Narayana Health Care

In 2015, 20% of that is 46 million women are living with osteoporosis and our population pyramid is a pretty steep meaning more ageing population by 2050. With the launch of numerous health schemes and programs, awareness among people, improving quality of life with the advancement in the medical field leading to life expectancy too is expected to rise to 70 which mean older population with osteoporosis.

What is Osteoporosis?

Bone formation is an ongoing process. If the bone degeneration is more persistent than regeneration, the normal bone mass is affected. Osteoporosis is identified as reduced bone mass interfering with the normal bone framework. Bones turn brittle and weak so that even the slightest strain can result in a fracture or broken bone.

Symptoms:

Osteoporosis is a progressive disease without any symptoms at an early stage. Usually, symptoms develop only after significant damage has already happened to the bones, like:

• backache
• decreased overall height over a time
• bent posture
• any prominence at back may be due to fractured or slipped vertebrae (listhesis)
• generalized weakness or easily tired
• exposed to frequent fractures

Causes and Risk Factors:

Lots of theories about the cause of the disease are evident but predominantly it’s the ageing process when depletion of bone mineral mass is much more than its formation. You will develop osteoporosis or not, depends on how good is your bone mass at the age of 30 where the formation is at peak. Then later it will only wear out faster than formation. The question is now why Indian women do not have good bone mass at 30…and severe osteoporosis at age progresses:

• Genetic predisposition
• Low calcium intakes with an extensive prevalence of Vitamin D deficiency
• Increasing longevity
• Sex inequality (yes it still exist, female children are still not offered milk)
• Eating disorders due to social pressure to remain thin
• Lack of diagnostic facilities & poor knowledge of bone health
• Avoidance of sunlight exposure due to socio-cultural reasons
• Early menopause and low estrogen level as in menopausal females
• Antacid, steroid epilepsy and cancer medicine
• Sedentary lifestyle, increasing alcohol intake and smoking and tobacco consumption

Complications:

Osteoporosis manifests extreme complications like fracture of spine or hip. A simple fall in the shower can result in disability for life or even death. You must have seen your great grannies in their 90s, how they look bent and immobile, that is mostly because of osteoporosis.

Diagnosis:

A lot of Indian studies discovered that lack of proper diagnostics and thus delayed or no intervention is the prime cause of complications of osteoporosis.

BMD or Bone Mass Density test measuring bone density at hip, spine. A portable machine can measure it at shin/heel.

Treatment: Includes

• Oral Calcium tablets
• Vitamin D supplements
• Bisphosphonates
• Hormone replacement therapy under strict medical supervision
• Estrogen agonists
• Calcitonin
• Intermittent parathyroid hormone
• Monoclonal antibody medications also are known as Receptor activator of nuclear factor – kappa B ligand inhibitor (Denosumab)
• Bone-building medications

Pregnant women and lactating mothers at ultimately high risk of calcium erosion and should be taken care of properly. All the above medications have benefits, side effects, and contraindications, therefore, should only be taken after proper medical consultation by an expert clinician.

Prevention and Home Remedies:

• If you haven’t till now quit smoking and alcohol consumption
• Stay careful enough to prevent falls, modify the house to prevent hurdles that could cause falls, wear a good quality shoe with a flat bottom, antiskid surfaces, preferably motion sensor lights
• Maintain a healthy weight not less not more. Healthy is the new HOT…
• A good diet rich in:

1. Protein like in soy, nuts, legumes, seeds for vegans and vegetarians, and dairy and eggs
2. 1,000 milligrams of calcium every day from low-fat dairy products, green leafy vegetables, canned fish like salmon or sardines with bones, soy products  such as tofu, fortified cereals, and orange juice
3. Vitamin D through sun exposure, food fortification, and supplements as in higher altitude and colder regions
4. Vitamin K2

• Physical Activity

1. Weight Training with dumbbells or machines
2. Cardio like walking, jogging, running, stair climbing, skipping rope, skiing, Zumba
3. Balance exercises like Yoga, tandem walking, weight shifting
4. Weight removing buoyancy exercises like swimming

As much as I have loved to share the integrities of Osteoporosis being a female myself I would like to target its origin. Our female children should be given an option of enough calcium substitutes so that they turn into healthy females. Shifting the exemplification of ‘pretty’ from slim and fair to the healthy and normal complexion. Like I said before ‘healthy is the new beautiful, healthy is the new HOT…’

Dr. Rajesh Verma, Director & Senior Consultant – Orthopaedics, Spine Surgery, Narayana Superspeciality Hospital, Gurugram