World Osteoporosis Day

October 20^th is observed annually as the World Osteoporosis Day to create awareness among people about its increasingly becoming common among aged people—say around 45 years and above—and particularly about the ability of medical system to treat it successfully. 

Osteoporosis, literally means, porous bone.  It manifests out of low bone mass and deterioration of bone tissue.  It is a progressive metabolic bone disease that decreases bone density leading to deterioration of bone structure.  As bones become more porous and fragile, they become highly vulnerable to the risk of fracture.   

Bone degeneration is, of course, a natural phenomenon with the advancing age. As one gets aged, some of the bone cells begin to dissolve bone matrix (resorption), while new bone cells deposit osteoid (formation) and this process of remodeling keeps going on. But in case of some people this bone loss outpaces the growth of new bone. In women, this loss of bone tissue increases after menopause as estrogen production stops depriving their bones the benefit of its protective effect and thus become more risk-prone to osteoporosis than men. With the result,   bones become porous, brittle and prone to fracture. And all such people are diagnosed as affected by osteoporosis.

Manifestation of osteoporosis is accelerated due to reasons such as:

• low calcium diet,
• less exposure to sunlight,
• cigarette smoking,
• excessive caffeine or alcohol intake,
• menopause,
• long-term use of corticosteroids,
• family history, and
• lack of physical activity

This loss of bone density occurs silently. Often, no symptoms of its onset are noticed till the first fracture occurs.

It is said that 1 in 3 women and 1 in 5 men are at risk of an osteoporotic fracture. People suffering from osteoporosis can fracture any bone, sustaining injuries to practically any body part. Commonest among them is, of course, fractures associated with hip, spine, and wrist. Of the three, it is the spinal fractures that are of serious consequences.  The likelihood of their occurrence, of course, increases with the advancing age.  Osteoporosis fractures, needless to say, lead to morbidity and disability, more so in the case of older people.

Encouragingly, osteoporosis is today a largely treatable condition. It can be diagnosed early, and with a combination of lifestyle changes and appropriate medical treatment many fractures can be avoided.   So, what is required to avert osteoporosis is timely accessing of medical advice. 

As there are no symptoms other than a fracture that occurs when the bone is already weakened significantly, it is desirable for people with any of the risk factors listed above to approach a doctor. After a thorough medical checkup, the doctor may subject him/her to bone mineral density (BMD) test. Amongst the many, DXA test is said to be the most accurate test, for it can detect even low percentages of bone loss.    

Based on the studies carried out about the bone density measurements of healthy young adults (T-scores), the World Health Organization has defined certain threshold values for osteoporosis. Osteoporosis is diagnosed when a person’s BMD is equal to or more than 2.5 standard deviations below these reference values.   

Status                                    Hip BMD

Normal                                   T-score of -1 or above

Osteopenia                           T-score lower than -1 and greater than -2.5

Osteoporosis                        T-score of -2.5 or lower

Severe osteoporosis           T-score of -2.5 or lower, and presence of at least one fragility fracture. 

Once diagnosed, the doctor may prescribe any of the approved medication for the treatment of Osteoporosis—to slow down the rate of bone loss—specifically tailored to a person’s specific needs in conjunction with the recommended lifestyle changes such as: maintaining adequate body weight, increasing weight-bearing exercise, minimizing caffeine and alcohol intake, and stopping smoking.

Hormonal treatment—prescription of estrogen—is also suggested for preserving bone density and prevent fractures. Their usage may however increase the risk of breast cancer, coronary heart disease, stroke and biliary disease.

Patients are also required to be educated about the risks of falls and fractures and individualized programs can be suggested to increase physical stability and attenuate risk. Medication is prescribed for relieving from the pain and maintaining the function. Acute back pain from a vertebral compression fracture is usually treated with orthopedic support, analgesics, and heat and massage. Avoiding lifting of heavy weights can help. Bed rest to be minimized and consistent, carefully designed weight-bearing exercise to be encouraged.

In the recent past, newer technology has emerged to treat spinal fractures resulting from osteoporosis: Ballon Kyphoplasty. It is a minimally invasive procedure. It involves usage of orthopedic balloons to lift the fractured bone and return it to its correct position. It is reported to significantly reduce back pain and repair the broken bone of a spinal fracture.

Incidentally, it is not wrong to say that osteoporosis is a ‘life-style’ disease. So, adoption of  preventive measures such as maintaining a healthy body weight, being physically active, adequate calcium and vitamin D intake, avoiding smoking, limiting intake of caffeine and alcohol and increased consumption of fruits and vegetables are known to avert the disease and improve the overall quality of life.