One of the dreaded ailments of advanced age and affecting mostly women is Osteoporosis. The meaning of osteoporosis is porous bone. One has less bone mass and strength. The disease often develops without symptom and pain and it is not discovered until it causes fractures, mostly of hip, wrist and spine.
It is estimated to affect 50 million Indians but many are neither diagnosed nor treated (B Priyambada 2019). World over, more than 200 million people suffer from osteoporosis. It is caused by slow degeneration of bone tissues causing loss of bone density. It leads to fragile bones highly susceptible to fractures. Around 230 million Indians are expected to be older than 50 years, of which 46 million are expected to be suffering with osteoporosis (Bhadada et al. 2021). As it goes undiagnosed and untreated until one suffers fracture, it is necessary for older people to take precautions to prevent it.
Globally, it was found in a large meta-analysis with over 100 million people in age 15 to 105 that prevalence of osteoporosis was around 18%. In another meta-analysis consisting of over 800 thousand women, it was found that prevalence among women was over 23% (Salari et al. 2021). In Europe and the US, 30% women are osteoporotic and it is estimated that 40% post-menopausal women experience osteoporotic fracture in their lives (Sozen et al. 2017).
Bones are living tissues containing of proteins and calcium & other substances. It is a store of calcium from which body can take calcium it needs and also deposits calcium from diet to replace it or add to the store. Thus they are continuously exchanging material and the process is called bone remodelling, which supplies calcium to body when needed while keeping bones strong. As children grow, their bones grow and become strong during which bone build up is more than breakdown. This process builds more bone than is broken till the age of 30. Bone density peaks at 30.
Bone tissue continually changes due to both the processes, loss by resorption and rebuilding by formation. In normal adult bone, remodelling of bone is constant and up to 10% of all bone mass may be undergoing remodelling at any time. If loss is more by resorption than rebuild by formation then tissue is gradually lost.
After 35, bone breakdown occurs faster than bone build up, which may cause gradual loss of bone mass. Women lose bone mass more rapidly than men. Losses may be reduced if diet contains good source of calcium so body does not have to take it from bones. In osteoporosis, there is greater loss of bone mass weakening the bones making them fragile. After menopause, rate of bone breakdown is even faster so women have greater dangers of osteoporosis. (Cleveland Clinic 2022)
Progression of Osteoporosis
The inside of healthy bone looks like a sponge, having small spaces like honeycomb. The size of these spaces increases when osteoporosis occurs. The holes in the sponge grow larger and more numerous. This causes bones to lose strength and density, which weakens the inside of bone. It is then prone to fracture. (Healthline 2019)
People with osteoporosis are at a high risk of fractures, or bone breaks, while doing routine activities such as standing or walking. The most affected bones are the ribs, hips, and bones in wrist and spine.
Early stages of osteoporosis may not show any symptoms. In most cases people with osteoporosis may not know they have this condition until they have fracture and an x-ray is taken. If symptoms do show, they may include receding gums, weakening grip and weak and brittle nails.
Without treatment, osteoporosis can worsen with bones getting thinner and weaker, increasing the risk of fracture. When there is family history it is always better to get examined for osteoporosis. Bone density test called densitometry or dual-energy X-ray absorption (DEXA) is used to measure bone density in wrist, hip or spine.
Biggest risk factor is age. Bone remodelling occurs throughout life, but after 30, the body breaks done bone faster than it replaces it. This causes bone to be less dense and fragile leading to breakage.
Menopause is also a major risk factor. This affects women around 45 to 55 years of age. Due to changes in hormone levels accompanying, menopause can cause women to lose bone more quickly. Men continue to lose bone but at a slower rate than women, but around 65 to 70, both men and women lose bone at the same rate.
Some of the other risk factors are:
- Being female
- Being Caucasian or Asian
- History of osteoporosis in family
- Poor nutrition
- Physical inactivity
- Low body weight
- Small-boned frame
Some of the above factors can be controlled such as poor nutrition and inactivity. Bone health can be improved by better diet and starting exercise programme. Other factors like age, gender, race or family history cannot be controlled.
Most common medications for osteoporosis are used to prevent the loss of bone mass. Some others may be used to prevent bone loss as well as stimulate bone growth. These include hormones. All the treatments must be carried out under the medical supervision as many have risks of other diseases.
An appropriate diet can help strengthen bones in addition to treatment. Certain nutrients need to be included in diet, the important ones being calcium and vitamin D. Calcium for strong bones and vitamin D to help absorb calcium. There is also recent evidence of Vitamin K2 being useful in this. Some of the other nutrients that promote bone health are protein, magnesium and zinc. One can plan a proper diet and meal with the help of dietitian.
Exercise is also important along with proper diet for healthy bones. Weight bearing exercises may be useful. Climbing stairs and resistance training help as muscles push and pull against bones strengthening bones. Exercises also help improve balance and coordination which avoids falls. Again, doctor’s advice is essential before starting any exercise programme.
Some of the risk factors can’t be controlled but other like good diet including calcium and vitamin D, exercises, and not smoking can be practiced.
As was mentioned earlier, bone buildup is easier up to the age of 30; thereafter the breaking is much more and there are steady losses. So ensuring that there are no deficiencies in early years is very critical. In later years, one can minimise losses by having adequate diet but buildup is extremely difficult.
Osteopenia is a state of having low bone density compared to normal but bones are not yet weakened as in osteoporosis. If one has osteopenia then risk factor of getting osteoporosis is high in older age. So if one has osteopenia then steps should be taken to strengthen bones to avoid osteoporosis.
Osteoporosis is a condition with possible serious effects like fractures which may take long time to heal. Hip fracture can confine one to bed for long periods raising risk of blood clots, pneumonia and other infections. However, one can prevent and also treat osteoporosis by eating right and having adequate physical activity and taking medication.