World Osteoporosis Day:

National awareness program, a must

by Nilma DOLE

As World Osteoporosis Day falls on October 20 the state and private sector hospitals and health institutions are once again putting Osteoporosis in the spotlight. This deadly disease that affects nearly 50% of Sri Lanka's female population especially the elderly, is definitely a cause for serious concern.

In Sri Lanka, the median age, which was 25 in year 1991, is expected to rise to 45 by the year 2041 and half of the population will be over 45 years and vulnerable to osteoporosis (Siribaddana, Lekamwasam).

Director of the Galle Research Network Prof. Sarath Lekamwasam (MBBS, MD(SL, HRCP(UK) FRCP(LONDON), FCCP) is an expert in osteoporosis and geriatrics including metabolic bone diseases. He is also a Certified Clinical Densitometrist of the International Society of Clinical Densitometry (ISCD), USA and a Commonwealth Fellow, Department of Medicine of the Cambridge University, UK.

At present he is the chief investigator of Community Osteoporosis Survey of Sri Lanka and has also many other honorary titles to his name including President Elect of Osteoporosis Society Sri Lanka. He heads the Centre for Metabolic Bone Diseases, Department of Medicine, University of Ruhuna, Sri Lanka. Excerpts of the interviews:

1. Describe what osteoporosis is and how does it affect the human body?

Osteoporosis (OP) is a disease primarily affecting the bones. The bones become thinner and less stronger as a result of loss of bone material which makes bones more vulnerable to fractures.

2. How does it affect people, especially the women? How are Sri Lankans affected in comparison to the rest of the world?

Healthy and strong bones are a result of complex interaction between many factors such as genetic background, body proportion, nutrition, physical activities, etc. In addition, there are many hormones regulating bone metabolism. Most noticeable are the hormones secreted by ovaries in women (oestrogen) and testicles in men (testosterone). Women tend to have a marked drop in blood oestrogen level around 50 years of age and this induces a gradual loss of bone material.

Men do not experience such a sharp decline in testosterone in old age and this helps them to maintain relatively better bone strength in old age.

Owing to the smaller body measurements, Sri Lankans, and Asians in general, tend to have smaller bones in comparison to their Afro-Caribbean counterparts.

This makes Asians more vulnerable to osteoporosis. Paradoxically, due to an ill-understood mechanism, Asians develop a less number of hip fractures when compared with women in Europe or North America. Women in Asia, however, experience spine fractures as frequent as their counterparts in other parts of the world and spine fractures are the commonest fractures in osteoporosis.

3. How are State medical authorities and hospitals working along side international organisations to prevent and cure this condition?

Although studies have been conducted in developed countries to estimate the impact of osteoporosis and fractures, the outcome is not made available to most of the developing countries. Hence hospital authorities and health policymakers in developing countries, especially in the South Asian region have failed to recognize the threat of the disease. Scientists have already indicated that most of the hip fractures which have been predicted for 2025 or 2050, would occur in Asian countries. This is purely based on changing trends in the population composition in those countries.

More elders are expected in such countries in future and it will lead to an exponential rise in the incidence of hip fractures.

4. In what way are the people better aware of the condition more than before? Are there easy methods of identifying the condition?

When compared to the period 10-15 years ago, people are today more aware of the disease. They, however, lack a clear idea of preventive measures of osteoporosis and fractures. This is partly due to lack of a national awareness program to educate them on various aspects of the disease.

There are no warning signs of osteoporosis and fittingly it is named a "Silent Disease". Most cases come to light only after a fracture. Apart from fracture, change in the curvature of the spine and chronic backache may signal the presence of the disease in some people.

5. In what way can osteoporosis be treated? Are there medical breakthroughs to deal with the conditions promptly?

There are many treatment options available to treat osteoporosis. They can effectively prevent subsequent fractures in people who have already got a fracture or prevent the first fracture in people who have a high fracture risk but not yet got a fracture. But the selection of drugs and monitoring patients while on therapy need expert skills.

6. What steps can an ordinary individual (in Sri Lanka) take to prevent osteoporosis?

Like in any other non-communicable disease such as high blood pressure or diabetes, there are many steps an ordinary person can take to prevent osteoporosis. These include lifestyle modifications, starting from very early age and then continuing them throughout life. Proper nutrition in critical periods of life such as during pregnancy, lactation, infancy and old age is vital. People should be encouraged to take a balanced diet all the time.

Special attention should be paid to the protein and calcium content of the diet. Calcium rich food items such as small fish, green leaves and milk are available in most parts of the country throughout the year.

Physical activities are essential for healthy bones. Again, it should be incorporated into the lifestyle very early and continued throughout life.

Fall prevention is a proven way of reducing the number of fractures. Both the elderly and the sick are prone to falls and as such especial attention should be paid to them.

7. Please describe a little about the IOF (International Osteoporosis Foundation) and their role in Sri Lanka.

The IOF is the key organization in the field of osteoporosis. It provides guidelines on screening, diagnosis and management of osteoporosis. Further, it pays attention to countries where facilities have not yet improved. IOF is concerned with the predicted fracture burden in Asian countries and tries to minimize the effect by adopting various strategies.

8. How will Sri Lanka together with the IOF celebrate World Osteoporosis Day on October 20 this year?

Osteoporosis Sri Lanka, the only organization related to osteoporosis will organize an education program for paramedical staff on this day in the SLMA auditorium in Colombo. This was done last year and was a major success. IOF has recognized paramedical training as an essential part of the osteoporosis education programs. The findings of the recent Asian audit sponsored by the IOF will be disseminated in this meeting.

Student know-how campaign for global handwashing day

Millions of schoolchildren in Sri Lanka and more than 80 countries worldwide celebrated Global Handwashing Day on October 15.

Did you know that knowledge isn't the only thing being transmitted in schools? Hands - the part of our body we feed and clean ourselves with - are covered with millions of invisible germs that cause infections and diseases, such as diarrhoea, pneumonia, cholera and dysentery. According to UNICEF, 272 million school days are lost each year across the world due to diarrhoea, but washing hands with soap after using the toilet and before eating, can reduce the chance of getting diarrhoea.

For your child, a day off school means missing out on play time with their friends, but it also means they could fall to the bottom of the class because they're missing out on valuable lesson time.

Each day across the world the equivalent of 160 classrooms full of children die unnecessarily from diarrhoeal disease - that's one child every 15 seconds.

So there are five good reasons to make sure kids are handwashing with soap:

1. Healthy children learn better than sick ones 2. Repeated bouts of diarrhoea can cause stunted growth 3. You won't have to spend time staying at home to look after them 4. They'll be able to spend more time with their friends, rather than on the toilet 5. It could save their life.

This simple but critical fact is the reason for Global Handwashing Day, which schoolchildren across the world will be celebrating in October.

Lifebuoy is working with the Health Education Bureau and the Ministry of Healthcare and Nutrition, bringing 1500 schools and 5000 pre-schools and medical clinics in Sri Lanka together, to help children across the country become the cleanest through awareness-raising and educational activities about this simple hygiene habit. Join those children who'll be washing their hands on this day.

Global Handwashing Day is part of Lifebuoy's commitment to health and hygiene. In Sri Lanka Lifebuoy is committed to spreading the global handwashing message by continuing to invest and dedicate time into local projects such as school awareness campaign. Last year this project had reached over 1,000,000 children and this year it aims to reach 1.3 million children.

Lifebuoy Brand Manager Kasun Liyanage says: "Every parent wants their child to do the best they can and make sure they reach their potential, so the less time they miss from school the better. Clean hands can help prevent your child swallowing any horrible germs that will make them sick."

All about breast feeding

Too busy to breastfeed? Perhaps you might like to consider the latest A-list accessory: a wet nurse. In the 18th century, wet nurses were all the rage as noblewomen deputised their responsibilities. Now, Hollywood's rich and famous are doing the same, figuring quite rightly that there's nothing better than mother's milk they just don't want their babies to feast on theirs.

While the wet nurse phenomenon is not commonplace in Asia, there are cases of mothers with milk surplus offering it at a price to those who are unable to provide it themselves for their babies. The good news, however, is that women don't have to avoid breastfeeding because they fear their breasts sagging.

A recent study by the American Society of Plastic Surgeons has found that breastfeeding does not cause sagging, as many women believe.

"Women may be reluctant to breastfeed because they believe that it means the end to youthful breasts," says Dr. Brian Rinker, author of the report. His study found that a history of breastfeeding, the number of children breastfed and the duration of each child's breastfeeding had little impact on breast shape. Rather, excess weight, a greater number of pregnancies, smoking and age were far more likely to cause sagging.

All of which will be welcome news for women who breastfeed in a bid to boost their babies' neural development and immunity to infectious diseases. Here are more breastfeeding myths:

Myth 1 - Some women fail to produce sufficient milk

FALSE Most women do have enough milk supply. If a baby fails to gain (or even loses) weight, this is more likely the result of the baby not latching properly onto the breast or not feeding often enough. It is common for newborns to feed eight to 12 times in 24 hours.

Myth 2 - A mother must drink milk to make milk.

FALSE A healthy diet of vegetables, fruits, grains and proteins is all that a mother needs to provide the proper nutrients to produce milk. Calcium can be obtained from a variety of nondairy foods such as dark green vegetables, seeds, nuts and fish. No other mammal drinks milk to make milk.

Myth 3 - Mothers who have had cosmetic breast surgery cannot breastfeed a baby.

FALSE Many women who have had breast augmentation or reduction have gone on to breastfeed.It is important that women consider the issue of breastfeeding before going under the knife, as some procedures reposition the nipple and areola. In these cases, breastfeeding may have to be partial rather than exclusive.

Myth 4 - Mothers who breastfeed cannot consume alcohol or spicy food

FALSE Usually, the body digests and processes all the food a mother eats before the body makes breast milk. An occasional glass of wine or beer would not hurt a nursing baby and the same goes for spicy foods. There is also no conclusive research to support the theory that mothers who consume gassy foods (such as beans or broccoli) will have a colicky baby.

Myth 5 - Breastfeeding is a great alternative for birth control

FALSE While in many instances ovulation is suppressed during breastfeeding, only abstinence will ensure that no little surprises happen. Nursing mothers can safely take low-dose birth control pills or use barrier methods of contraception without harming their baby.

Myth 6 - A breastfeeding mother should space her feedings so that her breasts will have time to refill

FALSE You're not alone Breast pain, otherwise known as mastalgia, is the most common breast complaint among women, affecting most of us at various life stages.

Typically, mastalgia is either cyclical (linked to the menstrual cycle) or non-cyclical. When breasts become tender or painful just before a period, a warm shower or hot compress to the chest can reduce painfulness; alternatively, some sufferers prefer an icepack to reduce the fluid retention that hormonal activity triggers.

Breast expert Dr. Benjamin Norris of Silkwood Medical recommends that women drink as much water as possible, and cut down on caffeine intake, if they wish to reduce fluid retention and breast pain around period time.

Fibroadenomas

If you're checking your breasts in the shower and you feel a small lump or two, don't panic. A biopsy could easily reveal benign masses of fat and fibrous tissue known as fibroadenomas. Commonly found in women under the age of 30, they also occasionally occur in older women. Typically they are small and firm to the touch, but painless. Patients can opt to have them removed - it's a straightforward procedure, although a general anaesthetic is required.

Nipple discharge

When breastfeeding, it is normal for milk to leak from the nipples, but if a discharge occurs at any other time, and particularly if the discharge is watery or bloodstained, see your doctor for advice. Similarly, any inversion (pulling in) of the nipple should be checked. Although often caused by harmless conditions, these symptoms can also indicate breast cancer.

Benign fibrocystic disease

Commonly found in women whose breasts are particularly sensitive to the menstrual cycle, benign fibrocystic disease is the most common cause of non-cancerous lumps, thickening of the breast tissue, and cysts.

Cysts can be painful and are caused by fluid trapped in breast tissue. Although harmless, they should be checked by your doctor, who may recommend removal of the fluid using a syringe with a fine needle. If cysts recur, more permanent surgical removal may be necessary. Typically, an ultrasound is used to determine if the lumps are fluid or solid.

Mastitis (Inflammation of the breast)

Mastitis is commonly caused by an infection during breastfeeding, but if symptoms occur when you're not breastfeeding, see your doctor immediately. Treatment with antibiotics is required to prevent abscesses forming. If you're too late, a simple surgical procedure can drain the abscess.

Courtesy: Readers Digest