Osteoporosis among Emirati

This research examined osteoporosis in national and non-national women who live in the United Arab Emirates. Questionnaires were administered to 53 women aged 20 to 50 years from Al Jazearh, Al Mafraq, and Al Noor Hospitals in Abu Dhabi.

The results showed that 57% of women never avoid dairy products. Also, the majority of women drink 2 cups and more of coffee or tea a day. Moreover, this result showed that 60% of women preferred walking as a type of exercise. It was found that 30.2% of the study population suffered from osteoporosis, approximately 23% of women are taking calcium supplements and 5.7% of women are taking hormone replacement therapy to treat this disease.

Women need to be more aware of the bad effects of osteoporosis and the ways of preventing its occurrence.

Our bones are strong in early life when we are in development. After the teenage stage, however, bones no longer increase in density. In some people, bones will gradually become fragile over the years and those individuals may develop a condition known as osteoporosis.

Reifenstein and Albright, in 1948, described this disease as being a stipulation in which there is “too little bone, but what bone there is, is normal”. In 1993 a group of experts at a consensus conference refined the definition of osteoporosis to “a systemic skeletal disease characterized by low bone mass and microarchitectural deterioration of bone tissue, with a consequent increase in bone fragility and susceptibility to fracture” (Minaur, 1999, p. 1496). Another definition of osteoporosis is, “a disease which is characterized by low bone mass and structural quality deterioration, leading to weakness and increased risk of fracture and bone fragility of the skeleton” (The Osteoporosis Society of Canada, 2002). Moreover, it is a condition in which the amount of calcium in bones is reduced, making them porous (Townsend, 1994).

Osteoporosis is generally categorized as Type I and Type II. Type I usually has an age of onset between 50 and 70 years, affects the trabecular bone, occurs approximately six times more frequently in women compared to men, causes fractures in the wrist and spine, and is thought to be caused by a lack of estrogen in women and testosterone in men. Type II osteoporosis, on the other hand, occurs only twice as often in women as in men, affects people over 70 years old, involves both the trabecular and cortical bone, is usually manifested by hip fractures and is primarily caused by reduced calcium absorption (Niewoehner, 1988).

Risk factors of osteoporosis include menopause, smoking, age, coffee, alcohol, lack of exercise, diet, family history, medical history, previous fracture and low body weight. Women are at a greater risk of developing osteoporosis than men (Health Caring, 2000). Almost all women are at increased risk of osteoporosis and lack of estrogen after menopause. Fractures of the wrist, spine and hip bones that result from osteoporosis are dangerous and one of the most important complications of this disease. Alcohol affects the loss of calcium from bones (National Osteoporosis Foundation, 2002).

Osteoporosis is called the “silent disease” or “silent thief” because this disease does not have any overt symptoms and this disease is evident after the age of 45. It is more common in women than in men. Osteoporosis patients become shorter, round shouldered and have backache (Smith, 1987). Osteoporosis merges with the natural process of aging, gradually and without warning. (The World Book Encyclopedia, 1997). Osteoporosis is typically diagnosed by doing bone x-rays, bone scans or bone density tests. In some cases, blood tests can be helpful (Izenberg, 2000).

This disease is primarily treated by inhibiting the resorption of bone (antiresorptive agents) or by promoting bone mineralization (proformative agents). Antiresorptive agents include hormonal replacement therapy, oestrogen agonists, calcium and vitamin D and proformative agents include anabolic steroids (O’Brien, 1999). The best way to treat osteoporosis is by hormone replacement therapy (HRT). It helps to exchange the hormones that the body stopped making. But it also can have harmful side effects (Mayo Clinic, 2002; Izenberg, 2000). On the other hand, nutrition and lifestyle play an important role in treating this disease. People should exercise three times per week, stop smoking and eat enough food high in calcium and vitamin D (Calgary Health Region, 2001).

To prevent this disease, both men and women should exercise, give up smoking and alcohol, and include calcium in their diet. Calcium plays an important role in maintaining bone mass and it reduces the risk of hip fracture (ISIS Group, 2001). According to O’Brien (1999) older adults need 1200 mg of calcium daily. On the other hand, Kimbery, (2000) indicated that women prior to menopause require 1,000 mg and this increases, post-menopausally, to 1,500 mg. Some foods that are rich in calcium include milk, cheese, yogurt, bread, sardines, salmon, sesame seeds, almonds and leafy green vegetables. However, to absorb calcium the body needs vitamin D, which is actually a hormone and regular exposure to sunlight . It makes calcium and phosphorus available in the blood and this benefits the bones. Some examples of food high in vitamin D are egg yolks, butter, fish and fortified milk. Vitamin D can also be made in the body by exposing the skin to sunlight. (Whitney, 1999).

Another way to prevent this disease is by exercising. Among other things, exercise helps people get balance and harmony of movement. Walking, lifting weights, stair-climbing, jogging, step aerobics, dancing and racquet supports are the best exercises for strengthening bones. One exercise which is not good for strengthening bones is swimming (WebHealthCenter.com, 2000).

Women are more likely to have osteoporosis than men because women have less bone mass than men. Bone loss speeds up in women during menopause but all adults start to lose their bone mass after age 35 (Brian. 2000). Black women are less likely to develop osteoporosis than white women (Tierney,1999). About 10% to 25% of women have less total bone mass in middle age (South Florida Spine. 2000). Older women may have lost between 35 percent and 50 percent of their bone mass (Mayoclinic.com). Patients may not know that they are have osteoporosis until they have serious signs such as low back pain or a broken wrist or hip (health library, 2000).

Family history, menopause, not enough calcium and exercise, being too thin, and drinking too much coffee are all factors to consider regarding women getting osteoporosis (Cooper, 1999). Some women think dairy products are too fattening and they don’t eat enough of these foods that are rich in calcium (Curry Health Center, 2000).

Treatment can slow down the loss of bone mass but it cannot eliminate this disease. Estrogen can help women’s bones stay strong (Curry Health Center, 2000) and the drugs raloxifene and statins are used to treat osteoporosis in women (Mayo Clinic, 2001).

Osteoporosis is a major public health issue for women and men who are over 50. However it is known that people of African ancestry have a lower incidence of osteoporosis than people of European ancestry (Izenberg, 2000). In America, osteoporosis is the most common bone disorder (Ronzio, 1997). Fifty percent of elderly people have osteoporosis, the majority of whom are women. Eighty percent of those affected by osteoporosis are women (Minaur, 1999). Eight million American women 50 years of age and older are estimated to have osteoporosis and 34 million women of the same age have low bone mass. In the same age group only 5 percent of African-American women 50 and over are estimated to have osteoporosis and 35 percent of women are estimated to have low bone mass. About 10 percent of Hispanic women over 50 are estimated to have osteoporosis and 49 percent are estimated to have low bone mass. About 20 percent of Non-Hispanic white and Asian women of the same age group and older are estimated to have osteoporosis and 52 percent are estimated to have low bone mass (National Osteoporosis Foundation, 2002).

One study shows that women in the United Arab Emirates do not know about this disease and they do not know how to avoid it. Forty percent of Emirati women aged 65 and older are estimated to have osteoporosis. In the UAE white women are at greater risk of developing osteoporosis than black women. This is because black women have stronger bones (Women in the UAE, 1995).

Osteoporosis does not affect women only; men can have osteoporosis. Dr. Robert Marcus said “ We think of osteoporosis as a disease of older women, but, in fact, the National Osteoporosis Foundation says one in eight men over age 50 will suffer a fracture because of osteoporosis, or the depletion of bone substance during aging” (United Press International, 2000). Men have lost of their bone mass between 20% to 35% (Mayo Clinic. 2001). However, because men have larger skeletons, their bone loss progresses more slowly, and there is no period of rapid hormonal change. So this disease develops less often in men than in women (National Institutes of Health Osteoporosis and Related Bone Diseases~National Resource Center, 2001). Men lose between 5 to 10 % of bone mass per decade after age 50 (Will, 1997).

Risk factors for men include smoking, lack of exercise, family history, eating habits such as consumption of caffeine and alcohol, aging, history of taking medicine, low testosterone, and not enough calcium and vitamin D (Roderick, 1999). Men should get 1,000 mg of calcium every day. If men smoke they are more likely to suffer from this disease (Mayo Clinic. 2001).

In men, medication and lifestyle changes are the most effective treatment of this disease. Drugs may decrease 40% of spine fractures and they are used to treat men who are at high risk of getting fractures. Other treatments are testosterone and bisphosphonates.

Prevention is the best treatment to prevent bones from becoming weaker. Men and women should get enough calcium and vitamin D. Men under age 65 should get 1,000 mg of calcium and men of 56 and older should get 1,500 mg of calcium daily (Will, 1997). Also, men should take between 400 to 800 IU of vitamin D every day. Exercise is the best way to prevent this disease. It help bones build calcium and improves agility, strength and balance. Alcohol and smoking should be avoided and caffeine limited. Drinking three or more cups of coffee a day is harmful to bones (Mayo Clinic. 2001).

Men are not as vulnerable to osteoporosis as women; only twenty percent are affected by osteoporosis. The prevalence in 36 European countries is 10-15 % in men between the ages of 50 and older (Minaur, 1999). In America two million men are estimated to have osteoporosis. Three percent of Hispanic men are estimated to have osteoporosis and about twenty three percent are estimated to have low bone mass. Seven percent of non-Hispanic white men are estimated to have osteoporosis while 35% of Asian men over 50 are estimated to have low bone mass. Four percent of non-Hispanic black men are estimated to have osteoporosis and approximately nineteen percent are estimated to have low bone mass (National Osteoporosis Foundation, 2002).

Studies show that men in the UAE do not know about this disease. There are no statistics for this disease in men. This study shows that there are several causes of this disease, such as lack of calcium and vitamin D. In the last few years the Ministry of Health has begun to hold conferences, and give lectures about osteoporosis to explain the risk factors, symptoms, prevention and the treatment of the disease (Women in the UAE, 1995).

In conclusion, this disease is more common in women than men and it is most common in postmenopausal women. Osteoporosis is considered to be one of the most common diseases in the world. It is prevalent in European countries, African countries and also in the UAE. White women and white men are more likely to have this disease than black women and black men. Osteoporosis is known as the silent killer because there are no symptoms. There are many risk factors which can contribute to low bone mass, such as age, genetics, menopause, smoking, family history, lack of exercise, not enough calcium and vitamin D, being too thin, and drinking too much coffee. Osteoporosis is typically diagnosed by doing bone x-rays, scans or bone density tests. In some cases, blood tests can be helpful. The best way to prevent this disease is treatment. Two ways to treat osteoporosis are drug treatment and getting high amounts of calcium and vitamin D. Early prevention during the childhood and teen years is the best time to take steps to prevent this disease.

The goals of my research were to learn more about this disease, and to make people aware of osteoporosis and how to prevent it.

The UAE government should initiate programs to discourage smoking, and drinking alcohol. They should put a small club in each clinic for older adults to exercise regularly and they should have experts on hand to talk about osteoporosis. Furthermore, they should sponsor more conferences on this disease.

UAE families should understand the importance of good nutrition, advise mothers to breastfeed their babies, make sure children have plenty of calcium in their diet, advise men to stop smoking to make them more aware of this disease, and make sure all the Emirati families understand the danger of neglecting this disease. Everyone should exercise regularly and drink coffee in moderation.

The main objective of this research was to examine osteoporosis as it relates to older adults. Lesser objectives were to find the relationship between the diminution of calcium and osteoporosis and examine the links between menopause and osteoporosis in women. The relationship between smoking and osteoporosis was determined.

There were three hypotheses. If a woman has three or more pregnancies, she will have a greater chance of developing osteoporosis. If a person drinks coffee more than three times per day, he or she will be more likely to develop osteoporosis. If people do exercise every day this will decrease the likehood of developing osteoporosis.

Fifty three women who had visited bone clinics were recruited to complete the data collection instruments. These women were recruited in three Abu Dhabi hospitals, Al Mafraq, Al Jazeerah and Al Noor. Any woman who lived in the United Arab Emirates was asked to participate.

A self-administered questionnaire, consisting of 31 closed ended questions was developed for this research study. The questionnaire was used to get information on the women’s nationality, age, whether breastfed as a baby, and information on eating habits and activities. If any questions were ambiguous, the respondent asked the person who distributed the questionnaire for clarification. The questionnaire required approximately 3o minutes to complete.

Permission to undertake the study was obtained from my advisor. Letters from the researcher’s supervisor were sent to Al Mafraq , Al Jazeerah and Al Noor hospitals requesting permission to ask for participants from these hospitals. One person in each clinic was responsible for giving the questionnaire to women who visit the clinic. The researcher remained present during the completion of the questionnaire to answer any questions that might arise.

Completed questionnaires were coded and data entered into SPSS version 11.0. Responses to the questions were analyzed using descriptive statistics.

Of the 53 respondents who completed the questionnaire, 43.4% were Emirati women and the majority identified their marital status as married (Table 1).

Demographic Characteristics of Questionnaire Respondents (n=53)

________________________________________________________________________

Characteristic Percentage

Hospital

Al Jazerah 54.7

Al Mafraq 32.1

Al Noor 13.2

The highest percentage (43.4%) of respondents are from United Arab Emirates. Most of the respondents (84.9%) are married and (54.7%) visit Al Jazerah Hospital (Table 1).

The majority (56.6%) of women’s body frames are medium while 37.7% of women have a large body frame (see figure 2).

The majority (64.2%) of respondents are not postmenopausal. About 18.4% are postmenopausal (see figure 3).

The majority of women about (67.9%) didn’t have a family history of osteoporosis. Seventeen percent were unsure of whether they had a family history of osteoporosis (see figure 4).

The majority of women (50.9%) would classify their activity as light. Twenty four point five percent of women didn’t do physical activity (see figure 6).

The majority of respondents (60.8%) drink milk every day. There are 3.8% of respondents drinking 3 or more cups of milk a day (see figure 8).

The majority (64.2%) of women “sometimes” or “often” eat yogurt. Also, the majority (84.9%) of women “sometimes” or “often” eat cheese (see table 2).

The majority (56.6%) of respondents never avoid dairy products. About (11.3%) of respondents often avoid dairy products (see figure 9).

The majority of respondents drink 2 cups or more of coffee or tea a day while (20.8%) of respondents do not drink coffee or tea a daily (see figure 10).

The majority (84.9%) of women do not take hormone replacement therapy, and about (50.9%) of women also do not take calcium supplements. Most of the women (52.8%) do not take Vitamin D supplements (see table 3).

Most of the women (69.8%) do not suffer from osteoporosis. Thirteen point two percent of women do suffer from osteoporosis and most of them are aged between 40 to 50 years. Most of these women who suffer from this disease were diagnosed between 30 to 40 years of age (see figure 11).

Twenty two point six percent of women who suffer from osteoporosis take calcium supplements to treat this disease (see figure 12).

Forty seven point two percentage of women breastfeeding their children between two months to twelve months (see figure 13).

This study ‘s finding that osteoporosis is most common in postmenopausal women is similar to that reported by Brian (2000) who found that bone loss speeds up in women during menopause and all adults start to lose their bone mass after age 35. According to my questionnaire results 18.9% of women are postmenopausal, about 11.% of women are currently in menopause and most of them have osteoporosis (see figure 3).

According to my questionnaire results women who suffer from osteoporosis take calcium supplements (22.6%) and hormone replacement therapy (5.7%) to treat this disease (see figure 12 and table 3). This finding is similar to that reported by Izenberg (2000) who found that hormone replacement therapy, calcium supplements and vitamin D supplements are used to treat this disease.

This study found that most women who have a bone fracture suffer from osteoporosis. According to my result 17.0% of women had a bone fracture and most of them suffer from osteoporosis. Most of the women (83%) had never had a bone fracture (see figure 5) . This is similar to other studies (Health Library, 2000) that reported that patients do not know they have osteoporosis until they have a broken bone.

This study found that the majority of women who eat dairy products don’t suffer from osteoporosis. According to my result about 64.2% of women sometimes or often eat yogurt and about 84.9% of women sometimes or often eat cheese. Moreover, 56.6% of women never avoid dairy products (see figure 8 & 9). This is similar to that reported by ISIS Group (2001) who found that eating dairy products plays an important role in maintaining bone.

This study found that women who suffer form osteoporosis are diagnosed between 30 to 40 years. According to my questionnaire results approximately 30% of women do suffer from osteoporosis and about 9.4% of women were diagnosed between 30 to 40 years of age seventeen percent of women were diagnosed between 45 years and older (see figure 11). This result is similar to that reported by Smith (1987) who found that osteoporosis is evident after the age 45.

According to my questionnaire results 50.9% of women classified their activity as light and 60.4% of women preferred walk as a type of exercise (see figure 7 & 6). These results are similar to Web Health Center (2000) that reported exercise is the best way to prevent osteoporosis and walking, step aerobics and jogging are the best exercises.

This study found that most women (81.2%) who have a family history of osteoporosis don’t suffer from osteoporosis. About 18.7 % of women who suffer from osteoporosis do have a family history of osteoporosis (see figure 4). This result is opposite to that reported by Roderick (1999) who found that family history was an important predictor of developing osteoporosis.

According to my questionnaire results 54.7% of women drink 2 cups or more of coffee or tea a day and about 20.8% of women do not drink coffee or tea daily (see figure 10). Cooper (1999) & Health Caring (2000) have indicated that coffee is one of the risk factors to consider regarding women getting osteoporosis.

The results of this study indicate that 56.6% of women never avoid dairy products which are rich in calcium and about 11.3% of women often avoid dairy products. This result doesn’t support those reported by the Curry Health Center (2000) which said some women think dairy products are too fattening and they don’t eat enough of these foods which are rich in calcium.

According to my questionnaire results 47% of women breastfeeding their children between two months to twelve months and about 15% of women breastfeeding their children twenty four months (see figure 13). Kovacs & Kronenberg (1997) found that maternal losses of calcium during 9 months of lactation are 4-fold higher than losses occurring during pregnancy. In breast milk they daily loss of calcium between 280-400 mg.

My recommendations about this disease are to eat enough calcium and eat calcium rich foods to build up your bone and take calcium supplements. Women before menopause can have a daily consumption of up to 1,000 mg of calcium and after menopause they should take 1,500 mg daily. Consume enough vitamin D and get adequate sunshine to enable the skin to make vitamin D. Also women can take fortified milk and milk products. Drink fluoridated water, stop smoking, stop drinking alcohol, and exercise regularly throughout life (Ronzio, 1997).

About Osteoporosis. (2001). [On-line]. Available: http://osteoporosis.org.au/html/aboutoseteomain.php
Bones and Osteoporosis. (2002). [On-line]. Available: http://www.bones-and-osteoporosis.com
Brian, R. (2000). Osteoporosis in Women. [On-line]. Available: http://www.theglassceilling.com/health2/he_17ost.htm
Cataldo, C. B.& DeBruyne, L. K. & Whitney, E. N. (1998). Nutrition and diet therapy. (5th ed). Wadsworth Publishing Company.
Conference: “Women In the UAE”. (May. 1995). Intercontinental Hotel in Abu Dhabi.
Continuum Health Partners. Osteoporosis. [On-line]. Available: http://www.wehealnewyork.org
Cooper, P. G. (1999). Osteoporosis in Women. [On-line]. Available: http://www.stjohns.org/HTL/Muscles/22815.htm
Curry Health Center. (2000). Osteoporosis in Women. [On-line]. Available: http://www.umt.edu/shs/healthlibrary/hlosteoporosis.htm
Diseases~National Resource Center. (2001). Osteoporosis in Men. [On-line]. Available: http://www.osteo.org/docs/73.586609407.html
ISIS Group. (2001). Osteoporosis. [On-line]. Available: http://www.lops.org
Izenberg, N. (2000). Human diseases and conditions. (V. 2). New York: Scribner's Sons.
Kenney, J.J. (2000). Diet and Osteoporosis. [On-line]. Available: http://www.foodandhealth.com
Kovacs, C., & Kronenberg, H. (1997). Maternal-fetal calcium and bone metabolism during pregnancy, puerperium, and lactation. Volume 18, No 6. USA: The Endocrine Society.
Mason, P. (2000). Nutrition and dietary advice in the pharmacy. (2ed ed). London: Blackwell Science.
Minaur, N. (1999). Treatment and prevention. In M. J. Sadler, J. J. Strain & B. Caballero (Eds.), Encyclopedia of human nutrition. (pp. 1495-1503). San Diego: Academic Press.
National Institutes of Health Osteoporosis and Related Bone Mayo Foundation for Medical Education and Research. (2002). Osteoporosis. [On-line]. Available: http://www.mayoclinic.com
National Osteoporosis Foundation. (2002). Fast Facts on Osteoporosis. [On-line]. Available: http://www.nof.org/osteoporosis/stats.htm
Niewoehner, C. (1988). Calcium and osteoporosis. Cereal Foods World, 33,747-787.
O’Brien, K. (1999). Treatment and prevention. In M. J. Sadler, J. J. Strain & B. Caballero (Eds.), Encyclopedia of human nutrition. (pp. 1504-1510). San Diego: Academic Press.
Osteoporosis Society of Canada. (2002). Osteoporosis. [On-line]. Available: http://www.osteoporosis.ca
Osteoporosis. (2002). [On-line]. Available: http://www.merck.com/disease/osteoporosis.html
Roderick, K. (1999). Men and osteoporosis. [On-line]. Available: http://www.senior-inet.com/articles/article38.htm
Ronzio, R. (1997). The encyclopedia of nutrition & good health. Facts on File, Inc.
Santrock, J. W. (1999). Life-Span development. (7th ed). McGraw-Hill.
Smith, D. (1987). The new macmillan guide to family health. London: Macmillan.
South Florida Spine. (2002). Osteoporosis and Women. [On-line]. Available: http://www.southfloridaspine.com/why_are_women_at_grater_risk.htm
The National Women’s Health Information Canter. (2001). Osteoporosis. [On-line]. Available: http://www.4woman.gov/faq/osteopor.htm
The world book encyclopedia.(1997).Volume14(p.516).London: World Book International.
Tierney, H. (1999). Women’s studies encyclopedia. Greenwood Press: Westport, Conn.
Townsend, C. E. (1994). Nutrition & diet therapy. (6th ed). Delmar Publishers Inc.
Web Health Center. (2000). Women’s Health. [On-line]. Available: http://www.webhealthcenter.com/general/wh_prob.asp
What is osteoporosis. (2002). [On-line]. Available: http://www.osteoporosis.ca/OSTEO/D01-01.html
Whitney, E. N. & Rolfes, S. R. (1999). Understanding nutrition. (8th ed). Wadsworth Publishing.
Will, R. (1997). Osteoporosis in Men. [On-line]. Available: http://www.rph.wa.gov.au/labs/biochem/osteop~1.html
Zaidi, S. (2000). Osteoporosis. [On-line]. Available: http://www.diabetesspecialist.com