Osteoporosis

What is Osteoporosis?

Osteoporosis, or brittle bone disease is characterized by low bone mass and an increased susceptibility to fractures, especially of the hip, spine and wrist.

Osteoporosis is a silent disease. People may not know that they have osteoporosis until their bones become so weak that a sudden strain, bump or a simple fall causes a fracture. Collapsed vertebral fracture may present with severe back pain and loss of height.

What is Bone?

Bone is a living and growing tissue. It is made mostly of collagen, a protein that provides a soft framework, and calcium phosphate, a mineral that adds strength and hardens the framework. This combination of collagen and calcium makes bone strong yet flexible to withstand stress. More than 99% of the body's calcium is contained in the bones and teeth. The remaining 1% is found in the blood.

How do we develop brittle bone?

Throughout the life, old bone is removed (resorption) and new bone is added (formation) to the skeleton. During childhood and teenage years, new bone is added faster than old bone is removed. As a result, bones become larger, heavier, and denser. Bone formation continues at a pace faster than resorption until maximum bone density is reached at around the age of 25 years. After that age, bone resorption slowly begins to exceed bone formation. Bone loss is most rapid in the first few years after menopause. Osteoporosis develops when bone resorption occurs too quickly or if replacement occurs too slowly.

How common is Osteoporosis in India?

Osteoporosis in India has had relatively little attention until recently. We do not have a clear data as of how many of our people has osteoporosis but it is likely 30-40% of people above the age of 50 years in India has it. Also this is happening around 10 years earlier than people in the west. In the west women are more affected but it seems in India it is equally common in men.

Who are at risk for Osteoporosis?

Certain factors are linked to the development of osteoporosis or contribute to an individual's likelihood of developing the disease. These are called "risk factors." Many people with osteoporosis have several of these risk factors.

• Menopause in women
• Diet deficient in calcium
• Excessive Alcohol intake
• Smoking
• Lack of physical activity
• Thyroid hormones problem
• Family history
• Use of steroid.

A simple X-ray can not diagnose osteoporosis until it is very advanced. The test needed is a special test of bone called bone mineral density (BMD) scan which measures the density of spine, wrist and hip bones (the most common sites of fractures). These tests are painless, noninvasive and safe. Bone density tests can:

• Detect osteoporosis before a fracture occurs.
• Predict your chances of fracturing in the future. .

There are three modes of treatment, i.e., diet, exercise and medicine. A diet rich in calcium and adequate sunlight exposure for vitamin D production in the skin is very important. A regular exercise also improves the rate of bone formation. Currently medicines available to improve the rate of bone formation and to reduce the rate of bone loss. Hormone replacement therapy in women after menopause is helpful to improve the bone mass.

Falls can increase the likelihood of fracturing a bone in the hip, wrist, spine or other part of the skeleton. In addition falls can also be caused by impaired vision and/or balance, chronic diseases that impair mental or physical functioning and certain medications, such as sleeping pills and antidepressants.

Some tips to help eliminate the environmental factors that lead to falls include:

• Use a cane or walker if your walking is unsteady.
• Wear rubber-soled and low-heeled shoes.
• Keep your rooms well lit and the floor free of clutter.
• Use nightlights.

Emphasis should be given to improve the peak bone mass by improving nutrition in childhood and adolescence. Regular exercise is extremely important to maintain bone mass. Stopping smoking and moderating alcohol are important in adults. Adequate calcium intake (1 Gm per day) is probably the most important step to prevent osteoporosis.