Osteoporosis is a bone disease that occurs when the body loses too much bone, makes too little bone, or both. As a result, bones become weak and may break from a fall or, in serious cases, from minor slips or falls. Osteoporosis essentially means “porous bone.” It is measured by Bone Mineral Density (BMD) scores. Our bones are constantly remodelled in the body. Old bones are replaced by new bones. Bones, the pillars of your strength need support and care, just like your hair and skin.
Bone metabolism is the interplay of many systems and hormones, like vitamin D, calcium, gastrointestinal system, parathyroid hormones, oestrogen and many other chemicals in the body. Bone development starts at the earliest age of 5 years! Bone is in its peak strength and calcium storage when an individual is in their 30’s. Thus we have 25 years ,from 5-30 years to build up our bones to the fullest extent.They can stay that way till the age of 40, but are heavily dependent on one’s lifestyle. Excessive triglycerides, smoking, alcohol, inactivity, steroid use may lead to early reduction in peak bone density.
In India, social factors, like gender inequality, underdiagnosed in women, heavy labour in women, too frequent and multiple childbirth, play a significant role in women causing osteoporosis. Women often refuse to consume calcium and vitamin D medications, only to repent later. Calcium and vitamin-D intake are extremely essential for women, especially during the formative years i.e. around 20s. The bone is at the strongest and it is when the peak bone mass develops to last a lifetime. After the age of 40, every year women lose 10-20% of this mass.
A 2015 study has shown that over 30% of postmenopausal women in India suffer from osteoporosis (2015 study). It is important to keep in mind that the stats only reflect the women who have been diagnosed. Due to the lack of good healthcare infrastructure in India, there are thousands of women who suffer but are never diagnosed.
The risk factors:
For women the chief cause of osteoporosis is lack of oestrogen. Oestrogen reduces the excessive removal of bone during remodelling. It also reduces the excretion of excess calcium from the kidneys. Moreover, this hormone is also responsible for increase in the absorption of calcium from the gut. It interacts directly with the bone and is often also known as the super hormone.
Usually, in a woman’s lifetime she does not face the issue of hormonal imbalances if maintained a somewhat healthy lifestyle. However, as menopause approaches, bone metabolism goes in panic mode. It constantly tries to balance out the bone formation and removal process. Normally menopause occurs when a woman is around 50 years old; and clinically, osteoporosis sets in 10-15 years later. However, menopause related bone loss starts within 4-5 years after menopause.
Why should we be worried if it’s a normal natural process happening in our body?
As the bone mass density goes lower and lower, the bone can break easily and can cause fractures. It starts with the radius (wrist fractures), or hip fracture and progresses to spine fractures, this worsens as it debilitates the individual causing chest infections, ulcers, GI problems and many more. A common saying among the doctors is that “the bone broke and the grandma fell” just shows how fragile the bone has become. It causes weakness amongst women too. While complicated fractures are one end of the spectrum, weakness is the start point. Generalised weakness, backache, sciatica, foot pain and inability to perform certain day-to-day activities can give us a hint that our body is struggling to keep up with the bone metabolism.
Prevention:
- Exercise is first and foremost when it comes to ensuring you don’t fall prey to osteoporosis. Girls should start exercising by the age of 5, that mainly involves running, playing etc. They should not be restricted in their homes for chores and duties. Bone building is encouraged by exercising. Gradually yoga asanas are to be introduced and then muscle strengthening at later stages. As age progresses to adolescence and teens, yoga, cycling, swimming, athletics are favourable. After 20s, daily exercise in some or the other form is essential, as is to eat and sleep daily. Muscle strengthening exercises regulate blood circulation ensuring the bones receive the required amount of blood from muscles. In consequence, it strengthens the bones. Muscles are protective during falls so building muscle strength is very effective.
- Diet- this constitutes the main part of osteoporosis in growing females. A balanced diet with calcium , vitamins and proteins goes hand in hand to improve calcium intake, absorption and storage in the body.Maintaining a calcium rich diet consisting of ragi, milk, cheese, low oxalate and phytates food (eg potatoes). Consuming more of vitamin A, vitamin C to increase absorption of calcium and iron in the body helps in increasing your calcium stores.
- The major risk involved is falling, hence for fall prevention especially for elderly women becomes crucial. Anti-skid footwear, use of night lamps, use of prescription glasses, avoiding wet floors and being careful while walking is necessary.
- Early diagnosis by BMD scanning by dexa scans will ensure early treatment.
- Regular consumption of calcium and vitamin d medicines since adolescence, during pregnancy, lactation, menopause helps in bone strengthening.
- Hormone replacement therapy in certain women after menopause helps in slowing the progression of osteoporosis.
- Adopting a healthier lifestyle with increased activity and decreasing alcohol, smoking, steroid use proves beneficial.
Treatment for osteoporosis:
- Medication helps in bringing relief in uncomplicated cases. Calcium intake of 1000-1200 mg daily helps maintain a regular lifestyle.
- In cases of severe osteoporosis, many effective injections are introduced. For example, Teriparatide, Denosumab, Bisphosphonates. It is to be noted that doctor's supervision is essential and one should not self-prescribe.
- For fracture treatment surgery is often needed for several instances, like hip fracture. The surgery may vary from case to case, from fracture fixation to hip replacement. Wrist fractures can be casted or splinted depending on its nature. Spine fractures are generally braced, and require surgery if associated with nerve damage or severe pain. Fracture treatment is also coupled with injectable drugs meant to increase bone production and reduce its resorption.
- Newer modalities: Injectable drugs are very efficient and reduce risk of re-fractures and help strengthening of bones.
- Last, but not the least, muscle strengthening exercises are very helpful in bringing relief as they load the bones and make them stronger.
Bottom line:
Osteoporosis is a bone disease which can lead to frequent fractures and bone fragility. However, it can be prevented through a proactive approach, consisting of a healthy lifestyle, good diet and exercise, early screenings, and regular consumption of essential vitamins and minerals. Additionally, there are a range of treatment options available today consisting of medication, injectable drugs, and muscle strengthening, among others.
Disclaimer : This information is provided for educational purposes and should not be construed as medical advice. Please consult with your healthcare practitioners before undertaking any changes in your diet or adding supplements.
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