Prevention Strategies

Prevention Strategies - Bone Guard Intro

• Metabolic Bone Diseases (MBDs): Disorders of bone strength, primarily osteoporosis (porous bones, ↑fracture risk) and rickets/osteomalacia (defective mineralization).
• Significance (India): High prevalence due to nutritional deficiencies (Vitamin D, Calcium) & ↓sunlight exposure. Prevention is crucial.
• Major Preventable MBDs: Osteoporosis, Rickets, Osteomalacia.
• Scope of Prevention:
  • Primary: Building strong bones from early life; optimizing peak bone mass.
  • Secondary: Screening & early intervention for at-risk groups.

⭐ Peak bone mass is largely achieved by age 25-30 years, making youth crucial for prevention!

Prevention Strategies - Diet & Defenses

• Calcium: RDA 1000-1200 mg/day. Sources: Dairy, ragi, sesame, leafy greens. Absorption ↑ by Vit D.
• Vitamin D: RDA 600-800 IU/day. Sources: Sunlight (10 AM-3 PM, 15-30 min), fortified foods, fatty fish. For Ca absorption. 📌 "Sunlight, Supplements, Salmon!"
  • Deficiency: Rickets, osteomalacia, ↑ fracture risk.
• Protein: For bone matrix. RDA 0.8-1 g/kg/day.
• Key Micronutrients:
  • Vit K: Green leafy veg; bone mineralization.
  • Magnesium: Nuts, seeds; bone structure.
  • Phosphorus: Dairy, meat; bone mineral.
• Goal: Balanced diet to prevent osteoporosis & fractures.

⭐ Ragi (finger millet) is an excellent, affordable, and widely available Indian source of calcium, providing approx. 344 mg per 100g.

Prevention Strategies - Active Armor

• Exercise: Cornerstone of bone health.
  • Weight-bearing (e.g., walking, jogging): ≥30 min, 3-5x/week.
  • Muscle-strengthening (e.g., weights, resistance bands): 2-3x/week.
• Lifestyle Adjustments:
  • Smoking cessation: Essential for bone density.
  • Alcohol: Moderate intake (e.g., ≤1 drink/day for women, ≤2 for men).
  • Caffeine: Limit intake (e.g., <400mg/day, approx. 3-4 cups of coffee).
• Fall Prevention (Elderly): 📌 SAFE Homes
  • Strengthen balance: Exercises like Tai Chi.
  • Assess & modify home: Good lighting, remove trip hazards (e.g., loose rugs).
  • Footwear: Proper-fitting, non-slip shoes.
  • Eye check-ups: Regular vision tests.

⭐ Regular weight-bearing exercise is associated with a 30-50% lower risk of hip fracture in older adults.

Prevention Strategies - Scan & Shield

• Screening (Osteoporosis):
  • DEXA Scan: Gold standard.
    • Indications: Women ≥65y, Men ≥70y. Younger with risk factors (early menopause, steroids >3mo, low BMI, prior fragility fracture).
    • Interpretation: T-score ≤ -2.5 (Osteoporosis).
  • FRAX Score: Assesses 10-yr fracture risk. Indian FRAX tool available; aids treatment decision-making.
• High-Risk (e.g., GIO):
  • Prophylaxis: Ca + Vit D for all on long-term steroids (e.g., Prednisolone ≥5mg/day for ≥3mo).
  • Bisphosphonates: Consider if T-score ≤ -1.5 or prior fragility fracture, especially with ongoing steroid use.
• Primary Pharmacologic Prophylaxis:
  • For very select, very high-risk cases.

⭐ Key DEXA indication: All women aged 65 years and older, and men aged 70 years and older, regardless of clinical risk factors.

High‑Yield Points - ⚡ Biggest Takeaways

• Adequate Calcium (1000-1200 mg/day) & Vitamin D (600-800 IU/day) are foundational.
• Engage in regular weight-bearing exercises like walking or jogging.
• Ensure sufficient sunlight exposure for Vitamin D synthesis (e.g., 15-30 mins daily).
• Avoid smoking and excessive alcohol consumption to maintain bone density.
• Implement fall prevention measures, especially in the elderly.
• Consider DEXA screening for high-risk groups (e.g., postmenopausal women, chronic steroid users).
• Maintain a balanced diet with adequate protein, magnesium, and Vitamin K supporting bone health.