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.
Osteoporosis is a decrease in the mineral content of the bone.
Osteoporosis or low bone mass (osteopenia) occurs in 55 percent of the population aged 50 and above.
Usually it is a problem of the elderly although it can occur in certain children who are taking medications for epilepsy.
Maximum bone density is usually seen in the 3rd decade of life.
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.
Osteoporosis can be diagnosed with a simple plain X-ray. A more sophisticated way is by measuring the bone mineral density.
It will lead to pain and an increased risk of fracture.
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.
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.
There is no clear-cut data to support this concept and it is not advisable.
If a women has an active life style and is not on any medication for other diseases then she does not require calcium supplements.
There are several misconceptions such as
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.
In the long term it does cause certain adverse effects.
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.
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.
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.
Eat a nutritionally sound diet and walk, walk and walk more!
Date:27th November 2016
Venue: Auditorium, Indraprastha Apollo Hospitals, New Delhi