Bones, the wonder of our physical structure are holding us together, helping us to sit, stand, walk, run and perform all daily activities. The basic structure on which our organs are held, which provides our body the framework and gives it appearance of what we understand as human body and without which we will just be puddle of skin and muscles. So it is very important to know how to maintain bone health in different phases of life. When a human baby is born, it has 300 bones while it grows up to be an adult human who has around 206 bones. Thus is because babies are born with more cartilage than adults, which gradually turns into bones via the process of endochondral ossification. When we are young, bones have more strength to handle any type of stress, but as we grow older, as organ functions start to decline, bones too become weaker and overall functioning of body slows down. This article brings out the facts on how bones change through every phases of life – childhood, adulthood and old age, along with diseases which can attack bones and how to maintain bone health tackling these ailments.
Childhood – Bone forming years:
Childhood and adolescent years are sculpted by modelling which helps bones in kids to grow in size and shift in space helping them to become taller as they grow. In this growth phase, resorption occurs inside bones and new bone formation occurs on its outer surface. Gradually, bones get thicker as formation occurs on both outer and inner surfaces. The formation of size and shape of the skeleton follows a genetic program, and is also greatly affected by loading and impact sustained by the bones which occurs with physical activity. Eventually, bones achieve the shape and size that fit their function best.
How to maintain bone health in childhood:
As the body grows, bones will grow too and to assist their healthy growth, children need ample supply of nutrients and must lead an active physical life like walking, running, playing outdoor sports. Our bodies are most capable of absorbing calcium and building stronger bones in these years, therefore investing calcium in childhood is important for building peak bone mass and density, so that later years of life are free from bone diseases due to aging or nutrient deficiencies. Vitamin D aids in absorbing calcium in body, therefore its normal levels are crucial for bone health and can be easily attained by sunlight exposure for 15 to 20 minutes.
From birth to the age of 25, a well-balanced diet rich in milk products, green leafy vegetables, fish, and tofu, adequately supplemented by vitamins and minerals is crucial for healthy bones and is a good first step in developing bone mass.
What robs adolescents from attaining peak bone mass are factors like smoking, poor nutrition, inactivity and excessive alcohol intake. Obesity and early or late onset of puberty can affect peak bone mass. Obesity accelerates the onset of puberty in girls while having variable effects on bone mass. Regular menstruation cycles are good indications of normal levels of estrogen being produced in the body which is crucial for calcium absorption in kidneys and intestines. Childhood obesity delays the onset of puberty in boys and can cause reduced bone mass more life.
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Bone ailments seen in children and adolescents mainly include:
- Rickets (softening and weakening of bones causing delayed growth, bowed legs, weakness main leg pain, which arises mainly due to vitamin D deficiency)
- Delayed or stunted growth due to nutritional deficiencies and malnutrition
- Juvenile Osteoporosis (Porous bones making them prone to fractures).
- Bone fractures or injuries
- Bone tumors
- Developmental skeletal disorders like connective tissue bone disease, Osteogenesis imperfect causing pathologic fractures, short stature and abnormal bone formation.
Adulthood – Bone Maintaining Years:
Remodelling of bones continues throughout life and replaces most of the adult skeleton about every 10 years. As we get older, resorption occurs on inner surfaces while bone formation occurs on outer surfaces, which can partially compensate for the strength loss due to thinning of the cortex. New bone formation does not occur as readily as before. Adulthood is marked by bones being at their peak strength after achieving peak bone mass.
How to maintain bone health in adulthood:
Maintaining bone mass throughout the adulthood is essential to prevent weaking of bones and early onset of bone diseases. Diet should include enough calcium, vitamin D and potassium to cater daily calcium needs of the body and prevent withdrawals of calcium from the skeleton.
In healthy individual, bone mass usually remains stable between ages 25 to 40, as calcium intake and loss are at equilibrium. However, during pregnancy or breastfeeding, body requires increased intake of calcium and vitamin D via diet or supplements to cater to needs of mother as well as developing child.
To slow down bone loss and maintain bone mass, physical activities like running, walking, weight-bearing exercises, aerobics etc are important. Leading an active lifestyle and acquiring good sunlight exposure in mornings will not only boost bone health but also maintain muscles mass, which is crucial to preserve and strengthen surroundings bones. A well-balanced diet rich in calcium and vitamin D will keep calcium reserves in bones stable and cater to body’s needs. Avoiding smoking, excessive alcohol and caffine consumption and timely treatment and management of other conditions like thyroid disorders and diabetes will also prevent bones from falling prey to diseases in the most energetic years of bone’s life.
Bone ailments seen in adulthood:
- Weaker bones due to nutritional deficiencies
- Joint pain and constant pain in bones of back limbs
- Bone fractures or injuries due to early onset of osteoporosis
- Arthritis due to viral infections, conditions like diabetes, thyroid disorders
- Osteomalacia (softening and weakening of bones causing developed growth, bowed legs, weakness and painful legs mainly due to vitamin D deficiency).
- Bone tumors
Post Adulthood – Bone Loss Years:
This phase is marked by decline in mechanical function of bones and reduced bone deposition with each cycle of remodelling, possibly due to reduction in number of osteoblasts precursor stem cells, or due to reduced lifespan of osteoblasts.
Women enter menopause between the ages of 42 to 55, which causes levels f estrogen to fall drastically, causing rapid bone loss. Most of women lose around 40% of their spongy, inner bone and 10% of their hard, outer bone within 10 years of menopause. Women are prone to weaker bones and various bone diseases and injuries in higher numbers than men in every age group.
Many aged individuals suffer from various diseases like diabetes, thyroid disorders, kidney diseases which worsen bone health. Body slowly has decreased ability to absorb calcium while the skin’s ability to absorb vitamin D declines as well. Most elderly lead indoor lifestyle which lowers chances of acquiring vitamin D from sunlight exposure, causing poor vitamin D status.
How to maintain bone health in post-adulthood:
The senior years of life need more care and attention to your bones and nutritious diet rich in fruits, vegetables, proteins, fiber foods, low-fat dairy foods (milk, yoghurt, and cheese) fortified with calcium and vitamin D are essential to keep bones healthy. Mild non-taxing physical activities like jogging, posture exercise, mild stretches, and yoga without pressuring joints or worsening illness should be performed. Prevent falls and support your spine with a cushion or mattress to prevent jerks on spine or fractures.
Bone ailments seen in post-adulthood:
- Ageing related joint pain and constant pain in bones of back, limbs.
- Various types of Arthritis, spondylitis, gout affect body’s joints manifesting as swelling, pain, redness and stiffness, causing difficulties in sitting, standing and other movements.
- Osteoporosis affects the bones as it weakens the bones, causing the bones brittle, porous and increases the risk of fractures.
- Bone tumors.
Diagnose of bone diseases:
Bone anomalies may present mild or severe symptoms which are analyzed by doctor who conducts various tests of the patients. If bone anomaly is suspected, following biochemical and imaging tests are done to confirm the diagnosis.
- Blood Tests: Blood tests estimate the levels of calcium, 25-hydroxyvitamin D, parathyroid hormones, thyroid hormones, vitamins, as well as markers for bone formation like bone specific alkaline phosphatase, osteocalcin etc. For diagnosing impending bone diseases, levels of follicle stimulating hormone (FSH) are analyzed to check for menopause in women and testosterone in men for its deficiency. Blood drawn is used to confirm arthritis with analysis of complete blood count, erythrocyte sedimentation rate, along with levels of rheumatoid factor, extractable nuclear antigen and certain specific antibodies like anti-citrullinated protein antibody (ACCP), antinuclear antibody (ANA) etc.
- Urine Tests: Urine tests are done to check for several markers of arthritis and osteoporosis by detecting the presence of white blood cells, red blood cells, proteins or pathogens in the urine sample.
- Bone Mineral density Measurement: Dual energy X-ray absorptiometry test (DEXA scan) is the gold standard test widely done to calculate bone mass by measuring the bone mineral density in the hip or spine bones.
- Imaging Tests: These tests are generally performed on joints and surrounding tissues to visualize inflammation, cartilage loss, bone spurs and fractures. These mainly include X-rays and magnetic resonance imaging (MRI) scan, Computed Tomography (CT) scans.
Treatment of bone diseases:
Delayed growth and development in kids is treated with nutrient supplements and medications are prescribed to treat bone injuries like fractures. For diseases like arthritis and osteoporosis, treatments focus on preventing symptoms from worsening as there is no cure available. They are tailored individually according to severity of the disease. Certain medications like vitamin D and calcium supplements, tablets to increase bone mass and other disease-modifying drugs like antirheumatic drugs (DMARDs), corticosteroids, nonsteroidal anti-inflammatory drugs (NSAIDS) etc are prescribed to relieve pain and inflammation and control the flare up of symptoms. Physical therapies like hydrotherapy, physiotherapy etc give relief from pain associated with arthritides. When treatments fail and symptoms hinder daily life activities, joint replacement surgeries are done.
Bones may appear strong, but still need care at every phase of life, regardless of being in childhood or adulthood. The more bone you lay down before 30 years of age, the more you maintain in your later years. Subtle signs of declining bone health must not be neglected and do needful as prescribed by your doctor and follow the suggestions mentioned above.