If left untreated, internal fractures… “If you lose more than 4cm in height, you will be suspicious”

Lee Soon-im (pseudonym), in her late 60s, has recently felt like her height has decreased. I went to the hospital after hearing from a friend who said, “It is said that if you suffer from osteoporosis (osteoarthrosis) you will lose your height.” He started with a bone density test. It wasn’t to the level of a problem. He was rather close to normal. However, the results of bone x-rays were different. The fracture had already occurred inside the bone.

Kim Beom-jun, a professor of endocrinology at Asan Medical Center in Seoul, said, “From the results, Mr. Lee started osteoporosis a long time ago and has progressed to internal fractures of the bones.” Bone density is normal, but a fracture has occurred. In general, when osteoporosis begins, bone density decreases. However, when osteoporosis progresses to a certain extent, internal bone fractures occur, which leads to flattening of the bones. In this situation, if you do a bone density test, the bone is compressed and comes out normal. Professor Kim said, “After the age of 60, it is necessary to check the bone condition by performing a bone density and X-ray examination at the same time.”

○ If you have lost more than 4 cm in height, osteoporosis is suspected.

Professor Kim recommended checking whether the height has decreased after the late 60s. If you have lost more than 4cm compared to the tallest person in your 20s, it means that osteoporosis is already in progress.

Of course, aging can also cause the vertebrae to bend. However, in this case, the range of height reduction is usually about 1 to 2 cm. Professor Kim said, “In order to reduce the height to 4 cm, internal fractures of the bones must occur and the bones must be crushed.” A significant decrease in height is a typical symptom of osteoporosis. Professor Kim said, “About two or three people a week lose height, so they come to the hospital to find out the reason and check for osteoporosis.”

In fact, other than this, there are few precursors of osteoporosis. When I have aches in my body or my knees hurt, I often say, “Are your bones dry?” However, in this case, there is a high probability of muscle pain or arthritis. Myalgia and arthritis are not associated with osteoporosis. In addition, osteoporosis patients often do not feel pain. That means it’s not easy to find. Professor Kim said, “It is best to have a bone density check on a regular basis.”

○“Osteoporosis, 70% of patients do not receive treatment”

Kim Soon-hee (pseudonym), in her early 70s, fell while going to the bathroom at dawn some time ago. She was rushed to the emergency room where she was found to have fractured her hip (her hip joint). Fortunately for her, the surgery to attach her bones went well, and her Ms. Kim is undergoing rehabilitation.

Kim already confirmed osteoporosis during a health checkup two years ago. However, despite the doctor’s recommendations, he did not receive treatment. Because he didn’t show any symptoms. What if Kim had received treatment at that time? First, the risk of fractures would have been greatly reduced. Even if he had not been able to prevent the fracture, the rehabilitation period would have been significantly reduced. Currently, Kim’s rehabilitation treatment is expected to take more than six months. There is a more serious problem. Professor Kim said, “If a fracture occurs without treatment in the early stage of osteoporosis, the probability of a fracture recurrence increases.

Cases like Mr. Kim are common. According to Professor Kim, about 70% of patients diagnosed with osteoporosis do not receive treatment. This is because the treatment period for osteoporosis is usually longer than 5 years, and even if treated, there is no immediate effect. For example, if you have arthritis, you may feel the pain lessen when you take an analgesic or anti-inflammatory drug. On the other hand, osteoporosis is treated with medication while improving lifestyle. This is to lower the risk of fractures, but the effect is not immediately felt.

○ Men should not ignore osteoporosis

Two years ago, a 60-year-old male named Kang Chul-seong (pseudonym) visited Professor Kim. A medical examination revealed that osteoporosis was suspected. Professor Kim investigated the cause. Kang was severely deficient in vitamin D because he worked mostly indoors. He also found that he drank more than four times a week. In general, women are more prone to osteoporosis after menopause. However, among men and young people, drinking and smoking, consumption of caffeinated beverages such as coffee and energy drinks, excessive weight loss, and vitamin D deficiency due to indoor lifestyle are cited as the causes. Professor Kim also recommended changing the eating habits of eating salty. He said that eating salty food makes bones weak because a lot of calcium is lost in the urine.

Professor Kim supplemented Mr. Kang with vitamin D and ordered a drink. He recommended walking exercises that can stimulate the bones at the same time. The results were good. As a result of actively improving lifestyle, the bone density test returned to a normal level after two years. Kang recognized the risk of osteoporosis and dealt with it properly. However, men generally think of this disease as ‘a disease that only women suffer from’. Of course, women are more likely to develop the disease. However, once onset, the severe morbidity and mortality from fractures is much higher in men. In the absence of indifference, the bone condition deteriorates rapidly, leading to fatal consequences. This is why men also need to pay attention to their bones.

Walking – It is good to stimulate the bones with strength exercise… Calcium intake, such as milk, also helps

bone model. The bottom is normal, and the higher you go, the more severe the osteoporosis. In the middle stage (third), the bone density is low, but in the final stage (top), the bones are flattened and appear to have high bone density. Provided by Asan Medical Center, Seoul

How to prevent osteoporosis

To prevent osteoporosis, exercise that stimulates the bones is good. Professor Kim especially recommended walking. This is because when you walk, more substances good for your bones are secreted.
You just need to know the condition of your knee. If the knee joint is not good, walking for a long time can make degenerative arthritis worse. In this case, the stimulation on the bones is less than walking, but it is better to replace it with indoor cycling. Swimming is not very helpful in preventing osteoporosis. Because the body is floating in the water, the stimulation on the bones is very low.

Strength training is also good for preventing osteoporosis. In general, as the muscle mass decreases, the stimulation to the bones also becomes weaker. In addition, healthy muscles secrete various substances including ‘myokine’, which is good for bone health. Naturally, less of these substances are secreted as muscle mass decreases.

If you are too dry, you are vulnerable to osteoporosis. This is because the weight is light and the stimulation to the bones is weak. Conversely, if you gain weight, the stimulation of your bones becomes stronger every time you move, which may lower your risk of osteoporosis. However, since the side effects of obesity are quite large, it is difficult to gain weight to prevent osteoporosis. Professor Kim said, “Controversy is still ongoing about the correlation between body weight and osteoporosis.”

You should get enough protein and calcium. Excessive weight loss causes nutritional imbalance and can lead to calcium and protein deficiency. Calcium is one of the important components to prevent osteoporosis. If possible, it is recommended to consume enough calcium after the age of 30, but let’s supplement it even after the age of 50. It is best to take it through food rather than a calcium supplement. Dairy products such as milk are usually high in calcium. If you drink 2 glasses of milk or 1 glass of high-calcium milk every day, you can consume about 400 to 500 mg of calcium. There is a myth that if you eat a lot of calcium, your blood vessels become calcified. Is it true? Professor Kim said, “If you eat too much, it can happen, but Korea is a typical low-calcium intake country. As long as you get your calcium through food, you don’t need to limit the amount,” he said.

Correspondent Kim Sang-hoon corekim@donga.com

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