Category: General

Healthy eating habits and good blood glucose control helps to prevent the occurrence of heart disease. There is no one-size-fits-all approach to diet, but it is important to have a regular meal pattern with healthy carbohydrates like whole grains, vegetables and fruits. Avoid processed, baked, and deep-fried foods, shortenings, margarine as all of these contain transfat. Limit the use of high-fat dairy products and red meat, which contain large quantities of saturated fat. Aim for less than 2300 mg sodium/day ( 1 teaspoon salt/day). Try to include vegetables, fruits, legumes rich in fiber, fish such as salmon, mackerel, tuna, and sardines rich in omega-3 fatty acids in the diet.
In short, consuming complex carbohydrates (fibre rich foods), lean protein, heart-healthy fats and improving activity levels will form healthy lifestyle modification.

People with diabetes are at increased risk of heart disease. This can be because of various reasons: uncontrolled blood glucose levels, high blood pressure, high cholesterol levels, overweight, lack of physical exercise and smoking. In addition, some ethnic groups like Asian Indians are at higher risk compared to other populations. High blood pressure and high blood glucose make the blood vessel walls thick and less elastic.
The risk factors lead to increased injury and inflammation of the vessel wall, deposition of cholesterol and formation of plaques, and calcification. As these blood vessels become narrow, blood flow tends to slow down and form clots. These clots may get dislodged and block other blood vessels. Depending on the blocked blood vessels, it may be heart attack, stroke, blindness, or a block in the blood vessels of the lower limb leading to amputation. Managing these risk factors and controlling them to target has been found to reduce the risk of heart disease.

Author
Dr. Mathew John

Cardiovascular disease(CVD) is prevalent among people with diabetes. Many people with type 2 diabetes will eventually develop cardiovascular disease. People with diabetes are 2 to 4 times more likely than others to develop cardiovascular disease. Because this risk is so high, cardiovascular disease remains the most common cause of death; over 40-50 % of all diabetes deaths are due to cardiac diseases or stroke. It is more striking that younger people with diabetes have an increased risk of death due to CVD.

It appears that Indians are more susceptible to diabetes and cardiovascular disease. In Indians, cardiovascular disease occurs prematurely, i.e., one to two decades earlier than in the West. Compared with people without diabetes, Indians with diabetes have twice the mortality due to cardiovascular disease.

Author,
Dr Deepa G

Yes, Osteoporosis is treatable. However, the treatment of osteoporosis is not treating the bone alone. It includes adequate intake of nutrients (Calcium and Vitamin D), regular exercise, preventing falls and avoiding risk factors like smoking and alcohol. After discussing with your endocrinologist regarding the need for treatment, recommendations are given which are based on the chance of your risk of breaking a bone in the next 10 years using information such as the bone density test. There are several classes of medications used to treat osteoporosis. There are factors to consider when choosing the right osteoporosis medicine. These include sex, age, previous fracture, and other illnesses. In addition, the preference of the patient is considered like oral vs injectable treatment, daily vs once a week vs once a month/year treatment.

The main classes of medications that are currently available in India are:
·Hormone and hormone-related therapy: When osteoporosis is considered to occur due to low levels of oestrogen (in females) and testosterone (in males), treatment with these hormones is considered beneficial. Other related agents like Raloxifene and Calcitonin are also sometimes used.
·Bisphosphonates: These medications stop the body from re-absorbing bone tissue. There are several formulations (oral and injectable) with various dosing schemes (monthly, daily, weekly, and even yearly). These include Alendronate, Ibandronate and Zoledronic acid.
·Denosumab: It is available as an injection given every six months to women and men.
·Bone Building medications: These products build bone in people who have osteoporosis. The available medication is called Teriparatide and Abaloparatide. These drugs act like the bone hormone parathyroid hormone, and it stimulates new bone growth. It’s given by daily injection under the skin.
Once you have been diagnosed with osteoporosis, consult your endocrinologist to discuss the best treatment for you. It’s often not possible to say there is one best medication to treat osteoporosis. The ‘best’ treatment is the one that is best for the individual patient considering all factors.

Author- Dr. Tittu Oommen

Osteoporosis is a silent disease and usually does not produce any symptoms. Usually, the first sign of osteoporosis is a fracture; however, sometimes people notice that they have kyphosis (a hunchback) or a loss of height. Severe osteoporosis can be seen in X rays.
In screening camps, a peripheral DXA is commonly used. It measures the bone density at the heel. This could be considered as a screening test and should alert the physician that a more elaborate central DXA is needed. A central DXA uses a small dose of X rays to look at the bone of the spine, hip, and forearm to understand the density of bone. The density of the person’s bone is compared to that of a healthy person’s bone to get a T score. The level of the T score decides the degree of osteoporosis. There are other methods like QCT used for measuring bone density in research settings.

Author- Dr. Mathew John

To maintain healthy bones, women who are postmenopausal needs around 1200 mg of calcium along with adequate vitamin D, a healthy diet with adequate protein and regular weight-bearing exercise. This calcium intake can come from food, supplements or a combination of both. You can get the help of a dietician to understand if you take enough calcium.
You can even calculate it yourself using the calcium calculator (https://www.osteoporosis.foundation/educational-hub/topic/calcium-calculator).
The rest of the calcium can be supplemented with calcium tablets. Around 500 mg of calcium can be used daily in most patients with the intake is low. Some studies have shown a reduction in osteoporotic fractures with calcium.

Author- Dr. Deepa

Calcium is required for all age groups to build and maintain strong bones. Calcium is essential for the heart, muscles and nerves to function properly. Calcium requirement varies with age and sex. Women younger than 50 years require 1000mg/day, 51 and above requires 1200mg /day. Men up to 70 years require 1000mg /day calcium and 71 and above requires 1200mg/day (National Osteoporosis Foundation). For proper absorption of calcium, our body needs vitamin D in the right amount. The daily requirement of Vitamin D for women and men under age 50 is 400-800IU/day, above age 50 and older require 800-1000 IU/day.
If our body fails to obtain adequate calcium from the food we eat, it is taken from our bones and gradually can lead to making our bones weak, porous and easier to break. A variety of foods contain calcium, if it is consumed in the right amount, it’s enough to meet daily calcium requirements. Common sources of calcium are milk & milk products (curd, cheese, yoghurt etc), Green Leafy Vegetables like drumstick leaves, spinach, kale, broccoli etc, fish with edible soft bone-like anchovy, sardines etc and nuts and seeds like almonds, pistachios and sesame seeds. Ragi is also a rich and cheap source of calcium. It is good to understand how much calcium is present in the food that you consume e.g 100 ml of milk contains 120 mg of calcium and 100 mg of ragi contains 340 mg of calcium. Caffeine present in coffee, tea and soft drinks may interfere and decrease calcium absorption, so use in moderation. Fish like tuna, mackerel, and sardines are a source of vitamin D also.

Author- Mrs. Rejitha

Bone development is a process that starts before birth and continues till the maximum amount of bone is developed. This is called peak bone mass. More than 90 % of the peak bone mass is achieved by age of 20 in boys and 18 in girls. However, bone continues to get deposited to reach peak bone mass till the late 20s. Even during this period, there is the bone formation and bone destruction, but the net effect is new bone formation. Higher bone mass is associated with adequate calcium and vitamin D intake, protein intake, physical activity, genetic factors and appropriate timing of puberty and adequacy of sex hormones.
After 30 years of age, the bone mass is maintained and as age progresses the bone destruction takes predominance over bone formation. In women, around the time of menopause, the level of estrogen reduces and there is rapid bone destruction. Adequate calcium and Vitamin D intake, protein intake, physical activity and adequate hormonal levels ensure better bone strength.
Chronic uncontrolled medical illness (e.g., diabetes, bronchial asthma), use of steroids, loss of sex hormones (ovariectomy or orchidectomy), chronic alcohol use and smoking can cause a more rapid loss of bone and lead to fractures.

Author- Dr. Mathew John

Bone is living tissue that is constantly being broken down and replaced. Osteoporosis occurs when the creation of new bone doesn’t keep up with the loss of old bone. Osteoporosis affects men and women of all races. But white and Asian women, especially older women who are post-menopausal are at the highest risk. Currently, it has been estimated that more than 200 million people are suffering from osteoporosis. According to recent statistics from the International Osteoporosis Foundation, worldwide, 1 in 3 women over the age of 50 years and 1 in 5 men will experience osteoporotic fractures in their lifetime. Studies in India estimate that more than 50 million people have osteoporosis. Studies have shown that one-third of post-menopausal women in India have osteoporosis of the spine.
So, osteoporosis and osteoporotic fractures are very common the world over and in India.

Author- Dr. Deepa

Teeth are important. The absence of a tooth or multiple teeth can make common tasks such as chewing and speaking much more difficult. Some of the options available to replace missing tooth / teeth are removable partial / complete denture: It is a denture to replace partially / completely missing teeth, and the people using it can remove and reinsert it when required without any professional help. Next option is Fixed Bridge: It helps to replace the missing teeth permanently. The latest and advanced tooth replacing option is Dental Implants: They provide a permanent solution if you need to replace a single tooth, or multiple teeth, in different areas. It a surgical procedure in which a screw is placed and fused with the jawbone, onto that a crown is placed.