Osteoporosis

With growing elderly population and increased number of musculoskeletal disorders amongst them, there is a growing need to know about osteoporosis, the most common bone loss disorder known.

International Osteoporosis Foundation (IOF) has launched a global awareness campaign about osteoporosis. It is close to a month now since the campaign was organized. As a continuation of this campaign, I would like to share key aspects of this condition.

What is osteoporosis?

Osteoporosis is a condition of the bone when it becomes brittle and fragile.

Well, bones have the capability to maintain strength and integrity through bone mineralization (formation) and resorption (break down process). With age and when there are low vitamin D / calcium levels, the resorption process exceeds the mineralization process thereby making the bones fragile and brittle. Technically, osteoporosis is diagnosed when more than twenty five percent of the bone is lost through resorption.

What causes osteoporosis?

Osteoporosis is generally a condition associated with age. Human bones are at its peak strength at 30 years of age. Beyond 30 years, resorption process gradually overtakes mineralization thereby increasing chances of osteoporosis. Genes, body weight, diet and lifestyle are the other determinants of the rate of bone loss.

Besides these, there are other factors where the risk of osteoporosis is high:

• In women, post menopause
• Women with irregular menstruation / low oestrogen / early menopause
• Petite women (small and dainty)
• Caucasian / Asian
• People who have had broken bones as an adult due to injury
• Someone with a family history of osteoporosis
• One who has a dietary deficiency of vitamin D and calcium
• People in a sedentary occupation or of a sedentary lifestyle
• Long term smokers and alcohol consumers

What are the symptoms and signs of osteoporosis?

Osteoporosis is also known as a ‘silent’ condition, the sneakiest condition, because it is symptomless until a fracture occurs. Statistically, some figures point to the fact that only 12% of all osteoporosis cases were diagnosed before a fracture. Today, there are more than 12 million Americans alone who are diagnosed with osteoporosis. This means that most of us do not know about the presence of osteoporosis before we break our bones. The only subtle symptom of osteoporosis is chronic back pain. In others, osteoporosis is incidentally found while investigating other medical illnesses.

How is osteoporosis diagnosed?

Radiological tools including X-ray are capable of revealing bone loss. However, as osteoporosis requires quantitative measurements, bone density testing is done to study the amount of bone loss. In this process, two X-ray beams are aimed at the bones where the amount of bone absorption helps identify the bone density. This test is called Dual Energy X-ray Absorptiometry (DEXA). The amount of absorption of various bones is scored. If the amount of absorption is close to zero (+1 to -1), it is of a normal reference range; a score below -2.5 is seen in the case of osteoporosis; between -1 to -2.5 is termed as osteopenia.

Medical treatment of osteoporosis:

Primary medications used to treat osteoporosis belong to a group of drugs known as bisphosphonates. These are drugs that slow down the bone resorption process. Calculated doses of these drugs are prescribed and monitored by physicians. Besides bisphosphonates, estrogenic drugs are used as a single therapy or as a part of hormone replacement therapy especially for the elderly and post menopausal women. Monoclonal antibody (Denosumab) and Teriparatide are newer drugs used for the treatment of osteoporosis.

How to prevent osteoporosis?

As stated in the beginning, osteoporosis is an age related change; however, there are some means available to slow down osteoporosis. Following are some options available to delay osteoporosis:

1. Vitamin D and calcium are important ingredients that can delay bone resorption. Make sure you get the daily dose of calcium (1000mg) and vitamin D (400 IU). 15 minutes in the sun without any sun protector is quite sufficient to meet vitamin D needs. Talk to a nutritionist for vitamin D and calcium dietary sources.
2. Make sure you maintain optimal weight. Weight proportionally damages the long bones and the spine in the body – two of the bones that are commonly affected by osteoporosis. Hence, it makes sense to shed those extra fat stores. Therefore, it is a must that you revamp your diet and choose a low calorie diet and start exercise.
3. Importance of exercise in the prevention of osteoporosis cannot be overstated say osteoporosis experts. It is important to engage in weight bearing exercise like running, aerobics, yoga, jumping and jogging. These exercises strengthen the integrity of the bones.
4. Stop smoking and drinking. There is an increased association between osteoporosis and smoking and drinking alcohol. Therefore, it is a must that you stop smoking and restrict drinking in order to strengthen bones.
5. Regular bone density screening. It is highly recommended that you talk to a doctor and perform a DEXA scan if you are one with high risks of osteoporosis. The risks of osteoporosis are mentioned in detail above.

Fracturing a bone is truly the outcome of osteoporosis. We have a choice to delay it or prevent it.