Osteoporosis is a bone condition when it becomes fragile, brittle and painful. So, Dr Ashish Jain from P.D Hinduja Hospital talks about its symptoms, diagnosis and prevention measures to tackle the condition.
Bone is a living tissue that is constantly being broken down and replaced. Our bony skeleton is similar to a beach where the tide brings in new sand while washing away some as it recedes. An imbalance between this new bone formation and old bone resorption affects the bone density, as a result, bones get brittle and fragile, painful on loading and easily broken with trivial injury. This condition is called Osteoporosis(OP). So, Dr Ashish Jain, Consultant General Orthopaedics and Trauma, P.D Hinduja Hospital and MRC talks about its symptoms, diagnosis and prevention measures.
Here’s what you should know about Osteoporosis?
Peak Bone Density
Bone mass is usually attained between 25 and 30 years of age after which there is a slow and steady loss of bone especially after the age of 40 yrs. Our bone calcium (density) is like a ‘bank balance; the more you have at maturity the lesser your chances of Osteoporosis.
What decides our Bone Density?
Uncontrollable factors:
Sex: women more likely than men
Age: risk increases as we age
Race: more in whites and Asians
Family: OP in siblings or parents, parents with a hip fracture increase the risk
Body frame: smaller body types have lesser bone mass
Hormonal factors:
Sex hormone: lowered sex hormones weaken bones. Menopause in women, low testosterone in elderly males (>70 yr), treatment for breast and prostate cancers.
Thyroid: Excess thyroid hormone causes bone loss; hypothyroidism can also retard bone density.
Dietary factors:
Low calcium intake especially in young age
Eating disorders: being underweight or severe food restrictions weaken bones
Gastrointestinal surgery like bariatric that shorten the bowel area.
Lifestyle choices:
Sedentary lifestyle: desk jobs without any exercise routine
Excessive alcohol consumption
Tobacco use
Coffee in excess reduces calcium absorption
Medical conditions:
Bowel disorders like IBD (Inflammatory bowel disease), celiac disease
Cancers
Rheumatoid arthritis
Chronic renal and hepatic diseases
Medications: steroids, seizure treatment, antacids and chemotherapy drugs
What are the Symptoms of OP?
Usually, there are no symptoms in the early stages of bone loss
Later:
Back pain
Loss of height over time
Stooped posture
Easily fractured bones (wrist, hip, spine)
Complications:
Compression fractures of spinal vertebrae
Hip fractures with high mortality in first-year post-injury
How can we prevent OP?
Dietary measures:
Proteins are important building blocks for our body and bones. Minimum 1gm/kg body weight is essential
Calcium:
1000mg/day is needed between the ages of 18 and 50 yrs.
1200mg/kg after 50 yrs
Milk and dairy products, dark green leafy vegetables, soya products
Calcium supplements can be added only when required
Vitamin D:
Essential for calcium absorption and bone health
Exposure to sunlight also helps
Egg yolks, oily fish (salmon), fortified cereal
600-800 IU daily needed after 50 yrs
Importance of Exercise in OP:
Helps build strong bones and reduces bone loss at any age.
Strengthens muscles, improves balance and reduces falls
Most effective when started early in life for improved Peak Bone Mass.
Strength training is best
Balance training like Tai-chi is helpful.
Impact cardio like skipping, jogging, walking, stair climbing (swimming, cycling not so effective)- 3 times a week for 30-45 minutes
How to diagnose OP?
1.DEXA Bone Density scan is the best test for OP even before symptoms arise or fractures occur. (T-score less than minus 2.5 means OP)
2.Ultrasound of the heel bone is a good portable test for screening a larger group
3.Quantitative CT scan is good but involves more radiation
4.X-rays of the spine and hips for undetected compression fractures
Treatment of Osteoporosis
1.Prevention is always better than cure. All measures are to improve and maintain Bone Mineral density especially dietary and exercise.
2.Drugs are prescribed that reduce Bone resorption; like Bisphosphonates
3.Some other drugs are used to increase bone formation; like Teriparatide (man-made parathyroid hormone)
4.Hormone Replacement Therapy (HRT) in certain cases is done
5.Many newer drugs and modalities are being tested to treat this growing problem
6.Strict medical supervision is a must in all these anti-osteoporosis treatment protocols to prevent complications
Surgery in OP:
Surgery is often needed for Hip fractures:
1.Fixation of the broken bone using plates and nails
2.Hip joint replacement
Spinal surgery for Vertebral compression fractures:
1.Vertebroplasty (injecting liquid cement into the soft bone)
2.Kyphoplasty (expanding the collapsed vertebra using a balloon)
3.Spinal fixation using plates and rods to correct the deformity.
Also Read: 5 BEST weight loss tips for women undergoing menopause
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