Osteoporosis means the deterioration of bone density – the term comes from “osteo” meaning bone and “porosis” meaning decrease in density or porosity. It is a significant medical concern, which increases the risk of fracture, morbidity, mortality and even the loss of active years.
It is estimated that 200 million people suffer from osteoporosis. The disease most affects the older age group – mainly people aged 60 and over. In this age group, postmenopausal women have a higher incidence of osteoporosis than men.
What causes osteoporosis?
Healthy bone requires titration of calcium gain and loss which depends on diet, hormonal balance, and physical activity. Any alteration in this finely tuned physiology can lead to poor bone quality.
A diet lacking in calcium and protein or inadequate absorption of calcium and vitamin D (malabsorption syndromes such as celiac disease, lactose intolerance, etc.) reduces bone and tissue healing and resistance. Excessive alcohol consumption, smoking, and anorexia can lead to dietary deficiencies causing osteoporosis.
Hormones such as thyroid, estrogen and testosterone are necessary for the functioning of the body machinery. Hormonal imbalance can lead to increased bone loss. In particular, it causes a decrease in estrogen followed by menopause, further leading to rapid osteoporosis.
Some essential drugs like antiepileptic drugs for epilepsy, PPIs for acidity, chemotherapy for cancer, and steroids for rheumatoid arthritis can also cause osteoporosis as side effects. But, these drugs cannot be stopped as it can lead to more damage.
Another important factor behind osteoporosis is a sedentary lifestyle and a lack of exercise. A vitamin D deficiency due to lack of exposure to the sun is an additional factor.
Other causes are advanced age, family history (heredity) and sex (women are more affected than men).
Young people with gastrointestinal problems affecting diet or suffering from hormonal imbalance and excessive weight loss / gain should see a specialist to prevent bone weakness.
Can young women get it?
Demographically, women are more affected than men mainly because of their physiology. Women go through periods, childbirth, breastfeeding, and hormonal changes that men don’t. This results in an increase in bodily losses.
A healthy young woman with a healthy lifestyle (which includes a balanced diet and a regular exercise routine) without any disease need not worry about osteoporosis. However, young people with gastrointestinal problems affecting diet or suffering from hormonal imbalance and excessive weight loss / gain should see a specialist to prevent bone weakness.
Women who lack sun exposure and an exercise regimen are at greater risk. All of these factors add to the decrease in bone strength leading to osteoporosis in women as they age.
What are the first signs to watch out for?
Bone pain, general weakness, malaise and easy fatigue are some of the symptoms of early bone weakness. This is more pronounced in older people where it can be clinically observed in their hunched posture and their inability to stand or be active for long periods of time.
In established osteoporosis, fractures are frequent even with an insignificant and insignificant fall. The most commonly affected areas are the spine, wrist and hip. History of multiple fractures should also raise red flags. Osteoporosis fractures are difficult to treat because they heal slowly and have little force to hold the implants.
Can a balanced diet delay it?
Eating healthy is the best way to fight osteoporosis. Bone is a tissue that requires constant maintenance and repair.
A balanced diet containing protein, carbohydrates, minerals and multivitamins is essential. Milk and dairy products, fish, soybeans, tofu, and nuts are good sources of calcium. Legumes, cabbages, eggs, milk, and meat / poultry are rich sources of protein.
The daily protein requirement is 1 g / kg depending on the daily body weight. The daily calcium requirement for adults is 1,000 to 1,500 mg per day (including food sources).
Vitamin D is not naturally available in food and must be supplemented or fortified in food. The daily requirement for vitamin D is 400 to 800 IU / day.
Eating healthy is the best way to fight osteoporosis.
What precautions should I follow?
A healthy lifestyle is of the utmost importance in the prevention of most diseases, including osteoporosis.
Daily exercise of moderate activity for 150 minutes per week – including two days per week of strength training.
Eating a balanced diet with a recommended daily intake of protein, carbohydrates, and roughage along with nutritional supplements (vitamin D, minerals, and antioxidants) can keep the body healthy and prevent disease.
Daily sun exposure of 15 to 30 minutes of mid-day sunshine is recommended by health experts in the United States. However, the absorption of sunlight depends on the pigmentation of the skin, clothing and environmental factors.
Adequate sleep is essential for the body to repair itself. Aim for a recommended sleep time of 6-8 hours per day.
Is osteoporosis treatable or curable?
Osteoporosis is a treatable and preventable disorder that can be diagnosed and managed quickly. Treatments can be divided into three types: exercise, diet, and medication.
It can be detected by x-rays, and the vulnerable population gets dual-energy x-ray absorptiometry (DEXA) scans – a gold standard for diagnosis. It gives an estimate of the bone density at the most frequent fracture sites (lumbar spine, upper femur, etc.). It gives a T-score reading – where 0 to -1 is normal, -1 to -2.5 is osteopenia, less than -2.5 is osteoporosis. Estimation of the degree of osteoporosis, in turn, will help decide on further treatment.
Treatment is a multi-pronged approach that involves healthy eating, exercise, and medical attention. Medicines in the form of vitamin D, calcium, bisphosphonates, hormones – teriparatide and biologicals are used.
Women who lack sun exposure and an exercise regimen are at greater risk.
Medicines can strengthen bones by decreasing calcium loss or increasing calcium absorption. Drugs such as bisphosphonates and denosumab that prevent bone destruction can help prevent bone loss. A bone building drug is teriparatide which is similar to parathyroid hormone.
Supplementation with hormones such as estrogen in women, testosterone in men, parathyroid hormone and calcitonin increase calcium supply to the bones. All of the above-mentioned drugs should be prescribed by a licensed physician at an adequate dosage. These drugs should only be administered under the supervision of a doctor.
Therefore, prevention is much more important than cure. A healthy lifestyle involving a balanced diet and regular exercise is essential. Performing lab tests to identify levels of vitamin D, serum calcium, phosphorus, and alkaline phosphatase helps identify bone disorders early on.
What advice would you have for caregivers?
For caregivers, it is essential to seek the advice of a licensed physician on required tests and treatment as soon as osteoporosis is suspected.
It is essential to treat people with osteoporosis with care and gentleness. The use of walking aids, the attachment of wall brackets for assisted walking, non-slip floors and good footwear are important.
The use of orthotics and braces (functional braces, lumbar braces, etc.) to maintain posture helps patient confidence and comfort. Keeping an eye on a healthy diet complete and exercise with the necessary medications is the key to management.
Dr Fahad M Shaikh is DNB, D Orth, MNAMSMBBS, MCH (US-AIM), Fellowship in Joint Chirurgies
– The author is a consultant surgeon in orthopedics, traumatology and joint replacement at Masina hospital