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Osteoporosis is a bone disease that causes loss of calcium from the bones. As a result, bones become weak and brittle making them susceptible to fractures from trivial trauma. The term Osteoporosis comes from Latin for ‘porous bones’.
Osteoporosis develops slowly and the patients may have no symptoms of the disease until fractures occur. Most of these fractures occur in the hip, wrist and spine.
Your bones are living tissue, the inside of which looks like a honeycomb. This spongy bone is called trabecular bone. It is surrounded by an outer dense bone known as cortical bone. In osteoporosis, the inside of the bone becomes weaker and the ‘holes’ in the ‘sponge’ grow larger. Osteoporotic bone lose calcium and becomes less dense. These fragile bones are very weak and prone to fractures. The fracture can be either in the form of cracks (like in hip, wrist) or a collapse (as in a compression fracture of the vertebra).
In the early stages of the disease, there are almost no symptoms or warning signs. In most cases, people get to know about it after they have sustained a fracture.
Once your bones have been weakened by osteoporosis, you may have these signs:
Back Pain – Can also be due to a collapsed vertebra
Loss of height over time
Change in posture – stooping or bending forward
Bone fractures
Joint and body pains
The risk of getting osteoporosis increases with age after the age of 50 years and hence the risk of fractures also increases. The broken bones after healing may cause permanent pain, stooped postures and disability. It also limits mobility which leads to isolation, depression and long term nursing care. About 20-30 percent of senior citizens who get a hip fracture due to osteoporosis are likely to die within one year of injury from various complications.
The two most important risk factors for developing Osteoporosis are gender and age.
Everyone is at risk of developing osteoporosis and osteoporotic fractures with increase in age. In women, the hormone estrogen protects against excessive bone loss in younger years. After the age of 50 years or in postmenopausal women, the amount of estrogen in females decreases increasing the risk of osteoporosis. They undergo rapid bone loss in the first 10 years after entering menopause.
Family History – You have a greater risk if your parents/grand parents had any signs of osteoporosis.
Lifestyle – Sedentary lifestyle, lack of exercises increases the risk.
Alcohol and tobacco consumption.
Dietary factors such as low calcium intake, low Vitamin D levels, eating disorders, history of bariatric surgery, celiac disease.
Medical conditions – A lot of medical conditions and treatments increases the risk of osteoporosis such as:
After a detailed history of your symptoms, your doctor will advice a Bone Mineral Density (BMD) test, also known as Dual-energy X-ray absorptiometry (DEXA) scan. It uses very small amounts of X-ray radiation to determine how solid the hip and spine are. The results are in the form of T and Z scores which classify the patient as normal, osteopenia or osteoporosis. People above the age of 65 years should get their bone density checked regularly.
A routine X-ray also reveals osteoporosis as bones appear thinner and lighter than normal bones. Unfortunately, by the time these findings appear on the X-ray a lot of bone is already lost.
DietSince bones are made up of calcium, you need a diet rich in calcium to keep them strong and healthy. The recommended daily allowance of calcium is 1000-1200 mg. Some good sources of calcium rich foods include:
> Dairy products
> Green leafy vegetables
> Fish
> Soy products
> Fruits and juices
If your diet is inadequate to provide sufficient daily calcium, then you must take calcium supplements. Calcium supplements should be taken in divided doses since calcium absorption is not readily absorbed.
Vitamin D is also important for maintaining bone health. Vitamin D improves the body’s ability to absorb calcium. The recommended daily allowance of Vitamin D is 600-800 IU. Vitamin D is produced by the body from sunlight exposure but this might not be enough if your sunlight exposure is less or if you regularly use sunscreen. People not getting enough Vitamin D need to take supplements.
Proteins
Proteins are the building blocks of the body. The basic structure of bones is made up of proteins upon which calcium is deposited. You should have good protein intake in your diet. Foods with good source of proteins include eggs, dairy, soy, nuts, legumes etc.
Exercise
Exercises help you build strong bones and also slows down bone loss. Exercises will benefit you irrespective of the age you start but you will get most benefits if you start exercising at a younger age and continue to exercise in old age.
You can start with basic strength training exercises with weight bearing and balance exercises. Exercises such as walking, jogging, running, skipping affects the bones in your legs, hips and lower spine
Lifestyle Modifications
> Avoid smoking as it reduces new bone formation
> Limit alcohol intake
> Be careful of your eating habits
> Be physically active. People with sedentary lifestyle have a higher risk of developing osteoporosis.
Prevention of Falls
> Remove trip hazards such as throw rugs and clutter.
> Ensure adequate lighting at home
> Install grab bars specially in the bathroom
> Get your eyes checked regularly for vision and keep your glasses up to date
Treatment
Treatment for established osteoporosis include exercise, vitamin and calcium supplements and medications. Exercises and supplements are also helpful in preventing osteoporosis.
People with Bone density scores -2.5 or lower, such as -3.0 or -3.5, should begin treatment to reduce the risk of fractures.
People who have had a typical osteoporotic fracture of the wrist, spine or hips even if the bone density scores are better.
Supplements
Your diet should have enough calcium and Vitamin D to meet your daily requirements. The recommended amount of daily calcium intake is 1000-1200mg and of vitamin D is 600-800 IU. Get your levels tested and if found to be deficient supplement them and maintain them.
Medications
There are several classes of medications to treat osteoporosis. We discuss with the patient all the treatment options and help them choose the best for them.
