Bone is primarily composed of osteoblast (which helps in new bone formation), osteoclast (which causes bone resorption), and organic and inorganic materials like calcium, magnesium, and phosphorous. Bone resorption is the process by which osteoclasts break down the bone tissue and releases the minerals, resulting in a transfer of calcium from the bone tissue to the blood.
What is Osteoporosis?
Osteoporosis is the most prevalent condition of the bone in the world today. It results from an imbalance between bone formation and bone resorption. When the body loses more bone than it can make, it causes the bone to become weak.
Osteoporosis literally means “porous bone”. It is the disease of the bone where there is a decrease in bone strength which causes it to become fragile and increase the risk of developing a fracture. Primarily, there is a decrease in the bone matrix and calcium in the bone causing the bone to become brittle and break easily. It could be either age-related or due to various other factors as explained later in this article. Osteopenia is another condition, where there is a decrease in bone density as compared to a normal bone, but not severe enough to be classified as Osteoporosis.
How common is this condition?
India is the country with second largest population in the world with approximately 10% of population (more than 100 million) over 50 years of age. According to study done in 2013, about 50 million people (half of the old age population) are suffering from osteoporosis or have low bone mass in India.
It is a common condition in women during menopause (more than 45 years) and in men more than 75 years of age. Prevalence of osteoporosis was found to be 24.6% in men and 42.5% in women above 50 years, according to study done in Delhi.
Who are the risk groups for Osteoporosis?
To keep the bone healthy, regular exercise, an adequate intake of calcium, and Vitamin D (which is important for calcium absorption) are required. Various factors are responsible for the development of osteoporosis – Men 70 years or older, Women 65 years or older, women of menopausal age, previous history of fracture after age 50, Vitamin D deficiency, decreased dietary calcium intake, chronic kidney diseases, prolonged immobilization, or a sedentary lifestyle. Other factors like Diabetes Mellitus, history of chronic alcohol use, smoking, excessive use of tobacco, chronic use of drugs for seizure disorders, long-term use of corticosteroids, low level of estrogen in the body (as during menopause), obesity, or malnutrition are also equally responsible for the development of osteoporosis.
What are the symptoms of Osteoporosis?
Osteoporosis usually involves the spine, hip bone, ribs, shoulder, or wrist bone. Patients are usually asymptomatic so it is often called a silent disease. However, they may present with acute back pain which may later lead to the development of spine disorders like kyphosis (where there is increased curvature of the spine causing a hump-back) or acute local pain of the involved site which worsens on movement. Symptoms can be mild to severe. Severe forms may present with a fracture. An osteoporotic bone is much easier to fracture than a normal bone. The fracture may involve the spine or the hip. A hip fracture may present with pain, inability to bear weight, and shortening of the involved limb as compared to the other.
How to diagnose a case of Osteoporosis?
A complete and detailed history and clinical examination are a must for the initial assessment of the patient. It can direct the treating surgeon to make an accurate diagnosis. On examination, there may be tenderness over the involved site. This pain to touch is almost always due to the fracture.
Investigations like blood tests, blood calcium levels, blood vitamin D levels, and liver and kidney function tests are done to assess the cause.
X-Ray and vertebral imaging techniques are usually done to determine the bone density, and also to diagnose a fracture. Osteoporotic bone appears much thinner and lighter on X-Rays. DEXA (Dual-energy X-Ray Absorptiometry) scan and sometimes Ultrasonography of the heel bone can be done to determine the density of bone. Sometimes Computed Tomography (CT Scan) can also be done to diagnose Osteoporosis. It is for this reason, it is important to visit an Orthopedic surgeon for an early diagnosis and effective treatment.
What are my treatment options?
The main aim of the treatment of osteoporosis is to reduce the chances of developing a fracture. Lifestyle modifications are equally important. Patients should be made aware of the importance of Calcium, Vitamin D, and regular exercise. These are important in the prevention of development of Osteoporosis. Regular weight-bearing exercises to improve bone health also helps.
Your physician may prescribe drugs such as Bisphosphonates and Calcium supplements. Estrogen replacement therapies are preferred in selected cases, especially for female patients. All postmenopausal women with a history of fracture are recommended drug therapy.
Pain management can be done with the use of analgesics and anti-inflammatory medications.
How can we prevent Osteoporosis?
Proper dietary habits, good nutrition, adequate Vitamin D and Calcium supplementation, according to age will help prevent onset of Osteoporosis. In addition, avoid smoking, alcohol intake, tobacco use, and take precautionary steps to decrease the risk of fall. Regular exercises (like swimming, cycling, yoga, lifting objects) can prevent the development of osteoporosis and improve bone health.
What can happen if I don’t seek medical assistance?
If medical advice is not taken at the earliest, the patient can land up with complications. It can lead to a fragile bone that is too weak to provide structural support to the body. The most significant complication being fractures of the hip, spine, wrist bone, or ribs leading to disability and deformity. Osteoporosis can also cause deformities of the spine like kyphosis that can cause breathing difficulties and respiratory infections. That is why timely intervention is a must.
- Kadam NS, Chiplonkar SA, Khadilkar AV, Khadilkar VV. Prevalence of osteoporosis in apparently healthy adults above 40 years of age in Pune City, India. Indian journal of endocrinology and metabolism. 2018 Jan;22(1):67.
Disclaimer: Please consult your physician before undertaking any exercise routine, change in diet or consuming vitamins & supplements.