Osteoporosis is affecting people in their 20s and 30s. Doctors are calling it an epidemic.
How safe is your lifestyle?
That constant ache in your back could be osteoporosis – even if you’re
still in your 30s. Rajesh Patil, a construction supervisor in Mumbai, was diagnosed
with osteopenia at the age of 33. A sedentary lifestyle combined with long hours of
standing and no exercise at all had combined to weaken his lower body. ’When I
saw his x-ray and MRI scans, I couldn’t believe I was looking at the bones of
a young man,’ says his doctor, orthopaedic surgeon Rajesh Badiyani.
The brittle bone disease is usually associated with women over 50, but sedentary
lifestyles, unhealthy diets and Vitamin D deficiencies are seeing earlystage
osteoporosis pop up in men and women as young as 35. “It’s become an epidemic,”
says Dr Amit Nath Mishra, senior orthopaedic consultant at Max Hospital, Noida.
“The numbers have shot up in the last decade and almost 30% of the patients under
40 that come to us today have early-stage osteoporosis.”
Osteoporosis is a silent disease and most people don’t realise their bones are
weakening until a spinal disc collapses or they suffer compound fractures after a
simple fall.
Among the red flags to watch out for are acute Vitamin D deficiency combined with
chronic pain in the back or legs, since Vitamin D helps the body absorb calcium.
“You also have a higher chance of developing early-stage osteoporosis if you have
or had an endocrine disease such as disorder of the parathyroid glands, thyroid
dysfunction, diabetes or kidney disease, or if you have taken steroids to treat
conditions such as asthma, premature menopause, testosterone failure or any other
hormonal disorder,” says Dr SV Madhu, head of the endocrinology department
at Delhi’s Guru Teg Bahadur hospital.
“If you spend most of your time sitting at a desk, indoors, and you have aches in
your limbs or back, you must get a bone densitometry test,” Dr Mishra adds.
For Mumbai-based construction supervisor Rajesh Patil, 35, the trouble began four
years ago. A sedentary lifestyle combined with long hours of standing and no
exercise at all combined to weaken his lower body.
“I was in near-constant pain for 18 months before I saw a doctor. I ignored it because
it was mild and that was a big mistake,” he says. By 33, the pain had become so
severe that he had to see a doctor, and was diagnosed with osteonecrosis, a
condition marked by low blood supply to the bones, and osteopenia.
The pain had been caused largely by the osteonecrosis, as a result of which
Patil had been moving around even less than usual, worsening his osteopenia.
“When I saw his x-ray and MRI scans, I couldn’t believe I was looking at the
bones of a young man,” says Dr Rajesh Badiyani, the orthopaedic surgeon at
Fortis hospital in Navi Mumbai who treated Patil. “If the osteopenia had developed
into full-blown osteoporosis, he would undoubtedly have suffered fractures in his
lower body. As it is, he needed hip replacement surgery and months of physiotherapy
and vitamin and calcium supplements before he regained his health.”
HOW TO FIX IT
She was only 15 when her cortisol hormone levels went through the roof, leading to
weakened bones and Cushing’s disease. “I began to put on weight at a terrifying rate,”
Anand says. “By the time I was diagnosed, I weighed about 130 kg and my condition
had got so bad that my shins would ache when I walked.”
Today, Anand weighs a healthy 54 kg and is osteopaenic, a pre-osteoporosis condition
in which the bones themselves have strengthened, but the body is still not absorbing
as much calcium as it ought to.
“If the cause of the osteoporosis is hormonal and is identified and treated, it will most
likely reverse the condition,” says Dr Madhu of GTB hospital. “We are seeing a
growing number of spine, hip and forearm fractures among people in their 30s as a
result of early-stage osteoporosis,” says Dr Badiyani. Additional factors causing weak
bones in young adults include higher incidences of smoking, and teenagers
crash-dieting. “Smoking leads to low bone metabolism and a decrease in bone mineral
density,” says Dr DD Tanna, orthopaedic surgeon at Mumbai’s Jaslok hospital.
“Dieting causes youngsters to end up deficient in proteins and vitamins at a crucial
juncture when their bones should be growing and strengthening.” Regular exercise,
a nutritious diet, calcium supplements and plenty of sunshine helped Sakshi Anand,
29, deal with her prema- ture osteoporosis.
BALANCE IS KEY
The first step is to eliminate pain. “Many people diagnosed with osteopenia or
osteoporosis think the more they work out, the better they’ll get, but this can cause
muscle fatigue,” said Lipi Verma, senior physiotherapist at AktivOrtho, New Delhi.
“Physiotherapy can help here, especially for people with osteopenia.”
Start with low-stress routines like head rotations, shoulder movements and movements
of other joints along with proper breathing. “Later, you can move on to strength
training and balance or agility training like standing on one leg and running an
obstacle course,” Verma says.
CAN YOU REALLY TRUST VIRTUAL DIAGNOSES?
How accurate are virtual diagnoses? Can artificial intelligence outperform IRL
(in real life) doctors in diagnostic accuracy?
Not quite, concluded a study by researchers at Harvard Medical School last week.
Their findings, published in JAMA Internal Medicine, revealed that doctors make
a correct diagnosis more than twice as often as 23 commonly used symptom-checker apps.
Computer checklists and other idiotproof apps are routinely used to reduce medical
errors, evaluate diagnoses and streamline infection-prevention protocols in clinics
and hospitals, but their increasing use outside hospitals by people with no medical
training is a potential risk.
With algorithms taking health diagnosis to anyone with a smart device, millions are
going online to self-diagnose before deciding whether they need a doctor at all.
And people seem to trust the online diagnosis implicitly. Almost half (47%) of more than 2,000 people surveyed in the UK said they had looked up their symptoms online before visiting a doctor; one-fifth said they had questioned their doctor’s diagnosis based on online information; and half would have preferred their doctor give them whatever prescription, treatment or referral they requested based on their selfdiagnosis, reported the BMJ on Thursday.
DOCS USUALLY DO KNOW BETTER
By insisting that your app knows best, you not only risk annoying the doctor on whose skills you are depending to restore your health, you are also risking your health itself. Human doctors know their job better than virtual ones, even though they are not always right.
And doctors do dramatically better than algorithms when the diseases are rare, severe and more difficult to diagnose, with computers faring better with less acute and more common conditions.
Physicians, too, make diagnostic errors – not recognising symptoms, diagnosing later rather than sooner – 10% to 15% of the time, found the Harvard study that judged the skills of 234 internal medicine doctors on 45 clinical cases, involving both common and uncommon conditions.
For each case, doctors were asked to give the most likely diagnosis, and two additional possible diagnoses. Doctors made the correct diagnosis the first time, 72% of the time, compared with 34% for the digital platforms. Eighty-four percent of clinicians listed the correct diagnosis among the top three possibilities, compared with 51% for the digital symptom checkers.
The Harvard study concludes that computer-based algorithms are best used along with human decision-making, to reduce diagnostic errors.
SYMPTOM CHECKERS
Online symptom-checkers also go wrong in triage advice, but they are better than phone triage services and Internet searches, found a study published in the BMJ last year. Symptom checkers hosted by medical schools (including Harvard Medical School), hospitals, insurance companies and government agencies (including the UK’s National Health Service) ask users to list their symptoms and use methods such as multiple choice checklists and free text entry to offer a list of potential illnesses that could cause the listed symptoms and suggest whether they need a doctor immediately, over the next few days, or whether the problem can be treated at home. The BMJ review of 23 widely used symptomcheckers found that they provided correct triage advice in 58% of cases, with the checkers doing better in more critical cases, correctly recommending emergency care in 80% of urgent cases. In comparison, online search engines led to content that prescribed emergency medical treatment 64% of the time. Diagnoses, however, varied across apps. Checkers with the most accurate diagnoses (Isabel, iTriage, Mayo Clinic, and Symcat) were not on the list of the programmes that did the best job of recommending the appropriate level of care for a given case (Healthychildren.org, Steps2Care and Symptify).
HOW TO CHOOSE A GP
So, if you want quick medical advice, where do you go?
Go to a symptom-checker, but treat it as an enabling tool and not a clinician. Doctors bring experience, observation and physical examination into the equation, which leads them to the correct diagnosis more often.
It’s important to have a general physician who either lives near you or responds quickly to emergency texts or calls. Since house calls are not possible, you should be able to call him or her to guide you in an emergency. Make a list of your symptoms and the questions you want answered before calling, to save time.
Always mention your prescription medicines, surgeries and treatments you’ve undergone, and pre-existing conditions such as high blood pressure, diabetes or thyroid disorders. It helps if your general physician is attached to a multispecialty hospital so he can review your treatment course in case you need hospitalisation.
HEARING PROBLEMS? IT COULD ALL BE IN THE BRAIN
The reason you end up repeating yourself so often at family dinners may have nothing to do with hearing—instead with how the aging brain perceives speech amid background noise. Researchers at the University of Maryland found that older adults struggle to follow speech amid background noise, even when their hearing is found to be normal on clinical assessment. The study, published by the Journal of Neurophysiology, states that adults aged 61 to 73 with normal hearing scored worse in noisy environments than youngsters between 18 and 30.
PUT IT OUT. WEED DOESN’T HELP YOU SLEEP
Marijuana users may say a joint a day helps them sleep better, but a new study by the Boston University School of Public Health has found that daily marijuana users actually scored higher on the Insomnia Severity Index and on sleep disturbances compared to occassional smokers. The study, published in the Journal of Addictive Diseases, examined sleep patterns of young adults in their 20s. The findings indicate that while occasional marijuana use doesn’t disrupt sleep, heavy or daily marijuana use is actually associated with sleep difficulties.
