World Osteoporosis Day: All you need to know about the bone condition common among most Indian women

According to the fifth National Family Health Survey, older adults in India commonly suffer from osteoporosis, a bone condition linked to the prevalence of Vitamin D3 deficiency among 50-70 per cent of adults. Mainly associated with bone strength and health, the National Health Portal of India defines osteoporosis as a medical condition that affects the bones, causing them to become weak and fragile and more likely to break (fracture).

Worldwide, it is reported that one in three women and one in five men aged 50 years and over will suffer from an osteoporotic fracture. These fractures can be life-threatening and a major cause of pain and long-term disability affecting the health of millions globally. "Osteoporosis is a major public health problem in Indian women. Low calcium intakes with extensive prevalence of vitamin D deficiency, increasing longevity, sex inequality, early menopause, genetic predisposition, lack of diagnostic facilities and poor knowledge of bone health have contributed towards the high prevalence of the condition," says Dr Vishal P. Thakur, consultant orthopedics, Masina Hospital, from Mumbai.

Experts say with increasing age the severity of osteoporosis increases along with increased chances of osteoporotic fractures which causes more debility, morbidity, and occasionally mortality. World Osteoporosis Day, observed on October 20 annually, is an effort towards increasing awareness about bone health and ramping up measures to reduce the burden.

Mid-day Digital reached out to Thakur and Dr Sneha Kothari, consultant endocrinologist at Global Hospital to understand more about the causes, symptoms and diagnosis of the condition.

Is Osteoporosis more common among women or men in India?
Kothari: Osteoporosis most often occurs in older women, but men are also at risk. One in three women and one in five men over age 65 break a bone because of osteoporosis.

Thakur: Osteoporosis is predominantly a disease of an ageing population with females more than 50 years of age and males more than 65 years of age. Women tend to have smaller and thinner bones than men. These days, we see early osteoporosis in early age in females secondary to hormonal/ endocrine problems, obesity, PCOS and lifestyle issues. Hereditary factors like presence of this disease in either of one's parents can increase one's risk of acquiring the same. Overactive thyroid glands and reduced amounts of sex hormones may also be one of the causes.

What are the main causes of the condition?
Kothari, Thakur:

Apart from age and sex, following are the risk factors for osteoporosis:
a. Early menopause
b. Being underweight (body mass index below 19)
c. Medical conditions associated with osteoporosis, such as rheumatoid arthritis, diabetes, breast or prostate cancer, or certain digestive diseases
d. Medications causing osteoporosis, such as longer-term daily use of glucocorticoids (steroids)
e. Parental history of hip fracture or osteoporosis
f. Sedentary lifestyle
g. Smoking and excessive drinking
h. Poor dietary intake of calcium and vitamin D
i. Previous fractures

When does an adult know that they might be suffering from Osteoporosis and how serious it can get?
Kothari: Although osteoporosis is a silent disease, the following signs and symptoms should be kept in mind:

a. Loss of height (getting shorter by an inch or more).
b. Change in posture (stooping or bending forward).
c. Shortness of breath (smaller lung capacity due to compressed disks).
d. Bone fractures.
e. Pain in the lower back.

Thakur: General change in posture causing one to stoop more forward than usual might be one early visual symptom. Pain in the lower back also might be because of weakening bones. Fractures induced via osteoporosis can be fatal though not a vast variety of these fractures are. Hip fractures, mostly the ones that are older do have greater mortality rate. With age, the problem is just supposed to worsen.

Play Quiz: World Osteoporosis Day 2022

How is osteoporosis diagnosed?
Kothari: Bone mineral density (BMD) tests, also known as dual-energy X-ray absorptiometry (DEXA or DXA) scans, are used to diagnose osteoporosis. These X-rays use very small amounts of radiation to determine how solid the bones of the spine, hip or wrist are.

All women over the age of 65 and all men above 70 years old should have a bone density test. The DEXA scan may be done earlier for women and men who have risk factors for osteoporosis.

What is the long-term impact of Osteoporosis and is it completely curable?
Kothari: Osteoporosis literally means "porous bone." With ageing our bones get thinner. It often develops unnoticed over many years without any symptoms or discomfort until a bone breaks. Because there are no symptoms in the early stages and it progresses quietly, it is often referred to as a silent disease.

Hip fractures are considered the most serious complication of osteoporosis. These fractures require surgical repair or joint replacement. Despite surgical repair, less than half of all hip fracture patients regain their former level of mobility after recovering and may suffer from chronic pain. Up to 20 percent of patients die within a year of fracturing a hip. Within three years, about 5 to 10 percent of patients who fracture a hip will experience a second hip fracture.

Since the progress of this debilitating disease can be slowed or halted with early detection and treatment, bone mineral density is used to detect osteoporosis. These tests are simple and painless, and avoid the worst consequences of osteoporosis like fractures, pain, disability, and joint replacement surgery.

Please suggest measures to be taken by grown up adults to prevent Osteoporosis.

Thakur: The treatment should be individualised and tailored to each patient's need:

a. Regular exercise is essential where resistance exercising and muscle strengthening exercises are important to improve bone density.
b. Healthy eating is vital with Vitamin D supplements.
c. Calcium is important for maintaining bone health. Adults require 700mg per day, which you should be able to obtain from your regular diet.

Bone health may be optimised by creating an environment to achieve peak bone mass during adolescence, maintenance of healthy bone throughout the life cycle, and prevention of bone loss postmenopausal. In Indian women, calcium, vitamin D, and bisphosphonates are the commonest first-line therapies used. The use of other drugs such as hormone replacement therapy, oestrogen agonists, calcitonin, parathyroid hormone, and denosumab (injection) is decided as per the affordability and availability of treatment options.

Also Read: Diwali 2022: Here's how these organisations in Mumbai are helping people manage dry and edible oil waste