Women smokers risk getting osteoporosis
Published on: Thursday, October 20, 2016
Kota Kinabalu: Beware female smokers – smoking is one of the risk factors for Osteoporosis, a medical condition in which the bones become porous from loss of bone tissue, as a result of hormonal changes after menopause, or deficiency of calcium or Vitamin D.But then not everyone who smokes will get Osteoporosis although the risk is there, said Consultant Geriatrician Dr Khor Hui Min of University Malaya Medical Centre (UMMC)."This is because there are other risk factors. In the case of smoking, it is dose dependent which means the longer and more cigarettes you smoke, the higher the risk. The same applies to alcohol as another risk factor.
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If you drink, say one or two pints a day, it is OK but if you take three pints a day for a week, then the risk is higher," she told Daily Express at the recent 12th National Geriatrics Conference, here.Dr Khor said other risk factors are a sedentary lifestyle, low bone mineral density (BMD) and low bone mass index (BMI), and if your parent has had a hip fracture in the past, then your risk of Osteoporosis is higher. Osteoporosis-related fractures (also known as fragility fractures) most commonly occur in the hip, wrist or spine.What is the correlation between smoking and Osteoporosis, smokers may ask. Dr Khor has the answer.
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"It's about how your bone re-models. Your bones are living tissue where there is always breakdown and build-up of new bones and this is called remodelling. When you smoke, it slows the production of bone-forming cells so that they make less bones. Smoking also reduces blood supply to bones as to many other body tissues," she explained. For postmenopausal women, Dr Khor said, estrogen is an important component in stimulating the bone-forming cells for the building up of strong bone structure and skeleton. "Hence in postmenopausal women, bone is broken down faster than it is formed, thus putting them more at risk of Osteoporosis."
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She was also asked on the difference between Osteopenia and Osteoporosis. Generally, women know what Osteoporosis is all about but are not aware of Osteopenia which is "Greek" to them. "Osteopenia is a condition characterised by low bone mass but not to a point where Osteoporosis is diagnosed."So will a patient with Osteopenia progress to Osteoporosis? "There is a possibility that people with osteopenia may progress to osteoporosis and we usually monitor these people with bone mineral density (BMD) test every two years. We would not normally repeat the scan any sooner as bone changes occur slowly and repeating the test earlier may not show any difference. We would assess your other risk factors and advise you to maintain a healthy lifestyle such as regular exercise, adequate dietary intake of calcium and vitamin D, quit smoking and limiting alcohol intake. Having said that, the Consultant Geriatrician made it clear that a lot of risk factors for Osteoporosis are independent of BMD scoring."Say if you developed a fracture at the osteopenia range, it is an indication to start treatment regardless of the BMD score. Similarly, if you are taking regular steroids for a certain medical condition, osteoporosis medication is necessary as steroids increase bone loss independently of your BMD score," she cautioned.Earlier in her presentation at the Symposium on Bone Health, Dr Khor said Osteoporosis is asymptomatic in the sense that it is largely a "silent disease", and women don't know they have it until a fracture occurs."The most common fracture site is the spine which is largely asymptomatic. Around thirty percent of the time, there is symptom – pain due to vertebral compression fracture (resulting in loss of height). But you may think it's your usual backache only without realising there is a fracture. Two-thirds of the time, a large proportion of it, women actually don't know they have Osteoporosis," she pointed out, adding once you have one vertebrae fracture, your risk of developing another vertebrae fracture increases fourfold. According to Dr Khor, the most debilitating fragility fracture is hip fracture. The mortality risk of osteoporotic hip fracture is high which is why it is important to go for operation as early as possible when it occurs to prevent the complications of prolonged immobility. "Don't wait for too long like two weeks or so. Many elderly patients have low trauma fracture where they fall from a standing height and are unable to walk after a hip fracture. The patient may think that it was not a serious fall and that the pain may go away after a while. "This may be a reason for the delay in seeking medical help. They then present only after one to two weeks when the pain and immobility persist. Hence if an elderly person falls and is unable to walk following that, they should be seen urgently to rule out osteoporotic fracture which is common in those aged 60 and above," she said matter-of-factly.How do we go about fracture risk reduction? "Make sure your dietary calcium intake is adequate. Sunlight exposure is an important source of Vitamin D which helps to absorb calcium in the body. Exercise, avoid smoking, avoid alcohol. The more active you are, the lower your risk of Osteoporosis. Falls prevention is very important," said Dr Khor, adding "if you keep falling, your risk is higher."At the same symposium, Consultant Geriatrician Dr Lawrence Lee of Hospital Kuching, Sarawak said Osteoporosis is the most common bone disease affecting older people, especially females.Stay up-to-date by following Daily Express’s Telegram channel.
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