Healthy bones play a vital role in our body. Its significance increases as the age grow and it provides structure to our body and protects internal organs, produce blood cells and support all of the other tissues of the body. The bones continuously change as new bones are formed and old bones are broken down with subsequent increase the bone mass.
In-depth, our bones have two types of structure. The Cortical bone, which is in dense form and Spongy bone, which is in a lattice form. When the bone density is reduced in the spongy bone and thinning of cortical bone, there arises a complication in the bones.
This is called as Osteoporosis, the bone-thinning disease. Often referred to as ‘silent disease’.
‘Osteo’ means bone and porous means pore. ‘Osteoporosis’ means loss of bone density. Our bones are made up of outer dense cortical bone and inner less dense trabecular bone.
Type 1 (early) osteoporosis is characterized by excessive loss of trabecular bone. Type 2 (senile) osteoporosis is characterized by loss of both trabecular and cortical bone which is usually an age-related disease.
As long as our bone density is normal, our bones are resilient to low trauma fractures. If bone density decreases there is a high risk of fractures even with a minor fall. Common sites of osteoporotic fractures are hip, spine, wrist and ankle. A decrease in bone density is usually painless and is diagnosed mostly after the patient has sustained a fracture
In such conditions, the replacement of lost minerals are delayed in the bones leading to a decrease in bone density causing brittle and much prone to fractures.
As long as our bone density is normal, the bones are resilient to low trauma fractures, if bone density decreases there is a high risk of fractures even with a minor fall. Common sites of osteoporotic fractures are hip, spine, wrist and ankle. A decrease in bone density is usually painless and is diagnosed mostly after a patient has sustained a fracture.
Facts about Osteoporosis
50% of fractures in the world occur in Asia
1 in 5 men and 1 in 3 women beyond 50 years, experience this silent disease.
20% - 25% of patients die after sustaining an osteoporotic hip fracture.
A Global survey finds that the number of days spent in hospital is more for osteoporosis and its complications in compared to other critical health issues like cancer and cardiac.
Screening And Diagnosis
The conventional dual-energy X-ray absorptiometry DEXA scan is the present method adopted for measuring bone mineral density.
The two types of DEXA scan
Peripheral DEXA – which inaccurate handheld devices used for mass screening purposes.
Central DEXA - which is an accurate measure of bone mineral density
DEXA Scan results are interpreted by Rheumatologist in conjunction with the clinical scenario.
Therapeutic options for osteoporosis treatment include drugs like oral and intravenous bisphosphonates, hormones like Teriparatide and calcitonin, monoclonal antibodies like Denosumab. Calcium and Vitamin D supplements according to the severity of the disease is a part of every osteoporosis prescription. Newer drugs like Romosuzumab and Odanacatib are in the pipeline.
Most of these drugs need close monitoring to avoid toxicity and hence must strictly be taken only under medical supervision.
"Rheumatologist" is the specialist who usually treats once Osteoporosis develops.
It is the need of the hour to love your bones as every passing minute, patients all over the world are silently succumbing to this easily preventable but tough to treat disease- osteoporosis.
Who Are At The Risk
The following populations are at high risk for developing osteoporosis and need to be aware of the screening and treatment options available.
Addictions - smokers and chronic alcoholics
Patients suffering from Rheumatological diseases like Rheumatoid arthritis, Ankylosing spondylitis, Psoriatic arthritis, Lupus and many more
Chronic endocrine diseases like thyroid disorders and diabetes
Tips For Prevention Of Osteoporosis
Intake of recommended calcium in diet from childhood. Calcium-rich foods include eggs, milk, curd, cheese, almonds, fish, coconuts, soya, oranges and greens.
Vitamin D is considered now to be more of a hormone than just a vitamin. It plays a major role in maintaining good bone health. A daily exposure to sunlight for at least 20-30 minutes, human skin synthesis vitamin D which is vital for bone health.
Avoid smoking and consumption of alcohol
Restricting Coffee or tea will accelerate the loss of bone density
Simple exercises for 30 minutes a day will improve bone strength
Precautions For Elders
It is of utmost importance to avoid falls in elderly to prevent fractures of hip bone which is most dangerous fracture beyond 65 years of age in view of the associated mortality and morbidity.
Ensure proper vision
Good lighting in the room
Use crane/crutches/walker/hand railings/modified footwear according to individuals needs for effective mobilization
Use railings for a cot to prevent accidental fall from bed
Avoid walking on slippery and polished surfaces
Avoid walking fast
Avoid high heels
Never let mobility restricted people unsupervised or unattended for long periods
Dr C. Balaji, is a Consultant Rheumatologist, Parvathy Hospital, Chennai