1. INTRODUCTION:

Osteoporosis, in which the bone becomes very brittle, though a knownavoidable clinical condition, affects about five lakhs and two lakhspeople with fractures and injuries respectively, per year.Osteoporosis by definition is a decrease in the mass of the bone and/or a bone-fracture due to fragility. According to WHO, osteoporosis refers to disease condition in which a decrease in the density of boneabout 2.5 standard deviation below mean for young healthy adults occurs, race and gender matched which is also denoted as T-2.5.

1.1. Measuring Bone Mineral Density:

Numerous noninvasive procedures are existing for estimating skeletal bone mineral density. They are DEXA (Dual energy x-ray absorptiometry) and SEXA (Single energy x-ray absorptiometry) X-rays, Quantitative CT scans and ultrasonographies. DEXA is quite precisemethod routinely used for measuring mineral density of the bone and hence utilized in the clinical determinations of the lumbar spine and hip bone. Portable DEXA equipment are established that quantifies the calcaneus and the forearm bones. In the DEXA technique two X-ray energies are utilized to measure the area of mineralized tissue and the amount of the mineral present is divided by the area, which moderately corrects for body’smagnitude.

Though research has shown that dietary requirements and exercise are the factors which can be modified to prevent fractures related with osteoporosis, literature lacks information about the detection technique which will enable for a better comparison of BMD (Bone mineral density) in adults having different dietary patters and physical activity. Hence, the present study was conducted to detect and compare BMD (Bone mineral density) in adultsof variable diet and physical activity by using Pixi Lunar Heel Densitometer that uses dexa (Dual energy x-ray absorptiometry) technique.

2. MATERIALS AND METHODS:

2.1. Study Type:

An outpatient based cross-sectional observational study, done in patients attending health camp organized by the Department of Orthopedics, Kasturba Medical College (KMC),Attavar, Mangalore, Manipal Academy of Higher Education (MAHE), Karnataka, India. Informed consent was obtained from study population, before the start of the research work.

2.2. Study Subjects:

Bone mineral density was determined intotal 173 individuals who aged between (20-80) years. 106 were females and 67 were males. There was no inclusion and exclusion criteria.

2.3. Study Procedure: p-dexa Method:

Present study involved PIXI machine, Lunar Corporation for heel BMD testing. The probes were pressed on ankle of the patient after the application of gel for the result obtained after the measurement of BMD from the machine was recorded. BMD values expressed as grams per square centimeter, were plotted on BMD chart, T-score was found out, age-matched and accordinglythe diagnosis of osteoporosiswas made. Osteoporosis was considered when t - score was less than - 1.6. T-score above -0.6 was considered as normal.

3. RESULTS:

Table 1: BMD and t-score compared in exercising ad non exercising individuals

Variables	Groups		P value
Variables	Exercising N₁=89	Non-exercising N₂=104	P value
BMD(gm/cm²)	0.48± .09	0.47± 0.09	NS
T-Score	-0.95± 0.71	-1.09± 0.86	NS

Values are expressed as Mean ± SD (P Value ≤ 0.05) is considered statistically significant

Fig 1.1 Shows subjects without history of exercise (N₁=104) were having mean BMD of 0.465gm/cm²and subjects with history of exercise (N₂=69) had mean BMD of 0.48gm/cm². Thus exercising subjects had more bone mineral density but not statistically significant.

Fig 1.1 BMD Compared in individuals with exercise and without exercise

fig1.2 shows non exercising individuals had mean T-score of -1.09 and exercising subjects had mean T- score of -0.95 indicating more risk of fracture in non exercising subjects but not statistically significant.

Fig 1.2 Mean T- score compared in individuals exercising and nonexercising

Table 2: BMD and T-score compared in exercising ad non exercising individuals

Variables	Groups		P value
Variables	Vegetarian(N₁=32)	Mixed(N₂=141)	P value
BMD(gm/cm²)	0.46± .11	0.48± 0.08	NS
T-Score	1.1± 0.99	-1.01± 0.78	NS

Values are expressed as Mean±SD (P Value <0.05) is considered statistically significant

Fig 2.1 shows vegetarians (N₁=32) with mean BMD of 0.46 gm/cm² and people having mixed diet (N₂= 131) with mean BMD of 0.48gm/cm² confirming more bone density in non vegetarians but not statistically significant.

Fig 2.1 Mean BMD in comparison with diet

Fig 2.2 shows vegetarians having mean T- score of -1.11 and nonvegetarians having mean T-score of -1.01. Since vegetarians have less T- score they are more prone for fractures.

Fig2.2 Mean T- score in comparison with diet

4. DISCUSSION:

Human lifestyle changes like, modifications in consumption of food, regular exercisehave beneficial effects on bone health[1]. Apart from balanced nutrition and exercise many other factors like genetic influences, peak bone mass (PBM), and lifestyle risk factors such as coffee, tea, and aerated drinks, cigarette-smoking and consumption of liquoraffect bone mass [2]. Previously studies have shown that people with less physical work were more proneto osteoporosis related fractures[3].On the other hand, physically dynamic people, even elderly, fight the reduction in BMD, and this brings down their probability of fracturing the bone. Previous research havedescribed that physical activity deliversconstructive effects on bone mass via mechanical loading mechanisms[4-11]. This was more evident among sportspersons who had elevated BMDs compared to age-group matched physically inactive control population[12,13]. Hip fracture in elderly especially female patients are almost always as a result of fall. Regular mild to moderate exercise increases muscle strength, coordination as well as flexibility and reduces the tendency of fracture. Exercise and balance training programs reducethe risk of falling by nearly 20%. [14]

The burden due to chronic disease is constantly increasing among the Nepalese population ; however adoption and maintenance of general health promoting behaviors are often an ignored concept. Perceived self-efficacy is recognized as an important factor in specific health promoting behaviors like smoking cessation, exercise, healthy dietary behavior. Highly self-efficacious individuals are able to maintain desired health promoting behavior [15]

Osteoporosis prevention can be done by calcium intake, physical activity and sun exposure. This study shows the rate of osteoporosis preventive behaviors in Iranian adolescent girls is not enough. . Mean calcium intake of dairy products was lower than of recommended by the World Health Organization (WHO) (1000-1200 mg/day for ages 12-18 years old). [16]

Old people have limited regenerative capabilities and are more prone to disease, syndromes and sickness than other age groups. There is often a common physical decline and people become less active. [17]

Childhood years are a time of steady growth; good nutrition is a high priority. Metamorphosis of food habits has led to the replacement of nutritious food by things that are tasty, convenient, in vogue-junk food. Food high in salt, sugar, fat or calories and low nutrient content is called junk food. Junk foods provide suboptimal nutrition with excessive fat, sugar, or sodium per kcal. Such poor diets can slow growth, promote obesity; sow the seeds of diseases like diabetes, hypertension, cardiac problems and osteoporosis[18].

The delivery of DHEA in the form of nanogel, nanoemulsion, nanomicelles or nanoprticles can not only reduce its dosing frequency but it also can improve its therapeutic benefits. Dehydroepiandrosterone and its sulphate ester has a broad activity spectrum against number of diseases like Alzheimer disease, depression, cardiovascular disease, osteoporosis,skin disorders etc. The development of novel drug delivery system of DHEA will enable them to be utilized as an adjuvant in various pathological conditions. No doubt, dehydroepiandrosterone and its derivative, need to be designed and developed into new synthetic analogs for enhancing their potentials in curing various ailments. [19]

P.E.Phytochemicals are naturally and biologically active plant compounds that provide health benefits. They are found in plant foods and they work together with nutrients and dietary fiber to protect against disease. Current studies on phytochemicals and nutrients found in fruits, vegetables and nuts, show that they help in aging process and also reduce the risk of many diseases, like cancer, heart disease, stroke, high blood pressure, cataracts, osteoporosis and urinary tract infection [20]

Diet can help to control menopausal symptoms. Food that can be avoided include high amount of caffeine and carbonated beverages containing phosphorous which inturn can increase bone loss. Limit the consumption of meats including beef, pork and chicken because these meats contain a high amount of saturated fats and decrease the body's ability to metabolize estrogen.[21]

5. CONCLUSION:

This work highlights disease prevention strategies that have confirmedto be effective in enlightening the study group about osteoporosis, facilitating proper lifestyle choices, by choosing balanced diet and regular exercise and hence achieve their maximum bone potential at early age.

6. LIMITATION:

A more in-depth knowledge can be acquired through further research to find out the various mechanisms involved in maintaining the bone mineral density with variable diet and physical activity.

7. REFERENCES:

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19. Anshita Gupta., Swarnlata Saraf., Chanchal Deep Kaur., Shailendra Saraf. The Potentials of Dehydroepiandrosterone (DHEA) in Skin ageing process. Research J. Topical and Cosmetic Sci 2013; 4(2): 43-47

20. Onwudiwe N.N et.al. Phytochemical Analysis and Acute Toxicity/ Lethality Study of Ethanol Extract of Eugenia uniflora Pulp. Research J. Pharmacognosy and Phytochemistry 2010; 2(4): 336-339

21. Veena Rajput. Menopause and Alternative Therapy. Asian J. Nursing Edu. and Research 2012; 2(3): 158-59

Received on 21.03.2018 Modified on 22.04.2018

Research J. Pharm. and Tech 2018; 11(6): 2404-2407.

DOI: 10.5958/0974-360X.2018.00444.4