Commonly referred to as a ‘silent disease,’ osteoporosis makes bones weak and brittle. It generally affects older women in their postmenopausal stage. Women are more prone to osteoporosis as they tend to have smaller and thinner bones as compared to men. However, men can also develop osteoporosis.
“There is no symptom for osteoporosis unless a person suffers a fracture. That is why it is called a silent disease. A fractured or collapsed vertebra can cause back or neck pain, a stooped posture and loss of height over time,” says Dr Chethana D, consultant, rheumatology, Aster CMI Hospital, Bengaluru.
Fragility fractures (fractures that occur even due to low-impact activities) are frequent in people with osteoporosis. Dr Sai Krishna B Naidu, senior consultant and orthopaedic surgeon, joint replacement and sports injuries, Altius Hospital, Bengaluru, points out that these fractures usually occur at the hip, spine or wrist.
Dr Chethana says that bone strength can be measured by taking a bone mineral density (BMD) scan. Osteopenia is when bone strength is slightly lower than it should be for the age (BMD between -1 and -2.5). Osteoporosis is when bone strength is severely low, increasing the risk of fractures (BMD <-2.5).
According to the National Cancer Institute, ‘osteopenia is a condition in which there is lower than normal bone mass or bone mineral density.’
Osteopenia could be a precursor to osteoporosis. But the good news is that not everyone with osteopenia will go on to develop osteoporosis. “If measures are taken to strengthen bones, osteoporosis can be prevented,” says Dr Chethana.
Malabsorption due to coeliac disease and other chronic gut conditions could lead to osteoporosis. Deficiency of vitamin D and calcium, chronic diseases such as rheumatoid arthritis, over-active thyroid or parathyroid glands, chronic liver or kidney disease and diabetes are the other causes of osteoporosis, according to doctors.
Osteoporosis can also develop due to the regular use of certain medications like glucocorticoids, anticonvulsant medication and anti-depressants. Other factors include smoking, excessive alcohol use, inadequate exercise, obesity and low body weight.
Men, women and osteoporosis
Osteoporosis manifests itself differently in men and women.
According to Dr Naidu, when a woman attains menopause (usually in their 40s and 50s), it also affects their bone density because of the massive hormonal change they go through. It is the fall in oestrogen that leads to a rapid decrease in bone density, adds Dr Chethana.
Men are at a lower risk of developing osteoporosis because of many factors. “Men have a larger skeleton and they also don’t see a sudden drop of hormones (oestrogen). Men’s bone mass also reduces at a slower rate in men than in women,” points out Dr Chethana. Men can also develop the condition due to testosterone deficiency.
A physical examination is done by conducting the DEXA (dual-energy x-ray absorptiometry) scan to measure bone density. Blood tests for thyroid function and vitamin D levels are also done. These tests will help identify the risk of bone loss and fractures.
Dr Chethana says that a quantitative heel ultrasound can be used as a pre-screening tool to assess osteoporosis treatment. But she points out that by no means can it can replace DEXA to assess bone mineral density.
Conventional x-rays are not essential for making a diagnosis of osteoporosis. For x-rays to show osteoporosis, at least 30 per cent of the bone mass should be lost.
Dr Chethana says that all women over 65 and those with a strong family history of osteoporosis and fractures, low body mass, early menopause, men with testosterone deficiency, smokers, people who consume excessive amounts of alcohol and person with certain diseases like rheumatoid arthritis, hyperthyroidism, coeliac disease and people who have been taking steroids or anti-epileptic drugs for a long period should go for a diagnosis of osteoporosis.
“Bone density scan should be performed at the baseline and an interval of two to three years, based on the individual’s associated risk factors,” adds Dr Chethana.
Signs of Osteoporosis
Dr Chethana says that the signs and symptoms of osteoporosis includes treating any underlying disease such as rheumatoid arthritis and coeliac disease. Medications can also be given to increase bone density, along with calcium and vitamin D supplements. Persons with rheumatoid arthritis are more prone to osteoporosis due to various factors like gender, deficiency of calcium, vitamin D, lack of exercise and steroid use, and can opt for the same screening as for osteoporosis.
She says that lifestyle changes can also improve bone health considerably. Weight-bearing exercises also help prevent bone loss and can strengthen already weak bones. A diet rich in calcium and vitamin D, limiting the consumption of fatty, salty and processed foods and avoiding smoking and excessive alcohol can help manage the condition.
Link between calcium, vitamin D
Calcium and vitamin D are interrelated and can help reduce the risk of osteoporosis. Calcium helps build bones and keep them healthy. If the body doesn’t get enough calcium each day from the food, it will take calcium from our bones and thus make them weak. Dairy products (like milk, yoghurt and cheese), figs, orange juice, and dark green and leafy vegetables are rich in calcium. Eating food rich in calcium is not enough; vitamin D also plays an important role as it helps the body to absorb calcium from the food we eat. Sunshine, cheese, oily fish, egg yolks and red meat are rich in vitamin D.
“If calcium and vitamin D are not in proper concentration it cannot absorb the food properly,” says Dr Naidu. He also says that calcium cannot be absorbed properly if hormones like thyroid, thyroxin and parathyroid are not functioning or released properly in the body irrespective of how much calcium one intakes.
Thyroid hormone can affect the rate of bone replacement. An excess of thyroxine can increase the rate of bone loss and if it continues for a long period then there is a higher risk of developing osteoporosis
Dos, don’ts to keep bones strong
- Those who lead a sedentary lifestyle with bare minimum exercise have a higher risk of developing osteoporosis. Try simple exercises like climbing the stairs, walking, swimming and jogging
- Flexibility exercises can be done gently and slowly without any pressure or strain on the body and bones
- Ensure a healthy balance of calcium and vitamin D in the diet
- Incorporate vitamin D fortified food
- Avoid consuming tobacco products and alcohol as they can reduce calcium absorption
- Avoid high-impact exercises and stretches that involve flexing the spine or bending the waist
- Staying awake late in the night also increases the risk of osteoporosis as good hormones (estrogen and thyroid hormone) are released when we are at the peak level of sleep