Bone of contemplation

Yesterday marked the occasion of World Osteoporosis Day. Though there’s some awareness about this ailment, majority of the population seems unaware of it despite it being extremely common among women and the elderly. We asked experts what makes osteoporosis so rampant and how safeguard oneself from it...

Not uncommon in men

Osteoporosis and its related fractures is common in India. Although it’s more prevalent in women, particularly after menopause, it’s not uncommon in men. Dr Dipti Patel, rheumatologist consultant, Wockhardt Hospital, sees at least 10 cases per week, and six to seven cases per week of post-menopausal osteoporosis. She says, “The exact prevalence in India is not known but given our population, it can be estimated that roughly 46 million, are women with osteoporosis. Worldwide, it is estimated that one in three women above the age of 50 will experience osteoporotic fractures, as well as one in five men.” This disease also does run in families probably because there are inherited factors that affect bone development.

Senile osteoporosis

This ailment is of two kinds, senile and post-menopausal. Senile osteoporosis usually occurs in both the sexes among the elderly in 60+ age group. “Senile osteoporosis is because of lack of mobility. Here, the bone density is reduced due to aging bones and Vitamin D3 deficiency. Calcium is an essential adjuvant to therapy, not the primary treatment,” says Dr Rakesh Nair, knee replacement surgeon at Zen Multispeciality Hospital.

Post-menopausal osteoporosis

Women tend to suffer from it more often and severely than men. This is due to hormonal factors, multiple pregnancies, prolonged breastfeeding and inadequate nutrition. One in two post-menopausal women have the lifetime risk of sustaining osteoporotic fracture, says Dr Manan Gujarathi, orthopaedic surgeon, SRV Mamata Hospital, adding that like diabetes and high blood pressure, osteoporosis has become so frequent, it’s practically an epidemic.

Osteopenia

Ninety per cent of Dr Nair’s osteoporosis patients are females who have it post-menopause. It occurs post 40s, but he also comes across patients in their 30s too. “Majority of them will have some elements of osteopenia — a condition wherein the bones are weaker than normal but not so far gone that they break easily, which is the hallmark of osteoporosis,” he says, adding that every woman irrespective of her earlier activity levels before menopause is prone to osteoporosis depending on how violent is the menopause.

Factors to blame

Orthopaedic surgeons are being increasingly confronted by fractures in people in their 30s to 40s who had a little tumble, says Dr Gujarathi. Lack of exercise, vitamin deficiencies, excessive caffeine, alcohol intake, smoking, diabetes, immunodeficiency syndromes, unhealthy diet are additional risk factors that are exceedingly common.

Diagnosis

Typically, diagnosis of osteoporosis is combination of history, clinical check-up and tests. Dr Gujarathi says simple screening tests include ultrasonic bone mineral density (BMD) estimation, often done at awareness camps. Further check-up, when required, may include blood test for ruling out hypovitaminosis (disease caused due to vitamin deficiency), endocrine disorders and diabetes, X-rays and DEXA (dual energy X-ray absorptiometry) Scan to quantify the disease, assess risk and formulate a treatment strategy.

Dr Nair says that ideally, DEXA test should be done by every woman closer to her 40s and for males, around 60s. Young people in their 30s, who have thyroid or any hormonal issue should undergo this test.