BONE HEALTH IN AGING

We all know that bone health is one of the most neglected factors in our daily routine life, especially in older individuals. As one grows out of childhood, bones acquire bone mass, which gives strength to the bone. This continues till 30 years of age, after which there is continuous decline in bone strength and mass. In women, post-menopause (cessation of menstruation) there is sudden and rapid decline in bone mass, which lead to increased frequency of osteoporosis in them. However, after 70 years of age, both men and women are at equal risk of developing osteoporosis.

What are the reasons for osteoporosis?

There are few common causes that lead to osteoporosis:

1. Menopause is an important cause of osteoporosis. Due to loss of protective estrogens there is rapid bone loss and women with premature ovarian failure at young age develop it to a greater extent.

2. Inadequate intake of vitamin D and calcium. Studies have shown that vit. D deficiency is rampant in India and that leads to calcium loss and bone demineralization, as calcium is not available through meals

3. Lack of physical activity leads to decrease muscle bulk and increase bone Calcium loss. Hence, regular exercise schedule is must to prevent osteoporosis.

4. Smoking and alcohol intake are detrimental to bone health and lead to increase chances of fracture.

5. Other endocrine disease, bone related diseases and chronic medications like steroids may lead to decrease in bone mass and increase fracture risk.

How can it be diagnosed?

Osteoporosis might stay hidden have till there is a fracture. While vertebral fractures are common, patients may present with complain of backache, forward stooping of back or with more severe hip fracture, which increase risk of death in person and cause movement restriction. Hence, the recommendation that every woman more than 65 years of age and men more than 70 years of age should under go testing for osteoporosis using a DEXA Scan of hip and spine which may detect incidental fractures also.

What are the treatment options available?

Treatment is simple

• Adequate physical activity 
• Nutritious food rich in vitamin D and calcium  
• Lifestyle modification: Quitting smoking and alcohol is of utmost importance.
• Women with early menopause (before 40 years) should be treated with hormone replacement therapy to prevent bone loss in consultation with their treating expert.
• Medication: both oral and injectable forms are available. But drugs have their side effects and should be taken under supervision of endocrinologist.

Is it possible to prevent osteoporosis?

A healthy lifestyle, and regular intake of calcium and vitamin D starting from younger age group helps in achieving a good bone mass and prevention of osteoporosis.   

Dr Vineet Surana

MD, DM Endocrinology

Consultant Endocrinology

Metro Heart Institute and Hospital

Delhi.

GUIDE TO A HEALTHY MENOPAUSE

There are three important hormonal milestones in any woman’s life cycle: 

• Puberty 
• Pregnancy 
• Menopause. 

Puberty and pregnancy are instrumental in defining womanhood. These hormonal events are responsible for continuation of mankind and make women biologically distinct and superior to their male counterparts. This positive hormonal balance continues till age of 45 to 55 years and comes to an end at, what we call, menopause.

Why this discussion about Menopause?

Menopause is an important milestone in any woman’s health cycle. Female hormones viz. estrogens and progesterone are responsible for maintaining cyclical menstrual bleeding and thus fertility in women. These hormones, especially estrogen, have been shown to have a tremendous positive impact on health of other organs like bones, heart and brain. At menopause, secretion of these hormones gets halted. This predisposes the women towards poor health outcome in form of disruption in sex life, osteoporosis (weak bones), heart problems and also increased risk of dementia (decreased thinking power).

How do you identify impending menopause?

Menopause happens usually between 45 and 55 years, but, the average age of menopause is 51 years. In general, you can expect to have menopause at approximately same age as your mother or sister had., Changing hormonal milieu can lead to some of the symptoms of menopause even years before you stop having menstrual periods. The most common symptoms are irregular periods, hot flashes, night sweats, mood changes, sleep problems, and vaginal dryness.

Can we discuss Hot-Flashes in little detail?

Hot flash:

Hot flashes are experienced as a feeling of intense heat with sweating and rapid heartbeat, and may typically last from two to thirty minutes, ending with chills and shiver.  The sensation of heat usually begins in the face or chest and it can spread throughout the whole body. Hot flashes may be associated with a feeling of anxiety or heart palpitations during the hot flash. The hot-flashes may happen few times each week or every few minutes throughout the day. Hot flashes are often more frequent and more intense during hot weather or in an overheated room. When hot flashes happen during sleep, they are called night sweats.

Does every woman with menopause needs treatment?

Menopause is a normal physiological event in any woman’s life. In view of positive impact of female hormones on all body function, there had been a great enthusiasm towards treating every woman with these hormones in past. But, recent studies have suggested that benefit of this treatment is not uniform and great and may even harm woman. But, this does not mean that a woman with menopausal symptoms have to suffer. We have safe and established treatments to alleviate these symptoms and thus improving quality of life during menopausal transition. Even hormonal replacement for short term periods has been shown to be safe. But, individualization of treatment is of paramount importance in management.

Apart from symptomatic management, what are the health issues requiring specific attention?

Heart and Bones. 

Osteoporosis is one issue, importance of which cannot be overemphasized. Every woman should get a DXA scan (bone density test) done ten years post menopause and get it evaluated by their hormone specialist (Endocrinologist). As diabetes is becoming more prevalent in our society, heart problems in post-menopausal age are becoming more and more common. So getting your blood sugars and cholesterol tested would be good idea. Another health issue which should not be overlooked is depression and anxiety. 

All these little things can help you to continue your life as before. 

Happy Menopause to you.

Dr Rajiv Singla

HOD and Consultant, Endocrinology Department

Kalpavriksh Superspeciality Clinic & Saket City Hospital

www.kvsc.in

Normal aging - a Myth

What do we understand by normal aging ?

Normal aging is a myth. Aging is a variable phenomenon that affects different individuals differently. The gradual wear and tear of any machinery depends on how well it has been maintained and taken care of. Till our youth the organs are growing and the regenerative capacity of our body organs is very active. But post youth the normal consequence of growth is the regenerative capacity decreases drastically because of genetic programming of cell death and the external environmental influences, which may hasten the process. The cell death lead to decreased capability to handle the environmental stress in return. The way we live, our diet, physical activity and the stress both physical and psychological causes a string of events in our body that would in the long run would determine the rate of decline in our normal functions. Added to this would be the illnesses that start appearing in the in the middle age and increase the burden of aging on the life quality.

What are the various changes that occur with aging?

Various organs show different physiological changes during aging. The table below summarizes the changes in a nutshell.

Organ	Aging changes
Skin	Skin becomes less elastic and more lined and wrinkled. Nail growth slows. The oil glands gradually produce less oil, making the skin drier than before.
Hair	Gradually become thinner. As hair pigment cells decline, gray hair growth increases
Face	Wrinkles, facial hair, bags under the eyes, double chin, longer ears, thinning cheek.
Hearing	High-frequency sounds become  harder to hear and changes in tone and speech less clear especially after 50.
Vision	Lenses in the eyes become less flexible (presbyopia). Night vision and visual sharpness to decline.
Nose	Ability to smell declines after age 65, amount of reduction varies widely between individuals.
Height	By age 80, it's common to have lost as much as 2 in. (5 cm) in height, posture and compression of joints, spinal bones, and spinal discs.
Body Weight	Weight declines between age 55 and 75, due mostly to loss of lean tissue, muscle mass, water, and bone.
Fat	Fat content and distribution change, storage increases
Sleep	Less sleep at night, and you may not sleep as deeply as you did when you were younger. Frequent midnight and early morning awakenings.
Brain	Gradual loss of brain tissue ( 5-10% by age 90), slow reaction, faltering memory, insomnia. Mental and physical responses to specific stimuli become slower.
Heart	Thickening of heart wall, gradual loss of effectiveness as a pumping machine.
Lungs	Lose elasticity and capacity (40% between ages 20 and 80), increasing difficulty to oxygenate blood.
Joints	Cartilage becomes cracks and frays, cushioning fluid gets thinner, tendons and ligaments are less resilient.
Bones.	Loss of bone cells accelerates at about age 35, bones become porous and brittle in the demineralizing process. Osteoporosis is common in women.
Metabolism and body composition.	Over time, the body typically needs less energy, and your metabolism slows. Hormone changes in the aging body result in a shift to more body fat and less muscle mass.
Abnormal Growth	Cancers, hyperplasia, and macromolecular aggregates become common.
Arteries	Cholesterol and calcium buildup, walls thicken, arteries harden, high blood pressure, risk of heart attack.
Blood	White blood cell and red blood cell count decrease.
Kidneys	Weight & volume of the kidneys shrink, marked reduction in the cleansing of impurities from the blood.
Bladder	Connective tissue weaken, lower capacity to store urine, and reduced efficiency of emptying content.
Prostate	Reduction in semen making after 60, enlargement in size may cause difficulty to urinate.
Reproductive System	Women go through menopause at ages of 45 - 50, reduced level of estrogen affects the whole body. Men's reproductive change with age is more like a reduction than a cessation.
Breast	Mammary (milk secreting) glands reduce in size, as does the breast.
Hormones	The level of several hormones, e.g., GH, DHEA, IGF falls with age, may be a major cause on ageing.
Immunity	Body's power to combat infection declines; auto-immune responses increase.
Muscles	Loss of muscular mass, partly due to un-use, other causes include loss of blood flow and energy supply.
Nerve	Demyelination - loss of myelin covering of nerve fibers, which is characteristic of neurological disorders.
Voice	Voice becomes weak and muffle
Tongue	Sense of taste loses only gradually with age, with equal reduction of all flavors.
Teeth	Teeth gum recession
Thermoregulation	Response to changes in environmental temperature becomes impaired.

What is Healthy aging?

Healthy aging is a way of lifestyle that may partially neutralize the deleterious effects of aging leading to a productive life for a longer life span. Even though genetic influences cannot be completely neutralized but the environment we create around us do influence the gene expression even when we are not able to appreciate those changes immediately in our body. Even minor changes in our lifestyle may lead to a happier and more satisfactory old age.

What is the role of preventive healthcare in healthy aging?

Preventive healthcare means actively intervening in the process of aging to look for illnesses, disabilities and stressful conditions so that they may be rectified at an early stage by lifestyle interventions. Preventive healthcare is a mindset that dynamically evaluates a lifestyle in terms of its long-term consequences both good or bad and finding where the problem lies and thereafter looking for the achievable solutions according to the individuals circumstances. This in the long term would decrease the load of chronic diseases in the old age and decreasing the economic burden due to health concerns of an individual and thence of a society.

More detailed overview of the different organs would be taken one by one in the next few posts.

Till then, stay healthy and stay ageless...

Dr Sweta Singla

Consultant Neurology

KVSC

www.kvsc.in 

AGING & the elusive search for ELIXIR

As we grow, from the infancy to childhood and thereafter progressing to youth, we have a natural eagerness to grow. We anticipate increasing stamina and maturity wherein we will be strong, energetic and would have loads of stamina to achieve our goals. But as we grow older, we want the time to stop in this elusive youthful state and want to defer growing old, as aging is commonly associated with illness, decreased stamina, loose skin and thin hair etc. And at a time like this, we wish we could get our hands on some elixir that would keep us in the state of youthfulness. We want to stay physically and mentally agile and remain beautiful as we once were in our young age.

The next series of articles in our blog would discuss various issues dealing with aging. What we understand by it? What are the normal changes associated with it?

What can we do holistically about decreasing the impact of aging or let’s say to keep our mental and physical machinery in a good state for longer time? In the next few articles, we will unfathom the mystery that is aging and how we can slow the process, thereby decreasing its impact.

Bringing you a GOOD HEALTH WISH.

Dr Sweta Singla

Consultant Neurology

Kalpavriksh Superspeciality Center

01128082828

www.kvsc.in

Sleepless in Pregnancy

Sleeplessness or poor sleep is one of the many problems that expecting mothers have to deal with. That leads to increase in the fatigue that a woman already faces during these trying times.

Why is good sleep important during pregnancy?

The possibility of the woman having a low birth weight baby and pre-term labor increases because of the poor sleep during this period.  There is a link between birth complications and expectant mothers’ sleep that appears to be in disruptions to normal immune system function, caused by insufficient and low-quality sleep.

Why do pregnancy lead to sleep problems?

Several factors that contribute to the sleep difficulty during pregnancy are:

Hormonal changes. 

Pregnancy is a time of major hormonal shifts, which change sleep cycles and can disrupt sleep. Rising levels of progesterone may cause increase in BMR and may cause fatigue, as well as more sleepiness during the day, leaving women unusually wakeful at night. Fluctuating levels of estrogen also interfere with sleep. Levels of the hormone progesterone soar and your metabolism is running high. This can make you feel exhausted. At the same time, lower blood pressure and increased blood production might team up to sap your energy. If you have another child or children to care for, you might experience even more fatigue.

Leg cramps: 

Dehydration, increase in weight and hormonal shifts all might cause the leg cramps and might hamper your sleep.

Shortness of breath: 

Because of the increase in the uterus size that might put pressure on the diaphragm, which is one of the breathing muscle. This pressure increase in supine position while sleeping and worsens the ability to sleep.

Nocturnal heartburn or gastro-esophageal reflux disease (GERD) : 

Pressure on the stomach by uterus and loosening of the lower esophageal sphincter leads to increased heartburn that again increases in lying down position.

Pain Syndromes:

Many types of pain that occur during this period like Back pain, Joint pain, Carpal tunnel syndrome (numbness in the hands that occurs due to fluid retention during this period) and Breast tenderness might hamper your sleep during this period.

Itching: 

Pruritus during pregnancy might get exaggerated and lead to persistent itching that might increase your sleeplessness.

Nightmares:

Vivid dreams or nightmares increase during pregnancy because of the hormonal shifts that increase the REM Sleep during this period and it is responsible for increased dreaming, which might cause increased anxiety in the pregnant women.

Anxiety.   

Anxiety about the pregnancy itself as well as about managing all the aspects of their lives alongside the impending arrival of a new baby might scare away the women to make them sleepless.

It is also during this phase of pregnancy that preeclampsia may occur, which has an impact on the timing of sleep or circadian rhythm.

What can a woman do to improve her sleep during this pregnancy?

Few simple things may improve your sleep and better the fatigue and the quality of life during pregnancy.

Sleep on the left lying position.                           

Lying on your left side can help improve blood flow to your baby and to your body. Also, try to keep one or both knees bent. And it's OK though, if you wake up in a different position.

Use pillows.                    

To prevent discomfort, consider using pregnancy or support pillows between your bent knees, under your abdomen and behind your back.

Elevate your headend while sleeping.               

Elevating the head of your bed can prevent or decrease heartburn or snoring.

Maintain a sleep schedule and follow good sleep hygiene.                    

Regularly go to bed and wake up at the same time. If you need more sleep, try napping early in the day.

Drink lots of fluids. 

Drink plenty of fluids during the day. To prevent frequent urination at night, cut down on how much you drink late in the day.

Plan your Nutrtion. 

Strive for a balanced diet rich in vitamins. A healthy diet can help you improve your energy levels and keep your pregnancy weight gain on target. To prevent heartburn, eat small, frequent meals and avoid fried foods, carbonated drinks, citrus fruits or juices, and spicy foods.

Keep active. 

Regular physical activity during pregnancy might help prevent excess weight gain and leg cramps, as well as boost energy.

Stretch. 

Stretching your calf muscles before bed may help prevent leg cramps during pregnancy.

Relaxation.

Breathing techniques, in particular, can help reduce tension.

Use nasal saline sprays or mechanical nasal dilators. 

These can relieve the nasal congestion that often occurs during pregnancy. Also, avoid smoking and exposure to secondhand smoke.

Creating an atmosphere to sleep.

A dark, quiet and comfortably cool environment can help encourage sleep.

Relieve pain safely. 

If minor pain caused by muscle stretching or your increased weight during the late stages of pregnancy is keeping you up, occasional use of acetaminophen (Paracetamol, others) might help.

Contributed By:

Dr Sweta Singla

Consultant Neurology & Sleep Disorder
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