Ummey Kulsum, wife of a university teacher at Rajshahi had been suffering from osteoarthritis (OA).

X-ray revealed that she had the knee joint of a 80-year-old though she was only 39. The shock absorbing cartilage between the right femur and tibia, the bones that meet at the knee, had gradually worn away leaving bone scraping against bone - the source of her constant pain.

As many as six to eight percent people in Bangladesh are afflicted with OA of the hip or knee, says Dr Hasan Masud, an orthopaedic surgeon of National Institute of Traumatology and Orthopaedic Rehabilitation (NITOR).

OA is a major cause of disability in people aged 60 and older. Despite its public health impact, the disease continues to be a relatively unaddressed health issue. Nobody knows for sure what causes OA, but Dr Masud says heredity, excess weight and previous joint injuries are major factors behind the disease.

"It is a common disease among women in Bangladesh," says Dr Masud. "Women are at increased risk because they sit or stand for prolonged periods, or most frequently lift heavy objects," he added.

Women are prone to OA in their knees. Study revealed, hormonal changes during a woman's menstrual cycle affect the elasticity of the body's ligaments. Women's knee muscles do not contract under stress as men's do, putting their knee joints at greater risk. Women who play sports involving jumping are up to eight times more likely to injure their knees than men playing the same sports.

Many people still regard it as a disease of elderly people. But OA may strike at any age, Dr Masud says, adding there is no cure for OA. Generally speaking, the process of clinically detectable osteoarthritis is irreversible and typical treatment consists of medication or other interventions that can reduce the pain of OA and thereby improve the function of the joint, he says.

The old adage "no pain, no gain" does not apply to people with arthritis. Pain during exercise is the body's mechanism for telling you to stop. A better cliché might be "move it or lose it." Exercise has been found to have substantial benefits depending on an individual's arthritis and the chosen exercise.

If the conservative management is ineffective, joint replacement surgery may be required, Dr Masud informs. Joints of individuals with very painful OA may require surgery such as fragment removal, repositioning bones, or fusing bone to increase stability and reduce pain.

The success rate of knee and hip replacement depends upon sterility of the environment and associated materials, Dr Masud says.

While speaking about cost, Dr Masud says actually the implant which we use for knee replacement costs about one lakh thirty thousand taka. However, no matter what the severity or where the OA lies, conservative measures, such as weight control, appropriate rest and exercise, and the use of mechanical support devices are usually beneficial to sufferers, he suggests.

Dr Masud informs that there is also a new procedure to knee and hip replacement - cartilage cell transfer, microfracture procedure or arthroscopic lavage or debridement.

About the treatment facilities in the future, he mentioned about rotational field quantum magnetic resonance (RFQMR), low level laser therapy, prolotherapy and radiosynoviorthesis.

Dr Masud encourages healthy persons regular exercise, if possible, in the form of walking or swimming to take care of joints. One must control his or her weight and eat a healthy diet, he says.

He stresses on different types of exercise to achieve different goals. One can check with his/her doctor before beginning a regular exercise programme.

Your doctor may recommend working with a physical therapist who can design an exercise programme to meet your specific needs, and who may also perform manual exercises that stretch and strengthen the muscles around your arthritic joints, he says.

Dr Masud concludes saying, "Walking is a good starter exercise. If you can't walk, try a stationary bicycle using no resistance or do hand or arm exercises. Aquatic exercise is another option, and many health clubs with pools offer classes. Maintain good posture while you exercise. Avoid exercising tender, injured or severely inflamed joints. If you feel new joint pain, stop. New pain that lasts more than two hours after you exercise probably means you've overdone it. If pain persists for more than a few days, call your doctor."