Osteoporosis is like rust. It can eat away at bones, silently and insidiously, until the advent of painful fractures, collapsed spine and the characteristic `dowagers' hump'. Fragile bones are the result of osteoporosis and can have serious effects on quality of life. Just like rust, prevention is much easier than cure. Genetics is the main determinant of bone mass, but as a result of research there is much we now know and can do about our lifestyle and nutrition to help to keep our bones healthy.
Are Palestinian women suffering from osteoporosis?
Low bone mineral density (BMD) in premenopausal or perimenopausal women can arise from their failure to accrue adequate peak bone mass, from loss of BMD subsequent to peak bone mass attainment, or both.
Although risk factors for low postmenopausal BMD have been well characterized, risk factors for low premenopausal BMD and for greater premenopausal and perimenopausal bone loss are not well understood, even though there is increasing evidence to suggest that bone loss is a process that begins prior to menopause.
The distinguishing of risk factors for low premenopausal BMD from those for premenopausal bone loss may assist in the identification of women at greater risk for low postmenopausal BMD.
Anthropometric, reproductive, and lifestyle-related exposures may contribute to the variation in either BMD or rate of BMD loss. Among premenopausal women, body weight has been consistently and positively associated with BMD, although whether this factor is also related to bone loss is less clear. Irregular menses and amenorrhea have been consistently associated with lower BMD, but age at menarche has shown no consistent association with BMD or long-term bone change. Most studies of the long-term effects of parity and lactation have found no association with BMD or bone loss, although several studies have observed considerable short-term bone loss during pregnancy and lactation that is recovered with the resumption of menses.
Dietary intake of calcium, vitamin D, dairy products, protein, and sodium, as well as supplemental calcium, have been evaluated for association with peak BMD or its loss, with no consensus. Few studies of other nutrients, such as vitamin C and vitamin A, have been conducted, and they provide insufficient evidence regarding the role of such nutrients in BMD accrual or loss. Studies of other lifestyle factors such as alcohol consumption, tobacco smoking and physical activity in general populations are limited.
Lower BMD is associated with chronic illnesses such as asthma and cancer, but the impact of these associations is not well documented in population-based studies. Because BMD is, in part, genetically determined, an understanding of how family history might determine lower BMD and/or bone loss would facilitate the timing of intervention strategies. While lower BMD is the single best predictor of fracture among perimenopausal women, other data indicate that a history of fracture might indicate lower BMD.
Our study is designed to examine the modifiable distribution and determinants of bone mineral density among Palestinian women by employing a questionnaire that addresses socio-demographic and lifestyle factors while BMD will be measured at the lumbar spine (LS) and femoral neck (FN) using DXA (GE Lunar, WI, USA).