Osteoporosis

It is a condition which leads to weakening of bones. Around 50 per cent of men and women above the age of 50 years will  a sustain fracture of compromised osteoporotic back bone, hip or wrist. The problem can occur in younger people also.  The highest strength of bones in an individual’s lifetime is around the age of 30 irrespective of the built, sex and the race. This is called Peak Bone Mass. Bone mass keeps on reducing after the age of 30 in both men and women gradually. However, it falls rapidly after menopause in women due to hormonal changes, making them more prone for osteoporosis.

The bone is a dynamic structure having constant turnover of its protein building scaffold and minerals, most importantly calcium salts deposited on it. At the microscopic level, it is like a huge meshwork of protein Trabeculae with minerals deposited on them. Several factors affect the process of bone turnover.

Quantitative and qualitative decrease in bone framework at microscopic level can lead to osteopenia (osteo—bone; penia —decrease) and more serious osteoporosis when bone density decreases below a particular level and can give disastrous result at times. With osteoporosis, fragility increases because body fails to form enough new bone when too much existing bone in washed away. Osteoporosis can cause suffering and acute pain because of fractures, constant chronic disabling pain because of crumbling bone framework and deformity in back. This disease can be a huge financial burden on individuals and society. But fortunately, it is preventable to a large extent and treatable with simple drugs and active lifestyle.

Dr Yash Gulati, senior consultant, Orthopaedics, Indraprastha Apollo Hospitals, New Delhi

When to suspect

• Unexplained aches and pains all over the body in women around menopause or older men and women.
• Fracture sustained because of relatively trivial injury.
• Continuing back pain in people above 50 years of age.
• Stooping posture in elderly caused by multiple back bone compression collapses. Often silent with little or no pain.
• Sudden acute back pain in elderly because of Vertebral Compression Fracture (VCF).

Dr Gulati

Treatment

It can now be treated to a large extent and tendency of bones to break can be significantly decreased by certain drugs and of course by remaining active.

• Specific drugs such as Bisphosphonates Calcitonin and Tereperetide are now available

• Calcium and Vitamin D is important

• Various formulations are available which can be given daily, once a week, once a month or once a year, depending on the severity of disease and certain other factors. This must be done under medical supervision.

You will be asked to take the oral drugs empty stomach with water and to walk for half hour. This is because absorption of these drugs is otherwise poor. Drugs like terepertide are given by daily injection under the skin (just as in Diabetes).

This is an expensive treatment; to be taken in special cases only.

Dr Gulati

Causes

• Age: Bone weakens with advancing age and is an important cause of osteoporosis.
• Lack of Activity: Sedentary lifestyle, lack of exercise leads to osteoporosis. Since bone is a living, dynamic structure, the more we stress it with activities like walking, jogging and sports, the more bone can remain healthy.
• Hormonal imbalance: Female hormone estrogen and certain male hormones have  a positive effect on bone formation. Females are more prone to osteoporosis around menopause due to hormonal disturbances.
• Drugs: Steroids, anti-etrilepsy and certain other drugs, can lead to osteoporosis.
• Alcohol and smoking: Heavy drinking and smoking have a definite negative effect on bone formation.
• Low body weight
• Race: Races such as caucacian’s and Asians are more prone to osteoporosis.

Dr Gulati

Diagnosis

There are simple non invasive methods available, like the DEXA scan which can accurately measure bone density and tell us if we have weak bones (osteopenia) or indeed osteoporosis. At the same time, we should check out mineral metabolism, when indicated, by doing blood test for calcium and Vitamin D.

It may be a good idea to check it once around menopause and after 50 year of age in case of men. There after it can be checked once every few years. In case of fragility fracture due to trivial injury after the age of 50 years around wrist, hip or spine, bone density must be checked.

Fragility Fractures of Back Bone

The VCF can often be treated with medication and bracing. If it isn’t successful and in certain fracture patterns, it is now possible to push bone cement into back bone without giving general anesthesia (vertebroplasty or kyphoplasty). This can give excellent relief in pain and get the elderly patient back or feet very quickly.

How to keep Bones Healthy

Here are five practices that can help one manage your osteoporosis better.

Vitamin D and calcium rich foods work wonders with bone strength. Dairy products, dark green vegetables like broccoli, green bell paper and okhra, soy products like soy milk, tofu are great source of calcium. Adult women in the age group of 19-50 years and men of 19-70 years should have an intake of 1, 000 mg calcium per day. Women above 70 should take 1200 mg of calcium

Weight-lifting exercise can improve bone mass and mineral content in young, and helps maintain bone mass in older persons.

Sunrays are a great source of vitamin D and sitting outside at least for 5-10 minutes early in the morning before the rays go harsh can improve bone health

Say no to alcohol and caffeine.

— Dr Maninder Shah Singh, senior consultant Orthopaedic Surgeon, Indian Spinal Injuries Centre, Delhi

Surgery

In fragility fracture around the hip, surgery is often required either to fix the fracture with nail, plate or sometimes hip replacement may be required. It is very important to get the elderly person with such a fracture out of bed quickly & mobilise them with the help of good fixation of fracture. Early mobilisation can avoid serious complications like bed sores, pneumonia & increase in osteoporosis. This can literally make a difference between life and death.