Osteoporosis in Jordan

70% of the Jordanian population surveyed believed there should be more awareness and education on osteoporosis.

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Osteoporosis is a disease that makes the bone brittle; it results in over 8.9 million fractures annually across the globe. Largely due to hormonal imbalances, women are at significantly higher risk, and women in Jordan are no exception. اضافة اعلان

One study found that osteoporosis has a prevalence rate of 30 percent among Jordanian women, regardless of the menopausal status, and 43.3 percent in postmenopausal Jordanian women. Nevertheless, education and understanding of how this disease manifests itself enables women to better work to prevent osteoporosis from developing later in life.

A separate 2014 study focused on assessing knowledge about osteoporosis and preventive measures among the Jordanian population. It determined that knowledge about the disease was modest, and more than 70 percent believed there should be more awareness and education about the topic.

What is osteoporosis

Osteoporosis, or “porous bones”, is a disease as a result of which the bones in the body lose their density, and thus become more fragile. It is considered a silent disease because for a long time it does not manifest in any unique way. Often the disease goes undiagnosed until a simple fall or bump that is normally harmless results in a dramatic fracture.

Contrary to popular belief, bone is living tissue and constantly undergoes replacement and repair. Due to the stress placed on bones, particularly those of the hip and spine, microfractures are common. In order to keep up with the demand, the body needs to be supplied with the proper minerals that make bones. The two most important minerals are calcium and phosphorus. Unfortunately, there are many diseases and conditions that result in inadequate intake of these minerals or resorption of them in the bone.

Risk factors of osteoporosis

There are many risk factors that may contribute to developing osteoporosis, many of which overlap with other diseases. The most contributing factor is age. With age, it becomes more and more difficult for the body to continuously break down and rebuild bone. Typically, around the age of 30, bone turnover (breakdown of bone) tends to occur at a higher rate then bone formation. In time, this will result in less bone density and great fragility, ultimately making the individual more prone to fractures.

Menopause is another primary risk factor for developing osteoporosis. Menopause typically occurs in women between the ages of 45 and 55. Due to the hormonal changes that occur during menopause, women undergo bone turnover at a faster rate than men of the same age. It is not until the age of 65-70, that men and women have a relatively equal rate of bone turnover.

Other risk factors include being of the Caucasian or Asian, having a family history of osteoporosis, poor nutrition, physical inactivity, smoking, and low body weight.

Causes of osteoporosis

There are many causes of osteoporosis. This is largely due to the fact that osteoporosis is a secondary disease, meaning that there is another underlying condition causing it.

Causes of osteoporosis can be divided into multiple categories, the three most common being drug-induced, endocrine disorders (hormonal), and gastrointestinal/nutritional disorders. Each category can then be further divided into causes by means of decreased bone formation, or by means of high turnover rate. In drug-induced osteoporosis, the most common cause is prolonged glucocorticoid use. The most common glucocorticoids include prednisone, prednisolone, and methylprednisolone. Glucocorticoids cause osteoporosis by several means including increased bone resorption, decreased intestinal calcium absorption, and, most predominantly, suppressed bone formation, all of which can be seen within the first few months of taking this medication. For those who must take glucocorticoids, this is considered an acceptable risk, but they should be weary of falls.

Other medications that may cause osteoporosis include certain immunosuppressants, such as cyclosporine, older generations of anti-seizure medications, such as phenobarbital and phenytoin, and heparin.

There are also many endocrine diseases that can cause osteoporosis. They include Cushing’s syndrome, hyperthyroidism, and diabetes mellitus. Gastrointestinal diseases and nutritional disorders may also increase the risk of osteoporosis. Eating disorders that result in poor dietary intake, vitamin D deficiency, and malabsorption syndromes tend to be the most common causes.

This is by no means a comprehensive list of causes for osteoporosis. Furthermore, these conditions only increase the risk of developing the disease so greater care must be taken.

Osteoporosis prevention

Osteoporosis is a multifactorial disease with many causes. Despite the best efforts, there is no guarantee that individuals can fully prevent getting it. Nevertheless, men, and especially women, should take care of themselves in order to reduce the risk.

Osteoporosis is not a disease that only affects the elderly. Anyone, at any age, can develop it. Diet plays an important role in this, and appropriate nutrition is important. In men and women between the ages of 18 and 50, 1,000mg of calcium are needed per day in order to keep bones healthy. Women after the age of 50 and men after the age of 70 may need to increase their intake to 1,200mg.

Excellent sources of calcium include low-fat diary products, soy products, and calcium-fortified grains. Alternatively, calcium supplements may be used, but with caution, as high doses of calcium have been linked to heart problems and kidney stones.

Vitamin D is another important nutrient needed to ensure bone health. Vitamin D improves the body’s ability to absorb calcium and can be obtained from two sources: sun exposure and diet. Typically, sun exposure is plenty for the average person, but for those more homebound, diet becomes vitally important. Sources of vitamin D in diet may include egg yolks, fatty fish, and fortified milk or grains. The optimal dose of vitamin D is still not known, but generally adults should start at 600-800 international units (IU) through foods or supplements. Those with vitamin D deficiency may need to start at a higher dose. 

Exercise is also important in preventing osteoporosis. As opposed to other diseases, like rheumatoid arthritis (an autoimmune inflammatory disease affecting the joints), in order to prevent osteoporosis, weight-bearing and strength exercises are important. Although activities such as bicycling and swimming are great for cardiovascular health, strengthening bones requires higher impact. Exercises such as walking, jogging, running, stair climbing, skipping rope, and even impact-sports such as tennis, all help improve bone strength while slowing down bone loss.

There are also lifestyle changes that can be made to reduce the risk of developing osteoporosis and experiencing fractures. Smoking increases bone turnover and may increase the likelihood of fractures. Excessive alcohol consumption (defined as more than two drinks per day), may decrease the rate of bone formation and the disorienting effects may increase the risk of falls.

Those who are more prone to falls, particularly the elderly, should avoid slippery surfaces and wear appropriate footwear both indoors and outdoors, keep the floors uncluttered to avoid tripping hazards, and use hand rails whenever available, especially in the shower.

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