires you to take steroids, and how much calcium and vitamin D you got while you were growing up are beyond your control now. But if you are a young adult or if you are raising children, there are things you can do to help develop strong bones and help slow down osteopenia and prevent osteoporosis.

Your bones don't reach their greatest density until you are about 30 years old, so for children and people younger than 30, anything that helps increase bone density will have long-term benefits. To maximize bone density, make sure you get plenty of calcium and vitamin D through your diet and by spending a little time in the sun, get weight-bearing exercise on a regular basis, don't smoke, and avoid cola and excessive alcohol. If you have children, teach them to eat healthy, get regular exercise, and avoid smoking and alcohol. Also, get them to play a little in the sunshine to help their bodies make more vitamin D. Talk with your doctor about how much and what sources of vitamin D are right for your child.

If you're older than 30, it's still not too late to make these lifestyle changes. A balanced diet and regular exercise will help slow the loss of bone density, delay osteopenia, and delay or prevent osteoporosis.