BUPA GLOBAL

Moans, groans and brittle bones

Osteoporosis - "porous bones" - and osteoarthritis are emerging as two of the biggest chronic disease threats today, writes our Medical Director.

Within the last century we have seen astounding increases in life expectancy. At the start of the 20th century, the average person’s lifespan was just 31 years. In the 21st century, this has doubled and the average person is now expected to live 65.6 years. In many Western countries, such as Japan and Australia, this average is considerably higher and people are now living well into their 80s. Much of this is down to better living conditions and advances in healthcare. But with chronic diseases like osteoarthritis and osteoporosis on the rise have we become a victim of our own success?

The natural ageing process means that we will all experience a decline in our health as we approach our twilight years. The heart will weaken and be unable to support strenuous activity; short-term memory, reaction times, hearing and sight will reduce gradually; bones will weaken, muscle mass will decline and joints will wear. But thanks to medical science, this process has been dramatically slowed and, in some cases, even cheated – the conditions that once killed us are no longer necessarily harbingers of doom.

This reality has, however, forced a new trend to emerge – chronic conditions that once only affected the few who lived into their 60s and 70s are now affecting larger and larger proportions of the population. Essentially, a series of ticking time bombs have been dropped all around us that will have enormous health, social and economic implications on us globally. Two of the biggest chronic disease threats are osteoarthritis and osteoporosis.

Back to the bones of it

Osteoporosis literally means "porous bones". It is a condition where bones lose density causing them to become weak and more likely to fracture (break). Worldwide about one in three women and one in five men over 50 will fracture a bone because of osteoporosis, according to the International Osteoporosis Foundation.

Osteoarthritis is a common type of arthritis. It is a degenerative disease that causes cartilage on the ends of bones to become rough and thin. The bones rub against each other and thicken, leading to pain and stiffness. Osteoarthritis is one of the most disabling conditions– the World Health Organisation has estimated that 10 to 20 percent of people over the age of 60 have the condition. Of those, eight out of 10 have limited movement, and almost three in 10 are so encumbered by the condition that they are unable to go about their everyday activities.

Because of the natural ageing process, bones thinning and joints becoming worn, your chance of developing these conditions gets more likely as you get older. There is no real definitive ‘cure’ for either condition, and the mainstay of treatment is in taking medications to strengthen bones or reduce pain. Surgery for osteoarthritis is the final option, and hip and knee replacements have come along apace in the last decade, such that having a joint replacement has become the routine rather than the exception.

So what is the cost?

Hips are the most commonly broken bones as a result of osteoporosis. In older people this always requires hospitalisation. Of those affected, two out of 10 people will die, five out of 10 will be permanently disabled, and only three in 10 will make a full recovery, according to the WHO. In 1990, 1.7 million hip fractures occurred worldwide. By 2050, when it is estimated that one in five people will be over the age of 60, it is thought that six million hips will be fractured every year.

The impact of osteoporosis and osteoarthritis to healthcare services around the world has been compared to many other major chronic diseases. In the US, the costs associated with osteoporosis-related fractures are equal to those of asthma or cardiovascular disease. It has been reported (PDF - 54kb) that osteoporosis results in more days spent in hospital beds than strokes, heart attacks or breast cancer.

Such disability has wider implications on society and the economy as a whole. Social and community care becomes an issue. Families can give some support, but professional care is often also needed. It is well recognised that the affected individual may have difficultly adjusting to a limiting way of life and the impact on morbidity is compounded by mental health issues, such as stress, anxiety and depression. It is inevitable that an ageing workforce that is less mobile and prone to periods of prolonged sickness will be less productive and therefore an economic burden rather than stimulant.

Diffusing the ticking time bomb

Global agencies, such as the WHO, have produced recommendations focussing on prevention to slow the prevalence of osteoarthritis and osteoporosis. Several government and lobbying groups in Australia and Canada have gone a step further by developing strategies to deal with the situation.

These are the seedlings that may come together to form a comprehensive, global approach that combines awareness raising and prevention advice, as well as screening to catch conditions early, investment in new treatments and the implementation of falls prevention strategies for the elderly at home and in care settings.

Your call to action

As with most things in life, prevention is better than management or cure. With conditions like osteoarthritis and osteoporosis, the sooner you start doing something about it, the better off you will be. And this is not something you should only be thinking about as an adult, there are things you can do to help your children develop strong bones through positive lifestyle choices.

Several factors increase your risk of osteoarthritis and osteoporosis. Some of these cannot be changed, such as age, gender or family history. However, most risk factors, such as being overweight, following an unhealthy diet, or smoking or drinking too much, can be modified or controlled with simple lifestyle changes.

Balance your body weight

Body weight plays an important factor in determining your risk of osteoarthritis and osteoporosis.

The effects of obesity on osteoarthritis are well documented. Carrying extra weight puts stress on your joints and increases your risk of osteoarthritis of the knee, hand and hip. If you are overweight or obese and have osteoarthritis of your knee, for each pound of bodyweight you loose, there is a four pound decrease in knee stress. This can make a real difference to your health.

But it is not just about carrying extra weight - being underweight can increase your risk of osteoporosis (www.iofbonehealth.org/...). Bones loose density quicker if you are underweight, becoming weak and more likely to fracture. If your body mass index (a measurement that takes into account your weight and height) is 20 you are twice as likely to fracture a bone as someone with a body mass index of 25. So what steps can you take to stay healthy and keep your bones strong?

Eat your bones healthy

A varied, well-balanced diet can help you maintain a healthy weight and reduce your risk of osteoarthritis and osteoporosis. In childhood, a healthy diet is important to help build bone mass. As an adult, a well-balanced diet helps to preserve bone mass and strength. Foods rich in calcium are essential to keep your bones healthy.

To absorb calcium properly your body needs vitamin D. The best source of vitamin D is sunlight, but you can also get it from some foods like oily fish. However, if you do not get outside often, your skin does not get much exposure to sunlight, or you do not eat meat or oily fish you may not be getting enough. Try to get all the calcium and vitamin D you need from your diet, if not, then consider taking supplements. A well informed nutritionist may be best placed to give you personal advice.

Get physical

Physical activity is not just good for your general health, it also helps to keep bones strong (http://www.iofbonehealth.org/...) and can reduce your risk of falls by strengthening muscles, increasing flexibility and improving balance. Exercise plays an important role in building bone mass in children and slowing down bone loss in adults. Weight bearing exercise, such as walking, jogging, tennis and aerobics are great for good bone health and preventing osteoporosis. However, an overactive lifestyle, such a playing sport professionally, may increase your risk of osteoarthritis because repetitive activity can injure your joints. It is about striking the right balance between exercise and rest.

The final word

Osteoporosis, and to some extent osteoarthritis, are silent diseases. Osteoporosis is not commonly associated with pain; you cannot see your bones getting thinner and you may be unaware of the disease until you break a bone or have a noticeable reduction in height. Do not ignore early warning signs - visit your doctor as soon as you can.

The facts remain that as our world population gets older, those who will enjoy a greater quality of life are those that are able to stave off the onset of these skeletal conditions. But we need to be prepared, in our quest for an ever elongated existence, to look for new technologies to try and tackle what nature inevitably inflicts on us.

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