Anaemic osteoporosis and what the future holds

Imagine:

You are in a large trauma orthopaedic department when a 26yo female presents with a comminuted, complex acetabula fracture. While plating the ileum to reduce the various fractures you note that the cortical screws appear glide into the bone like a hot knife through butter…

Does this sound strange to you?

Of course!

But what is the cause?

The literature is showing that within the Indian female population, of which a vegetarian diet is common for both monetary and religious reasons, a large number are presenting with anaemic osteoporosis pre-menopausal. https://www.hindawi.com/journals/isrn/2012/765476/

This is most commonly due to one of two causes; either b12 or iron deficiency.

Both of these have direct and indirect effects on the bone remodelling cycle.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4425147/ - iron

http://www.sciencedirect.com/science/article/pii/S0016508509021453 - B12

So, what about the Australian population?

Vegan, vegetarian and other reduced meat diets are in vogue, and justifiably for a number of political, sustainable and social reasons.

http://www.roymorgan.com/findings/vegetarianisms-slow-but-steady-rise-in-australia-201608151105

http://www.smh.com.au/business/consumer-affairs/australia-is-the-thirdfastest-growing-vegan-market-in-the-world-20160601-gp972u.html

https://www.youtube.com/watch?v=IEqBduQIx-Q - Before the Flood

But what about the long term effects on our population?

It’s clear than certain vegetables do indeed contain non-haem iron and B12 but on the other hand, there are various components that can inhibit the absorption of iron all together.

The following prevent iron absorptions - Phytates (found in cereals and vegetables), polyphenols (found in vegetables, fruits, some cereals and legumes, tea, coffee, and wine), calcium, and proteins inhibit iron absorption.

The following aid iron absorption - ascorbic acid and muscle tissue

http://www.sciencedirect.com/science/article/pii/S0140673615608650

OR available here:

https://search-proquest-com.libraryproxy.griffith.edu.au/docview/1768566237?pq-origsite=summon&https://search.proquest.com/central

On the flip side, the following study showed that a lacto-ovo-vegetarians (eggs + diary products) had less iron deficiency than red meat eaters. However, the third comparison group, poultry group (which consisted of ham/pork foods – being high in iron) was superior to both .

https://www.ncbi.nlm.nih.gov/pubmed/16197581

Together with the above information, from the literature we are all well aware that females are at a greater risk of osteopenia/osteoporosis post menopause due to the loss of the protective effects of oestrogen.

So, what’s the tie to surgery and the future?

Is this current dietary trend setting our population up for a future wave of osteopenic and osteoporotic injuries? And how are we as future surgeons going to advocate for our patients, health care system and environment effectively?

The answer could be as simple as early education, make people aware of the risks and provide answers and assistance for individual solutions.

Some general suggestions:

Get regular blood checks for: vitamin D, calcium, iron and B12 levels.

Do regular exercise – the benefits of which are overall bone strengthening.

Find out your family history – does anyone in your family have osteopenia/osteoporosis or any other related risk factors.

Supplement your diet – either pharmaceutically (iron tablets etc) or with purposeful eating (eat foods high in what you’re lacking, have the occasional haem-iron food).

Clearly this is not an exhaustive list of suggestions, nor does this article's depth appreciate the complexity of issues that surround the facets of this topic. But if anything is to be taken away it is to be aware, not necessarily beware.