Osteoporosis - Diagnosis and Treatment

Osteoporosis is a condition that features loss of the normal density of bone leading to fragility of the bone. Osteoporosis leads to abnormally porous bone that is more comprehensible like a sponge, than dense like a brick. This disorder of the skeleton weakens the bone leading to an increased risk of fractures. Normal bone is composed of protein, collagen and calcium. Bones that are affected by osteoporosis can fracture with even a minor fall or injury that normally would not cause a bone fracture.

We asked Dr. Balaji Srinivasan, Senior Consultant Orthopaedics, Apollo Hospitals Chennai about this common orthopedic condition.

Doctor, we read a lot these days about Osteoporosis, what in a nutshell is Osteoporosis?

Osteoporosis is a decrease in the mineral content of the bone.

How common is it?

Osteoporosis or low bone mass (osteopenia) occurs in 55 percent of the population aged 50 and above.

Can Osteoporosis occur at any age?

Usually it is a problem of the elderly although it can occur in certain children who are taking medications for epilepsy.

When does an individual have the maximum bone density?

Maximum bone density is usually seen in the 3rd decade of life.

How much of bone does a normal person lose?

There is tripling of the bone loss rate in the early postmenopausal years. In men under the age of 50 there is a slow rate of bone loss at the hip, but not the spine, and this continues throughout life.

How is Osteoporosis diagnosed?

Osteoporosis can be diagnosed with a simple plain X-ray. A more sophisticated way is by measuring the bone mineral density.

What will happen if Osteoporosis is not diagnosed or neglected?

It will lead to pain and an increased risk of fracture.

Why should Osteoporosis be prevented?

Prevention of Osteoporosis or low Bone Mineral Density (BMD) is preferable to treatment because finer bone changes associated with bone loss are largely irreversible.

Treatment may stabilize or increase BMD and reduce the risk of fracture, but is unlikely to fully restore bone quality and bone strength.

How is BMD determined?

BMD in adults is determined by peak bone mass (PBM) and the rate of bone loss. The prevention of Osteoporosis or low BMD is directed at maximizing peak bone mass and minimizing the rate of bone loss, with the ultimate goals of maintaining bone strength and preventing fractures.

Does routine bone mineral density screening for the population prevent the problem or decrease its incidence?

There is a real danger of over-diagnosing the problem. This will only cause panic among people and they might take calcium supplements unnecessarily.

Can Osteoporosis be prevented by taking calcium supplements even before menopause in a normal woman?

There is no clear-cut data to support this concept and it is not advisable.

Can Osteoporosis be prevented by routinely taking calcium supplements after menopause?

If a women has an active life style and is not on any medication for other diseases then she does not require calcium supplements.

What are the common misconceptions about Osteoporosis?

There are several misconceptions such as

• Treatment of Osteoporosis is mainly with calcium tablets.
• Osteoporosis is preventable, if one takes calcium tablets.
• Every woman, after menopause or after removal of uterus needs calcium supplements.

Once diagnosed, what is the treatment of Osteoporosis?

Contrary to popular belief, it is life style modification (encouraging the person to walk more and more) that is the mainstay in the treatment. For bone pains there is a special group of medications like calcitonin, alendronates, etc., along with calcium supplements.

Is there a real risk if a person takes calcium supplements unnecessarily?

In the long term it does cause certain adverse effects.

What is the "pyramid" approach to the treatment of Osteoporosis?

The Pyramid approach is for the prevention and treatment of Osteoporosis, with a foundation of lifestyle changes that include nutrition, physical activity, and fall prevention. This is needed for all.

A second tier of addressing drugs and diseases associated with bone loss or Osteoporosis is needed for a selected group of Osteoporotic patients.

The third tier is pharmacological therapy for the treatment of Osteoporosis.

What kind of diet and physical activity help in preventing Osteoporosis?

High consumption of carbonated soft drinks may impair bone acquisition and increase fracture risk.

Beneficial effects of exercise are seen on bone accumulation growth, with particular benefit from high impact exercise. On the other hand, excessive exercise can be harmful to skeletal health, as seen in adolescents. In fact there is an entity called the female athlete triad, which consists of disordered eating, amenorrhea (absent menstruation) and osteoporosis.

Does smoking / alcohol lead to increased risk of Osteoporosis?

Cigarette smoking and excess alcohol intake should be discouraged. In addition, administration of drugs that are known to be harmful to skeletal health, such as glucocorticoids and anticonvulsants, should be avoided or minimized in dose and duration.

What is a final message to prevent osteoporosis?

Eat a nutritionally sound diet and walk, walk and walk more!