What is osteoporosis? Osteoporosis is a condition that affects the bones. Its name comes from Latin for “porous bones.” Osteoporosis or porous bone is a devastating disease in which bone becomes less dense and fragile, resulting in chronic pain and disability and can rob people of their independence. Osteoporosis is a public health concern all over the world. In India, around 50 million people are estimated to be osteoporotic or low bone mass.
There are several factors including social and financial reasons which can contribute to osteoporosis in India. These are Family history, low calcium diet, lack of physical exercise, excessive alcohol and smoking, early menopause. By the age of 20 average person acquires 98% of the skeletal mass. This process of bone acquisition slows as you get older. Between age 35-40, we start to lose bone mass, remain reasonably stable until age 50 and then declines progressively. This loss if severe can lead to osteoporosis Our bone density is maintained by a fine balance between osteoblasts (bone forming cells) and osteoclasts (bone resorbing cells). Post-menopausal osteoporosis is an exaggerated form of physiological bone depletion that normally accompany ageing and loss of gonadal hormones
Symptoms and complications
The early stages of osteoporosis is asymptomatic. In most cases, people with osteoporosis don’t know they have the condition until they have a fracture. Some early symptoms which may occur are easy fatiguability, shortness of breath, generalized weakness. It is often known as the silent thief and the progressive loss and thinning of bone tissue happens over many years resulting in fragility fractures especially of the hip, spine and the wrist although any bone can be affected.
Symptoms of severe osteoporosis can include a fracture from a fall or even from a strong sneeze or cough. Back or neck pain or loss of height can be caused by a compression fracture. This is a break in one of the vertebrae in your neck or back, which is so weak that it breaks under the normal pressure in your spine.
Diagnosis of osteoporosis
Assessment is done using thorough clinical history and physical examination, X-rays and DEXA or dual-energy X-ray absorptiometry scan. Blood tests and ultrasound abdomen might be required to investigate cause of osteoporosis and various diseases related to it Prevention Osteoporosis can be prevented by adequate calcium and Vitamin D intake. Good sources of calcium such as dairy products- milk, cheese, yogurt, green leafy vegetables, nuts especially almonds, and Seafood. Vitamin D may be obtained from eggs, liver, or by spending 15 minutes in the sun 2-3 times a week. Weight bearing exercise such as low-impact aerobics, stair climbing, running and swimming helps keep your bones strong. Cut back on cigarette smoking or excessive alcohol intake.
Treatment includes medications such as calcium and vitamin D supplements, Bisphosphonates, Denosumab, Inj zolindronic acid and inj teriparatide which target key pathways in the calcium metabolism. Once fracture occurs patients need to get operated followed by physiotherapy to regain the function.
Effects of osteoporosis
If a person does not get investigated and treated for osteoporosis he or she will land up in bent spine, bent and deformed knees and will be susceptible to fractures around the hip, wrist and spine
Osteoporosis needs to be taken seriously by society, doctors and policy makers. The goal at managing osteoporosis is to slow or stop the bone loss and to prevent fractures by proper nutrition, lifestyle modification and exercises, fall prevention and proper medication. Improved understanding of the cellular basis for osteoporosis and new drugs to key pathway will lead to osteoporosis free society.
By Dr Prem Kotian