Active, energetic Nahid had remained absorbed in her career ever since she left university. Initially, there was enough time for outings, exercise and walks. Marriage, a baby, socialising plus career, all demanded more time. The inevitable result: out went the exercise and the walks; a sedentary lifestyle set in, and continued, till it was nearly too late.

Nahid’s history is typical of today’s educated urban women. Few pay attention to their personal health care needs, a tendency especially visible around age 20 to 35 years. Eventually, Nahid suffered due to limited awareness. Quite health-conscious, she nevertheless neglected those bones, and their need for exercise and sufficient calcium. All the predisposing factors were present: she is Asian, female, and has a family history of osteoporosis.

Came the day when a constantly painful knee joint took her to a well-known orthopaedist: maybe she needed prolonged treatment, or even surgery. But no: all the specialist did was to make her walk up and down the room (at that time she was already primed with strong analgesics, and could walk properly). His verdict: all she needed was analgesics for pain; she was otherwise pronounced fine.

This specialist did not recommend tests to measure calcium or vitamin D levels or X-rays or bone density tests to get to the root of the problem. Nahid was puzzled, but accepted the expert medical opinion. A few months later, that knee became so painful that walking was rendered near impossible.

Another orthopaedist, a battery of tests, and knee replacement was recommended. That worked fine but, had the first orthopaedist identified the problem correctly, and worked towards the building up of bone strength, perhaps the surgery may not even have been necessary. It was her misfortune that a subsequent freak accident led to a hip fracture, and more surgery; today, she walks with a stick. She shrugs off the experience as bad luck, but does feel that doctors need to take far greater care of their patients, and guide them with relevant information.

Osteoporosis, a thinning and porosity of the body’s bone structure, has a precursor, osteopaenia; if detected early, treatment can prevent its worst repercussions. Just being women automatically puts them at greater risk; in men, this risk is less. Whites and Asians are more likely to suffer fractures than blacks or Hispanics.

The largest at-risk group is post-menopausal women. Diminishing estrogen levels significantly reduce bone strength; in youth, estrogen plays a protective role, but with age this role diminishes, resulting in progressively greater bone loss — as much as four to eight per cent per year. If sufficient attention is not given to the maintenance and building of bone strength, the older woman risks becoming a near tailor-made case for fractures.

Poor women suffer significant malnutrition; multiple childbirths can lead to depletion of nutrients and reduction of overall energy levels. Petite women have less bone mass to begin with, and so are more at risk. Obesity reduces bone strength, as it requires bones to bear greater weight.

Pregnancy and childbirth, plus often a full time career, cause today’s young woman to neglect her personal health. Irregular periods interfere with estrogen production, and fail to give adequate protective cover. Women become subject to the same risks as older, post-menopausal women when ovaries are removed, as they play a key role in production of estrogen.

In men, testosterone plays a similar protective role; however, men too are at risk of broken bones and reduced bone mass, if there are low levels of testosterone. Both women above age 65, and men above age 70, experience decreasing bone mass with increasing age.

As with any other health problem, prevention is all-important. That means a balanced diet, with calcium, vitamin D, and other vitamins. Calcium, in fact, is the cornerstone for bone health, with vitamin D, which helps in the absorption of calcium.

So does regular exercise, preferably a mix of weight bearing exercises with walking, swimming or other such activity. Sunshine too has a positive effect for vitamin D formation, and calcium absorption.

There are several foods that are rich in calcium, and can easily be part of the daily diet, for both children and adults: milk is undoubtedly the ‘Pop Star’ of all these. So too is yoghurt.

In the fish category, sardines and salmon are the richest sources of calcium, while among vegetables, Chinese cabbage, mooli and shulgum (turnips), and fortified breakfast cereals occupy top slot.

Adults up to age 50 need 1000 milligrams of calcium each day, while women of 65 and men above 70 need 1250 milligrams. But don’t consume too much — that could lead to kidney stones!

The best way to measure bone health is by monitoring bone mass density, or BMD, a simple 15 minute test. High BMD is represented as 1, + or =, while low BMD is -2.5 or even higher.

Besides calcium and vitamin D, which should be part of the daily diet, treatment with new products for at-risk people is now available: with regular use, they can help prevent fractures — a boon to those who are prone to them.