Bone Deep

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Bone Deep

Sunday, 24 October 2021 | SUPRIYA RAMESH

Bone Deep

According to the studies conducted among women across the country, it is estimated that among the 230 million people expected to be over the age of 50 years, 46 million are women with osteoporosis. SUPRIYA RAMESH speaks with experts to bring you a report

World Osteoporosis Day is observed on October 20, every year. Osteoporosis is a bone-related condition that weakens bones and causes fractures more easily. Similar to a honeycomb, the inside of a healthy bone has small spaces. In this condition, the size of these spaces enlarges, resulting in the weakening of bones, losing strength and density. Moreover, the outside of the bone grows weaker and thinner. Bones become so brittle that a fall or even a mild stress such as bending over or coughing can cause a fracture. It is quite common later on in life, even more so in women after menopause. Osteoporosis-related fractures most commonly occur in the hip, wrist or spine.

According to the studies conducted among women in India across the country, it is estimated that among the 230 million Indians expected to be over the age of 50 years, 46 million are women with osteoporosis.

“In a country like India, most of the osteoporotic cases go untreated and even undiagnosed.  Therefore, it is necessary for both men and post-menopausal women to have adequate measures to prevent osteoporosis in later years in life,” Dr Biren Nadkarni, Senior Consultant Orthopedic and Joint Replacement Surgeon, Sitaram Bhartia Institute, New Delhi, tells us.

Osteoporosis is further classified as primary and secondary. Primary includes type I and II. It is observed in post-menopausal women and men and women over 70 years of age due to ageing. Whereas, diseases like systemic diseases, endocrine diseases, and malignant neoplasms cause secondary osteoporosi. Treatments or idiopathic could also lead to the same.

Women more prone than men

Women are four times more likely to develop the disease than men because of the rapid bone loss in the first 10 years post-menopause, which results in slower production of estrogen, a hormone that protects against excessive bone loss. Over time, the risk of fracture increases as older women lose more bone than they replace. “Younger women who stop menstruating which is very common today or girls with anorexia also have compromised bone density. Having both ovaries surgically removed, called a bilateral oophorectomy, may also cause osteoporosis and low bone density,” Dr Nadkarni says adding that men over the age of 50 are more likely to have an osteoporosis-induced bone break than to get prostate cancer. 

Senile Osteoporosis

“Senile osteoporosis represents a condition of significantly diminished bone mass due to a long-standing imbalance between bone resorption and bone formation,” Dr Shubhang Aggarwal, Orthopaedic and Robotic Joint Replacement Surgeon, Director, NHS Hospital, Jalandhar, tells us.

Osteopenia

Osteopenia is when your bones are weaker than normal but not so far gone that they break easily, which is the hallmark of osteoporosis. “Osteopenia is a condition that initiates with loss of bone mass and bones becoming weaker. This happens when the inside of your bones become brittle from a loss of calcium. This is the precursor to osteoporosis,” says Dr Loveleena Nadir, Senior Gynecologist, Rosewalk hospital, Panchasheel Park, New Delhi.

Treatment

There is no cure for osteoporosis but it is advisable to get tested on a regular basis for the diagnosis at an early stage. Taking proper treatment and precautions before it is too late can help in controlling the breaking and thinning of bones. Delaying or avoiding proper treatment can worsen the disease and the weakening of bones can higher the risk of fractures.

Dr Aggarwal tells us how the testing process works and what possible treatments can be given. “The identification of symptoms and confirmation of diagnoses can be done with an X-ray and Dual-energy X-ray absorptiometry (DEXA) scan, an imaging test that measures bone density (strength). Really severe calcium deficiency is incidentally picked up in the blood test,” he says.

He adds that treatment starts with adequate calcium intake in diet and supplements in the form of tablets. Adequate vitamin D supplementation, regular stretching exercises to encourage intake and absorption of calcium into the bones and other medication which are used for bone-building like Biswas for nets, Salman calcitonin spray and in very severe cases of osteoporosis, injections like teriparatide are used. These are to be used under the expert supervision of an orthopaedic surgeon.

Another important factor may be the identification of upset digestion that can prevent calcium absorption even if the intake is proper. He says that early osteoporosis is definitely completely treatable, in the later stages, however, one can only try to strengthen the existing bone mass and prevent fractures.

“Testosterone and hormone therapy are also recommended in men and women respectively according to the severity of the condition,” says Dr Nadkarni.

Symptoms

Initially, it becomes tough to identify the disease as the person rarely experiences any symptoms. Once the bones start weakening, signs may show up which could possibly be similar to other diseases’ symptoms.

“There are no particular symptoms but look out if there is a back pain caused by a fractured or collapsed vertebra, loss of height over time, a stooped posture when it starts affecting the spine, a bone that breaks much more easily than expected, weak and brittle nails, receding gums and weakened grip strength,” says Dr Nadkarni.

Along with osteoporosis, there is a risk of developing other conditions like digestive disease, rheumatoid and diabetes. 

Precautions

Although medicines can help control the disease, it is also required to find ways which would help your bones get stronger naturally by opting for healthy lifestyle habits. Consumption of tobacco or alcohol in high amounts can be problematic. Keeping yourself active by exercising or engaging more in weight-bearing exercises reduces the risk. Balancing exercises like standing on one’s toes and repeating it is an effective way to strengthen your legs. For those suffering from stooping shoulders, posture exercises are important. Carrying out functional exercises like wall slides can also be helpful. Hip and back strengthening exercises improve balance.

“Eating calcium and vitamin D rich food, regular weight-bearing exercises including weight training, brisk walking, running and jogging and being physically active throughout the day helps,” says Dr Nadir.

She adds that good nutrition is as essential as regular exercise for keeping your bones healthy throughout your life.

“Calcium-rich items such as dairy products, dark green leafy vegetables, fish with bones and soy products like tofu make for some good options. Whereas, vitamin D is required as it enhances the body's ability to absorb calcium and improve bone health,” she says.

“Massage with oils can also tone up the muscles, encouraging calcium absorption,” Dr Aggarwal tells us. 

Your bone requires proper maintenance and care, choosing a balanced diet involving proteins, carbohydrates, minerals, and multivitamins can keep the disease at bay.

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