Dr Rashid Anjum, Dr Sabarathinam Ravi, Dr Tarsem Motten, Dr Amit Thakur
As the crisp October air settles in, medical professionals and health advocates worldwide are gearing up for World Osteoporosis Day on October 20, 2024. This year’s theme, “Say no to fragile bones,” isn’t just a catchy slogan-it’s a rallying cry for a healthier future. As we delve into the complexities of this often-overlooked condition, it’s clear that osteoporosis is more than just a medical issue-it’s a public health crisis that demands our immediate attention.
The Silent Epidemic: Understanding Osteoporosis
“Osteoporosis is a systemic skeletal disorder characterised by low bone mass and microarchitectural deterioration of bone tissue. On a cellular level, there’s an imbalance between forming new bone tissue and removing old bone tissue. Osteoclasts, which break down bone, become more active than osteoblasts, which build new bone. This imbalance makes bones porous, brittle, and more susceptible to fractures.”
Osteoporosis, often dubbed the “silent disease,” lurks in the shadows, quietly weakening bones until a sudden fracture brings it into sharp focus. It’s a condition that affects millions globally, with India facing its osteoporosis crisis. Recent estimates suggest that over 50 million Indians are either osteoporotic or have low bone mass, a number that’s set to climb as our population ages.
The Devastating Impact
The consequences of osteoporosis can be severe and far-reaching. A minor fall or simple action like bending over or coughing can lead to a fracture, often in the hip, spine, or wrist. These fractures aren’t just painful-they can be life-altering, robbing individuals of their independence and, in some cases, leading to long-term disability or even death.
Hip fractures, in particular, can have devastating consequences. Many patients never regain their previous level of mobility, and the mortality rate in the year following a hip fracture is alarmingly high. Spinal fractures, while less immediately catastrophic, can lead to chronic pain, loss of height, and a stooped posture.
Risk Factors
While osteoporosis can affect anyone, certain factors significantly increase the risk:
- Age: Our bones naturally become thinner and weaker as we age. After the age of 50, the risk of osteoporosis increases significantly.
- Gender: Women are up to four times more likely than men to develop osteoporosis. The rapid decline in oestrogen levels during menopause accelerates bone loss.
- Family History: Genetics play a significant role in bone health. If a parent or sibling has osteoporosis, your risk is higher.
- Race and Ethnicity: Studies show that individuals of Asian and Caucasian descent are at higher risk compared to other ethnicities.
- Hormonal Imbalances: Conditions affecting hormone levels, such as hyperthyroidism or hyperparathyroidism, can contribute to bone loss.
- Dietary Factors: A diet low in calcium and vitamin D throughout life can contribute to diminished bone density and early bone loss.
- Lifestyle Choices:
4 Sedentary lifestyle: Lack of exercise, especially weight-bearing activities, weakens bones.
4Excessive alcohol consumption: More than two drinks a day can increase osteoporosis risk.
4Tobacco use: Smoking is directly linked to decreased bone density. - Medical Conditions: Certain diseases and conditions increase the risk of osteoporosis, including:
4Rheumatoid arthritis
4Celiac disease
4Inflammatory bowel diseases
4Kidney or liver disease
4Cancer
4Multiple myeloma - Medications: Long-term use of certain medications can affect bone density:
4Corticosteroids (e.g., prednisone)
4Proton pump inhibitors
4Some anti-seizure medications
Early symptoms:
One of the most insidious aspects of osteoporosis is its lack of early symptoms. However, some individuals may experience subtle signs such as:
4Gradual loss of height (1-2 inches) over time
4Development of a stooped posture
4Back pain caused by fractured or collapsed vertebrae
This silent progression underscores the importance of early detection and prevention. Regular bone density scans, particularly for those at higher risk, can help identify the condition before a fracture occurs. The World Health Organization (WHO) defines osteoporosis based on bone mineral density (BMD) measurements, with a T-score of -2.5 or lower indicating osteoporosis (high fracture risk). This standardised definition helps in early diagnosis and intervention.
Building Better Bones: Comprehensive Prevention Strategies
The good news is that osteoporosis is largely preventable. Here are detailed strategies for maintaining and improving bone health: - Nutrition:
4Calcium: Adults need about 1,000-1,200 mg of calcium daily. Sources include:
4Dairy products (milk, yoghurt, cheese)
4Leafy greens (kale, spinach, collard greens)
4Fish with edible bones (sardines, salmon)
4Calcium-fortified foods (juices, cereals, breads)
4Vitamin D: Aim for 600-800 IU daily. Sources include:
4Sunlight exposure (15-20 minutes a day)
4Fatty fish (salmon, tuna, mackerel)
4Egg yolks
4Fortified foods
4Supplements (especially for those with limited sun exposure)
4Other important nutrients:
4Protein: Essential for bone matrix
4Vitamin K: Helps in calcium regulation
4Magnesium: Contributes to bone strength - Exercise: Regular physical activity is crucial for bone health:
4Weight-bearing exercises: Walking, jogging, dancing, tennis
4Resistance training: Weight lifting, using resistance bands
4Balance exercises: Tai chi, yoga (to prevent falls)
4Aim for at least 30 minutes of exercise most days of the week - Lifestyle Changes:
4Quit smoking: Smoking decreases bone mass and increases fracture risk
4Limit alcohol: Excessive alcohol interferes with calcium absorption
4Maintain a healthy weight: Being underweight increases osteoporosis risk
- Reduce caffeine intake: High caffeine consumption can decrease calcium absorption
- Regular Check-ups:
4Bone density scans (DEXA): Recommended for:
4Women aged 60 and older
4Men aged 65 and older
4Younger postmenopausal women and men aged 50-69 with risk factors - Fall Prevention:
4Home safety: Remove tripping hazards, improve lighting
4Vision checks: Ensure proper vision correction
4Medications review: Some medications can affect balance
4Assistive devices: Use canes or walkers if needed
Treatment Options: A Multifaceted Approach
For those diagnosed with osteoporosis, a range of treatment options is available: - Medications:
4Bisphosphonates: (e.g., alendronate, risedronate) – inhibit bone resorption
4Denosumab: A monoclonal antibody that targets bone resorption
4Teriparatide: Anabolic agent (PTH analogue) that stimulate bone formation
4Hormone Replacement Therapy (HRT): For postmenopausal women, considering risks and benefits
4Romosozumab: A newer drug that both increases bone formation and decreases resorption - Lifestyle Modifications:
4Tailored exercise programs focusing on weight-bearing and balance exercises
4Nutritional counselling to ensure adequate calcium and vitamin D intake
4Fall prevention strategies - Pain Management:
4For those with fractures, various pain management techniques may be employed
4Physical therapy to improve mobility and strength - Orthopedic surgical Interventions:
4Vertebroplasty or kyphoplasty for spinal fractures
4Osteosynthesis or arthroplastyfor hip fractures
AIIMS Jammu: Spearheading the Fight Against Osteoporosis
At the All India Institute of Medical Sciences (AIIMS) in Jammu, we’re taking a multifaceted approach to combat osteoporosis: - Advanced Diagnostics:
4State-of-the-art DEXA scanner for accurate bone density measurement - Comprehensive Treatment:
4Personalized treatment plans combining medication, nutrition, and exercise therapy
4Multidisciplinary team approach involving orthopaedics, endocrinology, and physiotherapy - Community Outreach:
4Regular awareness programs and screening camps in rural areas of Jammu and Kashmir
4Educational initiatives in schools and colleges to promote early bone health awareness
4Telemedicine services to reach remote areas with limited healthcare access
A Call to Action: Breaking the Silence
As we mark World Osteoporosis Day 2024, it’s clear that the fight against this silent epidemic requires a collective effort. From individuals making healthier lifestyle choices to healthcare providers offering cutting-edge treatments, everyone has a role to play.This World Osteoporosis Day let’s commit to breaking the silence surrounding this condition. Here’s how you can take action: - Educate Yourself and Others: Learn about osteoporosis and share your knowledge with friends and family.
- Assess Your Risk: Talk to your healthcare provider about your osteoporosis risk and whether you need a bone density test.
- Make Lifestyle Changes: Incorporate bone-healthy habits into your daily routine.
- Support Research: Advocate for increased funding for osteoporosis research and treatment.
- Join the Conversation: Use social media to raise awareness about osteoporosis using the hashtag #WorldOsteoporosisDay.
Remember, it’s never too early-or too late-to start caring for your bones. Whether you’re building peak bone mass in your youth or working to maintain it in later years, every step towards better bone health is a step towards a morerobust, healthier future. For more information or to schedule a bone health check-up, please get intouch with the Department of Orthopaedics at AIIMS Jammu. Together, we can build better bones and more vital lives, turning the tide against this silent epidemic and paving the way for a future where fragility fractures are a thing of the past.
(The writers are Dr Rashid Anjum, Dr Sabarathinam Ravi, Dr Tarsem Motten, Dr Amit Thakur Department of Orthopaedics, AIIMS Jammu).