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Osteoporosis

Osteoporosis is one of the primary cause of morbidity among elderly individuals in India.

1 out of 8 males and 1 out of 3 females in India have osteoporosis, making India one of the largest affected countries in the world. Osteoporotic fracture rates in India are among the highest in Asia.

Post menopausal osteoporosis affects 80% women above 65 years. Women after menopause lose about 2% of bone density. Osteoporosis is responsible for 15 million fractures each year.

Frequently Asked Questions

What is osteoporosis?

"Osteo" means ‘bone’ and "porous" means ‘pores’ or 'holes', meaning 'holes in bones'. It is a common condition in which bones become weak and are at risk of breaking easily compared to normal bones. It affects both men and women, mainly in old age.

Osteoporosis is a "silent" condition and is asymptomatic till the bone breaks. Usually this happens at the spine, wrist and hip. Such fractures lead to long-term pain and disability and may even cause death. Hence, the main goal of treating osteoporosis is to prevent these fractures.

Why does it happen?

Bone is living tissue that is in a constant state of cycling - old bone is removed and new bone is formed. Osteoporosis results from loss of bone mass and from a change in bone structure. With ageing, bone loss exceeds bone replacement eventually making them thinner and weaker. This may be accelerated sometimes by certain diseases (eg. Rheumatological diseases).

Do I have any risk factor?

Many risk factors for developing osteoporosis have been identified. Some of these risk factors can be changed, but not others. It is important to identify risk factors in each patient and treat them. Major risk factors for osteoporosis include:

  • Older age
  • Race: Asian ethnic background
  • Small bone structure
  • Family history of osteoporosis - an osteoporosis-related fracture in a parent or sibling
  • Prior fracture due to a low-level injury, particularly after age 50

Risk factors that you may be able to change include:

  • Hormonal Imbalance, maily estrogen in women (e.g., due to menopause)
  • Eating disorders such as anorexia nervosa (reduced eating) and bulimia (excessive eating)
  • Cigarette smoking and Alcohol abuse
  • Low calcium and vitamin D, due to low intake in diet or inadequate absorption
  • Sedentary (inactive) lifestyle or immobility with no physical activity
  • Certain medication like steroids, heparin:
  • Inflammatory arthritis

Will I get Osteoporosis?

Osteoporosis can affect anybody. Age related Osteoporosis…… Osteoporosis occurs with aging. Postmenopausal women are at higher risk due to hormonal changes- leading PMOP (Postmenstrual Osteoporosis). Sedentary lifestyle with poor physical activity can lead to Osteoporosis even at an earlier age.

How will I know whether I have Osteoporosis or not?

Osteoporosis is diagnosed by measuring bone mineral density by DXA (Dual-energy X-ray Absorptiometry). Bone mineral density - often called BMD - is the amount of bone that is present in a given area of the skeleton. The measurements are made at the spine, hip and wrist, including a part of the hip called the femoral neck.

The test for measuring BMD is quick and painless. It is similar to an X-ray, but use of radiation is much less.

DXA test results are scored compared with the BMD of young, healthy people. These results in a measure called a T-score. Based on the T-score, various grades of bone loss such as osteopenia and osteoporosis can be diagnosed.

How can I keep my bones healthy?

Diet rich in

  • Calcium. The National Osteoporosis Foundation recommends 1,000 mg per day for most adults and 1,200 mg per day for women over age 50 or men over age 70.
  • Vitamin D. The recommended daily dose is 400 - 800 International Units (called IU) for adults younger than age 50, and 800-1,000 IU for those ages 50 and older. (These are the current guidelines from the National Osteoporosis Foundation.) Dose should be adjusted depending on blood level of vitamin D.
  • Physical activity. Weight-bearing exercises, Walking are important.

Do we have medicines to treat?

Primary Medications

Teriparatide: Teriparatide is a form of parathyroid hormone. It helps to stimulate bone formation. It is useful for treatment of osteoporosis in postmenopausal women and men at high risk of osteoporotic fracture and also for treatment of glucocorticoid-induced osteoporosis. It is given as a daily injection can be used for up to two years.

Bisphosphonates: These class of drugs are called "antiresorptive" drugs. They help to slow bone loss. They can decrease the risk of fractures.

Denosumab: is a latest medication: A injection given as 6 monthly basis

Supportive Medications

Calcitonin: It is given as a nasal spray. It is also helpful in controlling pain after an osteoporotic vertebral fracture.

Certain other medications useful in osteoporosis treatment are:

Estrogen or Hormone replacement therapy

Selective Estrogen receptor modulators