2015 – Charlene Yared West

Osteoporosis and broken bones do not need to be a normal part of aging… you can take charge of your bone health and longevity.

Not many of us spare a thought for our hardworking skeletons, until of course, we experience a bone fracture. Only then do we realise how much we appreciate each and every one of the 206 bones of the skeletal system. Our bones provide protection just like body armour, keeping our essential organs safe, such as the skull for the brain and the spinal column and the rib cage. Our bones also allow the body movement, through the leverage of the muscles and are also magnificent storehouses of minerals, such as calcium and also work as factories to produce blood cells. As we age, our bones change, break down, repair and rebuild themselves throughout our lives, which makes it a necessity to understand the ins and outs of optimising our bone health. Charlene Yared-West speaks to Life Healthcare Orthopaedic Surgeons and brothers, Dr Duwayne Vermaak and Dr Slade Vermaak on the topic and finds out how to achieve this lifelong goal.

Your bones are alive and changing
Skeletons conjure up images of Halloween, where bones are dry and stiff. However, this idea couldn’t be further from the truth of the bones which are in your body. In truth, your bones are made of tough, healthy, living tissue. “When bones crack or fracture, they are able to recover through rebuilding themselves and are usually restored to their original strength,” says Dr Duwayne Vermaak, Orthopaedic Surgeon at Life Healthcare Little Company of Mary. “However, the age and general health of the person must be taken into account – as this can affect the healing and regeneration process, which happens all the time – even when there is no injury.” Dr D Vermaak points out that there are often little or no warning signs that one can pick up on that could indicate a problem. “Bones don’t tell you much until it is too late – and then they break… Only then does the patient seek advice – and in most cases, some form of pain relief, as fractures can be very painful,” he says.

What is osteoporosis?

The body uses calcium to rebuild bones and 99% of the 1kg calcium in our bodies is located in the skeletal system. “If there is a shortage of calcium in the body, there is less building material available to the bones for rebuilding, repair and maintenance, which can mean more brittle, weaker and fragile bones; a condition known as osteoporosis. The word literally means ‘porous bone’,” explains Dr Slade Vermaak, Orthopaedic Surgeon at Life Healthcare Little Company of Mary. “Healthy bones can look like a honeycomb, but when you have osteoporosis, the holes in the spaces of the honeycomb comparison, are much bigger.The bigger holes indicate that your bones have lost density or mass, which means that your bones are weaker and more likely to break as you age.” Dr S Vermaak recommends going for a bone density test to assess your bone health.

Who is affected the most?

Worldwide, over 200 million people are affected and one in three women and one in five men over the age of 50 will suffer from a fracture due to osteoporosis. An osteoporotic fracture occurs every three seconds and by 2050, the worldwide incidence of hip fracture in men is projected to increase by 310% and by 240% in women. At the age of menopause, women experience a reduced level of oestrogen, which simultaneously causes a rapid reduction in their bone mass. In men, bone loss occurs at the age of 70 years old. Broken bones can occur anywhere in the body, but most commonly occur in the wrists, spine and hips.

When it comes to bone health… prevention is better than cure

Bone health begins in the womb, where good maternal nutrition ensures the healthy development of the baby’s skeleton in utero, which continues into later life, through living a healthy lifestyle and eating right, explains Dr S Vermaak. “The focus for children and adolescents is on building the maximum bone mass, which happens until the age of around 25, where about half of our bone mass is accumulated. Thereafter, as adults, the emphasis is on maintaining healthy bones and avoiding premature bone mass loss, which can occur through unhealthy lifestyles,” he says, adding that gastrointestinal disorders also affect the nutrient absorption – especially calcium, in people of all ages – and they can be at risk of bone disease, and therefore, may need to supplement with calcium and vitamin D. “When in doubt, consult your GP,” adds Dr D Vermaak.

How can you prevent osteoporosis?

There are certain risk factors which increase a person’s susceptibility to bone disease and these are a sedentary lifestyle and poor nutrition, smoking and alcohol use. In addition, the age is taken into account, previous injuries, the body mass index and existing metabolic and health conditions, such as arthritis. “Smoking and alcohol use should be avoided as much as possible and exercise, including weight bearing and muscle strengthening is important for building strong, healthy bones. This applies to both men and women,” says Dr S Vermaak. “A well-balanced diet cannot be emphasised enough – and one that is high in calcium-rich foods, vitamin D and proteins, as well as other micronutrients, including vitamin K, magnesium, zinc and carotenoids – can reduce the risk of osteoporosis.”

Six top tips to get bone healthy…

Soak up the sun! Get 600 IU of vitamin D per day. Sunlight has become the enemy in the last few years, as consensus tells us to cover up with sunscreen… Also, young people spend less time outdoors, as computers, mobile phones and television take centre stage. All that is required is 10 to 20 minutes of sun exposure on bare skin, outside of peak sunlight hours (before 10am and after 2pm), without sunscreen, while taking care not to burn.
Ensure sufficient calcium, vitamin D, protein and micronutrient intake daily.
- Calcium-rich foods: Milk, yoghurt, cheese, broccoli, dried figs, almonds, tofu.
- Vitamin D-rich foods: Salmon, sardines, tuna, shitake mushrooms, egg yolk.
- Protein-rich foods: dairy products, meat, fish, poultry, lentils, beans, nuts.
- Micronutrient-rich foods: green and leafy vegetables, cabbage, kale, liver, seeds, carrots, red peppers.
Avoid smoking and excessive alcohol and caffeine. If you love your coffee, or other caffeine-heavy beverages, drink less than four cups per day, as more than three cups could be associated with a 20% increase in the risk of osteoporotic fractures… and make sure you are getting enough calcium!
Include daily exercise and muscle strengthening into your regime.
Identify your risk factors.
Take prescribed medication if necessary.

<Sidebar>Are you getting enough calcium?

Calculate your average daily calcium intake in three easy steps. Available online and on mobile devices. http://www.iofbonehealth.org/calcium-calculator

<Sidebar> Knowing your risk factors

Take the International Osteoporosis Foundation One-Minute Osteoporosis Risk Test to find out whether you may have specific factors which place you at higher risk of osteoporosis and fractures.

www.iofbonehealth.org/iof-one-minute-osteoporosis-risk-test

<CASE STUDY>
May Lubbe (75)

(Daughter – carina – 0824664368 carinavd@mweb.co.za)

“One day, like any other day, I was making my bed and as I lifted the corner of mattress slightly, I heard something crack in my back. I lay down on the half-made bed and prayed that when I got up, I would be able to walk. Luckily I could walk after a rest and so I continued with my day, not giving the niggling sensation in my back a second thought. The sensation became painful as it became evening and in the morning, I visited my GP, who prescribed pain medication. No medication seemed to work; it only got worse. Two weeks later after seeing numerous doctors and having an XRAY, I was diagnosed with osteoporosis, a condition I had never heard of. I am a diabetic and have been living with the condition since 1957, so it was bad news that I now had to contend with another ailment. One thing I didn’t know was that as a diabetic, it is even more important to consume calcium-rich foods, which is now a priority in my diet. I have since been on medication to treat the osteoporosis and have made certain lifestyle adjustments and thankfully, I am pain-free and living a full and happy life.”

Have you been diagnosed with gestational diabetes? While that might sound overwhelming at first, it turns out the condition is more common than you may think. / Recent studies indicate that gestational diabetes is on the rise. How can you protect yourself and your baby during pregnancy from this condition?

Gestational diabetes only happens during pregnancy and affects about three to five out of every 100 pregnant women. Even women who have not have diabetes before can experience gestational diabetes in pregnancy. So, what are the risks and how can they be overcome to ensure a healthy mom and baby throughout the nine months of pregnancy? Charlene Yared-West speaks to Dr Bandile Masuku and Dr Gaontebale Matlhaga, two obstetrician/gynaecologists from Life Suikerbosrand.

What causes gestational diabetes?

Pregnancy can affect the normal way a woman’s body processes sugar. In normal circumstances, explains Dr Gaontebale Matlhaga, obstetrician/gynaecologist from Life Suikerbosrand, food is ingested and digested and glucose from the food enters the bloodstream. “In response to this increase of sugar in the blood, the pancreas releases the hormone insulin, which helps to move the sugars from your bloodstream and into your body’s cells, where it is used as energy,” he says. “In pregnancy however, the placenta produces pregnancy hormones, which impair the action of insulin, which automatically then raises the blood sugar levels.” As your pregnancy progresses and your baby grows, the placenta, he says, produces even more insulin-blocking hormones, which create a cycle of increased blood sugar levels. He adds that the condition is most common from around 20 weeks of pregnancy, but generally not earlier than that. “It isn’t always easy to notice signs or symptoms – which are non-specific and so it is usually picked up in the urine test, which is then followed up with a fasting blood test to ascertain if the woman has this condition,” he says.

<Sidebar> What are the different types of Diabetes Mellitus?
Diabetes mellitus, otherwise known as diabetes is a metabolic condition where there are uncontrolled high blood sugar levels over a long period of time. Symptoms can include increased hunger and thirst, as well as frequent urination.

Type 1 Diabetes: An autoimmune disease, where the pancreas produces very little or no insulin at all. It is most common in people under the age of 20.

Type 2 Diabetes: A disease found in people who are overweight as they get older, where the pancrease does not produce enough insulin, or the body does not use it properly. It can be considered a lifestyle disease which is usually triggered by little or no exercise and being overweight.

Type 3 Diabetes: A condition otherwise known as gestational diabetes, which occurs in pregnancy.

<Sidebar>Who is at risk of gestational diabetes?

Women older than 25 years of age are more prone to metabolic conditions.
Women with polycystic ovary syndrome.
Family or personal history and pre-pregnancy diabetes.
Women with a body mass index of 30 or higher.
Women who are black, of indian origin or Asian are more likely to develop gestational diabetes.

What are the complications of developing gestational diabetes?

If left undiagnosed, the complications for mother and baby can be dire, explains Dr Bandile Masuku, obstetrician/gynaecologist from Life Suikerbosrand. “Babies are born with a high birth weight, because of the extra glucose in the bloodstream, which crosses the placenta and triggers the baby’s own pancreas to make extra insulin – and this causes the growth rate to speed up. As a result, many of these babies with this condition known as macrosomia, are born via Caesarean because of their size,” he says. “Preterm labour is also a risk, which also means that the baby’s lungs are not fully developed and the baby will not be able to breathe on its own. In addition, babies can also develop low blood sugar, because their insulin production is so high, which can also lead to seizures. As a result the blood sugar levels in the baby must be closely monitored after birth to help normalise the baby’s blood sugar level. Babies of mothers who have gestational diabetes also have an increased risk of developing obesity and type 2 diabetes later in life,” Dr Masuku adds gestational diabetes can also increase the risk of high blood pressure and preeclampsia, which are also dangerous to mother and baby. Furthermore, women with gestational diabetes also often develop future diabetes; whether in a future pregnancy or type 2 diabetes later in life.

Why is it challenging to fall pregnant when you have diabetes?

Women suffering from Type 1 or Type 2 diabetes usually face challenges when trying to fall pregnant as the “conception environment” can be compromised, explains Dr Matlhago. Type 1 Diabetes sufferers also tend to have higher incidences of miscarriage or have a baby born with a birth defect. In a healthy person, food is digested with the help of the hormone insulin – and in diabetics, there are flaws in this metabolism system. Hormones and hormone production are an essential part of the reproductive process – especially for a person wanting to conceive – and diabetics have a compromised system of hormonal control. “In addition, diabetic men may also want to consult their doctor about problems that can arise such as erectile dysfunction and damaged nerves, which can cause the sperm to enter the bladder during ejaculation,” he adds.

Getting ready for pregnancy: Consult your ob/gyn

“It would be beneficial for all women who want to fall pregnant to see their obstetrician/gynaecologists before conception, for counselling and to develop a plan – especially if they have diabetes as an existing condition. It is important for all women to gain control of their blood sugar levels before pregnancy, which can also help to avoid the onset of gestational diabetes,” says Dr Masuku. “It is also more challenging for women who have pre-existing diabetes to fall pregnant, so a consultation can help to see where the problem is and also to create a programme, which includes dietary advice and exercise guidelines. It even helps if a woman can lose extra weight before conception to also help achieve a healthier pregnancy and lower her chances of getting gestational diabetes.”

Managing gestational diabetes

According to Dr Masuku, it can be psychologically challenging and inconvenient to be diagnosed with gestational diabetes, because of the lifestyle and dietary changes that come with the treatment strategy. “Daily checking of the sugar levels, before and after meals is necessary to make sure the levels are within a healthy range,” he says. “In addition, eating the right kinds of food in healthy portions is one of the best ways to control the sugar levels and help to avoid weight gain. Exercise also plays an important role and can help lower your blood sugar by encouraging your body to move glucose into your cells where it will be burned for energy – and less insulin will be necessary.” He adds that if diet and exercise are not impacting your sugar level, medication might be necessary, which is assessed on an individual basis. “Medication in the form of oral drugs and injectible insulin might be necessary to control the condition.”

<Case Study>Millicent Ndlovu

“I was 30 weeks pregnant, on the highway and driving to work one winter’s morning in June, when I suddenly felt extremely hot, so I opened the car window and then felt terribly nauseous. I started vomiting and moved over into the slow lane. Luckily I was close to the office, but the nausea wouldn’t go away and I started vomiting some more. My colleague took me to hospital, where I was kept for observation. They measured my sugar levels and they were exceedingly high and wouldn’t go to normal levels even that evening when the levels were taken again. It was decided to put me on insulin, which brought my levels back to normal. I also had to speak to a dietician who advised me on diet and exercise. Diabetes is hereditary in my family; both my parents and sister have it, but I did not – and I thought I was having a healthy pregnancy; no morning sickness or nausea, I only had fatigue. It was very frustrating for me to have this condition and of course I was worried about the health of my baby too. Thankfully, through diet and injectible insulin I controlled my sugar levels well and my 4.5kg baby girl, Humelelani was born on July 22, last year, via caesarean section. The gestational diabetes cleared after I had given birth, but after a health screening at work about a year later, it was determined that I had diabetes type 1, which I now manage with medication and a strict diet.”