What Is Osteoporosis?
Osteoporosis is a disease in which the quality and the density of bone is reduced.
This make the bones more porous and fragile, which ultimately increases the risk
of fracture. The loss of bone occurs progressively and silently. One might never
know the symptoms until the first fracture occurs.
When a healthy bone is observed under a microscope, it looks like a honeycomb. When
a bone with osteoporosis is observed, the holes and spaces in the honeycomb shape are
much larger making the bone weaker and more likely to break.
According to the International Osteoporosis Foundation, one in three women and one in
eight men are affected, and most do not know it. In India, the figures are much higher
one in two women and about a quarter of men above the age of 45, could be struck by
the disease. About 5 crore Indians are estimated to be at risk.
Recent study says that lack of exposure to sufficient sunlight has a big role in tropical
India, in addition to factors like poor nutrition and a sedentary lifestyle.
What Causes Osteoporosis?
There are numerous causes of osteoporosis. Bones not only lose density with age, but
medications use to treat breast cancer, asthma, arthritis, inflammatory bowel disease
etc, can also lower bone density. Some illnesses such as hyperthyroidism, hypopituiaritism
(pituitary gland fails to produce hormones) and eating disorders also cause bones to lose
strength. Osteoporosis is more common in women than men, especially after menopause.
A detailed description about the same will be discussed in the third article. Yet, a number of conditions may be associated with a decrease in bone density
As this largely ignored disease finally comes to light, so does a flood of treatment.
Osteoporosis attacks the existence of our bones, which are the framework of our body
just like steel and cement in buildings. The living and growing bone tissue, filled with
calcium and phosphate, forms a cement-like structure when mixed with water. However,
calcium is also needed for various important functions like transmitting thoughts through
the nerves and to maintain heartbeat at a regular rate. Hence, the body and bone are
constantly involved in a tug-of-war for calcium. When the calcium in blood gets too low,
it is recharged from the bone. As calcium slips out, the bone becomes porous and eventually
osteoporosis occurs. More bones are formed in childhood, than are broken down, so the bone
mass increases and peaks at around 30 years. Then, more bones are lost than can be replaced,
as a normal part of aging.
How does menopause affect bone density?
In women, till menopause, bone density decreases by 1% per year and after that by 4%.
That is because the level of oestrogen which is the chief source of calcium, drops drastically
post-menopause. Oestrogen is produced by ovaries and it controls menstruation with another
hormone progesterone. Post-menopause, ovaries no longer produce high level of oestrogen
which directly affects the calcium level in the body.
The risk of osteoporosis arises in two cases. The first is, the optimal bone mass is not
reached due to some deficiency in childhood. The second category is when bone loss
increases faster than normal with age. Although genes also play a role; nutrition,
exercise, smoking are all factors in determining peak bone mass. Less or an inadequate
calcium intake in the Indian diet is thought to be the main reason for osteoporosis. Studies have shown that Indian women have almost
half the intake of calcium as compared to the western counterparts.
When exposed to sunlight, body produces Vitamin D, which in turn helps the body absorb
calcium. A study (2014) by Ambrish Mithal, President of Indian Bone and Mineral Society,
shows that 78% of the healthy individuals studied had Vitamin D deficiency. "Mostly in
work place, one is often stuck in an artificially lit office. Therefore, Vitamin D deficiency
and a sedentary lifestyle lead to osteoporosis," says Mithal. Another Delhi-based study
blames severe pollution for lack of sunlight and Vitamin D deficiency in children in several
parts of the city.
How is a person diagnosed with osteoporosis?
As osteoporosis has no obvious symptoms, it is necessary to go to a doctor to check for
any applicable risk factors. Bone Mineral Density (BMD) test as the name suggests checks
the bone density. Although traditional X-ray can determine spine fractures, but it cannot determine the bone density. Hence, BMD test is the only
way to confirm osteoporosis.
The World Health Organization has defined a number of measurements for osteoporosis.
The reference measurement called as T-score, is derived from BMD in a population of
healthy young adults. Osteoporosis is detected when a person's BMD is equal to or less
than 2.5 T-score.? Lifestyle changes and a number of available therapies (under doctor's
guidance) can be made to slow down bone loss and to prevent fractures.
What are ways to prevent and manage osteoporosis?
Living with osteoporosis does not have to be a life sentence. There are available medications
and lifestyle changes to help prevent and manage the osteoporosis. Following are some points
which should be kept in mind.
Adults should:
Participate in regular weightbearing activity
Consume a nutritious diet and ensure adequate calcium intake
Avoid under-nutrition especially the effects of severe weight loss diets
Maintain an adequate supply of Vitamin D
Avoid smoking and passive smoking
Avoid heavy drinking
Children and adolescents should:
Consume a nutritious diet
Avoid under-nutrition and protein malnutrition
Maintain adequate supply of Vitamin D
Do regular physical activity
Avoid the effects of passive smoking
The best prevention begins early in childhood. However, it is never too late to make
small but effective changes that can reverse bone loss.
Why is osteoporosis called the silent killer?
Osteoporosis is a disease that weaken bones to the point where they break easily, most
often, backbone (spine), bones in the hip, and wrist. Osteoporosis is called a "silent disease"
because one may not notice any changes until a bone breaks.
Bone is a living tissue. To keep bones strong, the body breaks down the old bone tissue and
replaces it with a new bone tissue. Sometimes, around age 30, bone mass stops increasing,
and the goal for bone health is to keep as much bone as possible for as long as one can. As
people enter their 40s and 50s, more bone may be broken down than it is replaced.
India is the second most populated country in the world with approximately 10% of population
(more than 10 crore) over 50 years of age. Worldwide, it is estimated that 1 in 3 women and 1
in 5 men, above the age of 50 will experience osteoporotic fractures. In 2013, sources estimated
that 5 crore people in India are either osteoporotic or have low bone mass. A study in Delhi
estimated that the prevalence of osteoporosis is 24.6% in men and 42.5% in women above
50 years of age.! Osteoporotic fractures in men are more common than prostate cancer and
myocardial infarction (Heart attack). Male osteoporosis largely remains underdiagnosed and
untreated and is revealed only after the occurrence of a fracture.
Growing old is a natural part of life and it cannot be avoided. As we grow older, we begin to
lose more bone than we build. The declining bone health accompanies various ailments causing
pain and discomfort. As we age, body eventually absorbs lesser calcium from diet, which causes
more and more calcium loss from bones. During childhood and young adulthood, if proper bone
care is not taken by exercising or consuming healthy diet, then there can be a higher risk of
fractures even due to relatively not-so-taxing activities like
coughing or minor injuries. Aging in combination with intrinsic and extrinsic factors decreases
bone mass that leads to fractures. Intrinsic factors include genetics, alterations in cellular
components, hormonal status, etc. Extrinsic factors include nutrition, physical activity, medical
conditions and drugs. To reduce the societal burden of fracture, it is important to take a combined
approach of not only focusing on the skeleton but also focusing on fall prevention.
What contributes to the strength of bones?
When people learn they have osteoporosis, it can be scary for them. Realizing their bones
are more fragile and likely to break easily, it sometimes just restrict people to even move.
Instead of staying still, though, one should move in a smart way to improve strength and balance. One should not change everything at once, but gradually incorporate these A-to-D
lifestyle changes:
A for Activity:
"When I was first diagnosed, my doctor told me, if you fall, you will probably break something,
" Sunita recalls. "I got scared!" But then she started walking. A few sessions with a physical
therapist to learn exercise safely and properly will lower the risk of falls. Lifting something
can also pose risks. For instance, one should not lean over to pick up something heavy. If
somebody has low bone density in their spine, they can actually sustain a fracture, by doing
that. Instead of leaning over to pick up a toddler from the ground, sit down and have him/her
climb into your lap.
B for Balance:
Building balance is the key for avoiding falls. Stability and balance exercises help the
muscles work together in a way that keeps one more stable and less likely to fall.
Simple exercises such as standing on a leg or movement-based exercises such as
Tai-chi can help improve one's stability and balance. Adults who have good balance
and muscle strength are usually able to save themselves when they trip.
C for Calcium:
As discussed, the average elderly person is in negative calcium balance and
loses more bone mass. Reduced absorption efficiency further lowers effective intake. But
other nutrients such as protein and fiber, taken in excess, effectively increases the calcium
absorption. Also, estrogen withdrawal at menopause leads to a decrease in intestinal calcium
absorption efficiency. Hence, it is necessary to get enough calcium in the diet, or if that is
not enough, through calcium supplements.
D for Vitamin D:
It is important to keep away vitamin D deficiency in osteoporosis, as vitamin D is the key
for absorbing calcium in the body. For this, the skin needs enough sunlight to produce the
vitamin, but we need to practice safe sun exposure to reduce the risk of skin cancer. If one is not getting enough from sunlight and food, one may need to take a
supplement under doctor's guidance.
How do you keep your bones healthy?
Osteoporosis risk begins in childhood, though it shows up
in adulthood. The important time for prevention should start at day one, in order to
build the strongest bones possible. All women must have a bone density scan after 65
or earlier if they have additional risk factors. As recommendations vary for men, the
National Osteoporosis Foundation advises testing for men aged 70 years and older. Also,
lifestyle changes really do help. By eating better, exercising and taking care from the start,
can help prevent osteoporosis.
Osteoporosis in Post-Menopausal Women
Has your grandmother ever complained about aching knees and having difficulty in
walking? And you just considered it as an inevitable part of ageing? But what if age
is not the only factor affecting it? What if it is preventable or reversible? Here's the
answer to all these questions!
What is Menopause?
Menopause is a natural physiological condition characterized by absence of menstruation
for at least twelve consecutive months. Preventing bone loss is an important concern for
women in the menopause and during postmenopausal stages as research indicates that
up to 20% of bone loss can happen during these stages. Menopause significantly speeds
bone loss causing the bones to break down more quickly than it is formed and thus,
makes it the most common cause of osteoporosis.
Osteoporosis is a major problem in post-menopausal women and approximately 1 in
10 women over the age of 60 are affected by it worldwide.' It weakens the bones to
such an extent that even minimal trauma may lead to fractures and thereby, affects
the quality of life. Studies show that one in two postmenopausal women are likely
to have osteoporosis and most will suffer a fracture during their lifetime.
How is
and Osteoporosis linked with each other?
It is believed that calcium and Estrogen (a hormone secreted by the ovaries) are major
factors in building and maintaining the bone strength in women. The higher frequency
of osteoporosis in postmenopausal women is attributed to the rapid loss of calcium from
the bones and lower levels of estrogen in the blood as the functioning of ovaries decline
with age.
Estrogen helps to protect against bone loss by slowing the natural breakdown
(resorption) of bone. It does so by regulating the parathyroid hormone which
in turn promotes calcium reabsorption. However, to accommodate normal
menopausal changes, estrogen levels start to fluctuate and then drop which
leads to increased bone resorption than formation. This forms a direct link
between the lack of estrogen during menopause and the development of osteoporosis. Early menopause,
that is before the age of 45, and any prolonged periods of infrequent or absent menstrual
periods in which estrogen levels are low can cause loss of bone mass.
What are Your Chances of Getting Osteoporosis?
It mainly depends on two factors on reaching menopause:
The amount of bone you have-
Greater the initial bone density, lower is the chance of developing osteoporosis. Having
low peak bone mass or other risk factors that causes bone loss, increases the chance of
getting osteoporosis.
How fast you lose bone-
Bone loss happens faster for some women than for others. If bone loss happens quickly,
the chance of developing osteoporosis is greater.
What are the risk factors associated with osteoporosis?
Following are the risk factors:
Age:
Around the age of 30, after maximum bone density and strength is reached, bone
mass starts declining with age
Ethnicity:
Asian women are more likely to develop
osteoporosis
Bone structure and body weight:
Petite and thin women have a comparatively greater risk of developing osteoporosis
than women with more body weight and larger frames as they have less bone mass
to lose
Family history:
If an individual's parents or grandparents have had any signs of osteoporosis, they may
be at greater risk of developing the disease
Prior history of fracture/bone breakage
Certain medications:
Long term use of steroids and medications can increase the risk of developing osteoporosis
Some medical conditions:
Some diseases such as cancer and stroke may increase your risk for osteoporosis
How Can postmenopausal osteoporosis be Diagnosed?
Any fracture in postmenopausal women can be considered due to postmenopausal
osteoporosis unless related to an accident or major trauma. A painless and accurate
test, known as "Bone mineral density" test can provide information about bone health
and osteoporosis before problems arise. This test is indicated for women who are 65
years or older, have numerous risk factors and menopausal women who have had fractures.
Prevention and Management of Postmenopausal osteoporosis
The goal of the management plan is to prevent further bone loss and to stimulate new bone
formation, thus decreasing fractures associated with osteoporosis and maintain good bone
health. Lifestyle changes that can improve bone health are
Exercise:
Exercise makes bones and muscles stronger and prevents bone loss. Weightbearing exercises
like walking, jogging, playing tennis, and dancing, done at least three to four times a week, are
best for preventing osteoporosis.
Additionally, strength and balance exercises may help you avoid falls, thus decreasing your
chance of breaking a bone.
Calcium:
Calcium helps to build and maintain strong bones. Excellent sources of calcium
are milk and dairy products, canned fish with bones like salmon and sardines, dark green
leafy vegetables, such as kale, collards and broccoli, calcium-fortified orange juice, and
breads made with calcium-fortified flour. The U.S. recommended daily allowance of calcium
for postmenopausal women is 1,200 mg per day.
Know your Calcium Levels
Vitamin D:
Your body uses Vitamin D to absorb calcium and phosphorus (both required for healthy bones).
Being out in the sun for approximately 20 minutes every day helps make enough vitamin D in
the body. You can also get it from dietary sources like eggs, fatty fish like salmon, cereal and milk fortified with vitamin D.
Supplements: Calcium and Vitamin D supplements enhance bone formation and
prevent fractures.
Medications:
Most of the bisphosphonates as well as raloxifene help prevent osteoporosis in people
who are at high risk for fractures.
Estrogen Therapy:
Replacing estrogen lost after menopause slows bone loss and improves calcium
absorption and retention. However, it carries risks and is only recommended for women at
a high risk for osteoporosis.
Know the high risk medications:
Medications containing steroids, some breast cancer treatments, drugs
used to treat seizures, blood thinners, and thyroid medications can increase the rate of bone loss. If an
individual is consuming any of these drugs, the risk of bone loss can be reduced
through dietary and lifestyle changes or other medications.
Limit alcohol consumption and avoid smoking:
Smoking causes your body to make less estrogen and too much alcohol can damage
your bones and increase the risk of falling
Osteoporosis is a chronic condition that affects millions of postmenopausal women all
around the world as it is closely linked to estrogen deficiency. Medications such as calcium,
Vitamin D, bisphosphonates and hormone replacement therapy are found to be beneficial for its effective management. Also,
proper care should be taken to prevent fractures and risk factors such as cigarette
smoking and alcohol intake should be avoided.
As much as the skeletal system is there to protect us, just like anything else it can also
be broken or damaged. When we were kids and played on the monkey bars outside, we
might have fallen and broken an arm. This is an outside effect on the skeletal system but
we cannot see what happens inside. Our changing lifestyle and ignorance can lead to bone
disorders such as Osteoporosis, Osteoarthritis, etc., which we would not worry about until
later in life.
It is true that age is a leading risk factor for osteoporosis. Middle aged women and men start
experiencing a decline in bone mass, with women losing bone density quickly in the years
following menopause. Still people of all ages can suffer from osteoporosis, and age is just one
of the many risk factors related to bone damage.
Our genetic makeup only accounts for half of the bone mass, while lifestyle, habits and
environment account for the rest. This tells us that, in order to reduce the risk of bone
disorders by half, we need to adopt preventive and healthy habits, especially during
childhood when we can most influence our peak bone mass.
What Habits are Best for Bone Health?
Various healthy habits, can strengthen our bones and lessen the risk of bone diseases.
These habits are what we need to adopt for a strong life.
Monitor your diet
Diet is a large part of our lifestyle. If it is not properly balanced, proper bone nutrition
can be missed. Longterm deficiencies of calcium and vitamin D are the causes for reducing
bone mass. Both are vital for bone growth, hence the best strategy in preventing bone
disorders is the adequate intake of both calcium and vitamin D.
Calcium -
Dairy products are the richest source of calcium. It is also present in orange juice, canned
fish and green vegetables.
Vitamin D -
It can be found in oily fish, egg, butter and sunlight (main source of the vitamin). Exposing
our skin to sunlight for 10 to 15 minutes can satisfy body's need for vitamin D.
Vitamin D Levels
Maintain a reasonable weight
This is particularly important for women. Menstrual periods often stop in women who are
underweight, due to poor diet or excessive exercise. It usually means that their estrogen
levels are too low to support bone growth. On the other hand, increased fat mass stimulates
greater estrogen production and acts as a cushion against bone trauma such as a fall, in
elderly women. But it has no advantage to skeletal health when this increase becomes
excessive. Prolonged inactivity also leads to bone and muscle loss. Hence, it is
important to regulate the body weight through exercises which includes
Weight-bearing Exercise -
Forcing the body to work against gravity by walking, free-weight lifting, climbing stairs,
playing sports, running and dancing helps to strengthen the bones
Balance Exercise - Improves the
ability to hold the body upright and prevents falling, which is the maior cause of fractures.
For example yoga provides better balance and coordination.
Flexibility Exercises - Keeps our muscles limber and joints mobile. It includes
yoga, squats and stretching
Physical Therapy - It includes exercise program that strengthens the bones
without causing excessive pain and swelling. This should be done under the guidance of a
therapist physical
Quit Smoking and Alcoholism
Smoking and consuming too much alcohol can decrease bone mass. There is a direct relationship
between smoking, alcoholism and decreased bone health. Chronic alcohol use is linked to an
increase in bone fracture, as drinking too much alcohol interferes with the absorption of calcium
in the body. It affects hormone production, which has a protective effect on the bone So, limiting
alcohol intake and quitting smoking reduces the risk of getting bone diseases.
Prevent Drug-induced Bone Damage Today, many medications such as
glucocorticoids, proton pump inhibitors, heparin and some chemotherapy have been shown
to decrease bone mass and increase fractures. Raising awareness of these side effects will
allow monitoring of bone health and therapeutic tests to prevent druginduced bone damage.
Also, many patients are treated with combinations of these medications, doubling the
effects of
Discuss With Your Doctor
Some medical conditions like celiac disease and medications (steroids) can increase the chances
of developing bone related diseases. It is important to discuss with your doctor about the risk
factors related to bone damage and to develop a prevention strategy that accounts for these
factors.
Educate Yourself
Bone related disease affects a growing number of people and have no cure. Therefore,
health education and management of osteoporosis is required. By educating ourselves
through attending lectures or sessions on bone health, one can spread awareness around
the world, reduce the risk of getting bone disorders and increase the quality of life.
It is never too late for us to adopt bone-preserving habits. It will help to store up bone
strength as a hedge against developing bone related diseases. Lifestyle changes involving
smoking, alcohol intake and diet can have the biggest impact on bone health, so it is
important that we focus on our lifestyle more and live a healthy life. One can say that
prevention against bone damage must begin as early as in childhood to incorporate healthy
habits for keeping bones sturdy and healthy!
Bone Profile - To Monitoring Bone Health
Bone is the rigid, hard connective tissue that turns over at a rate of about 10% a year and
comprises majority of the skeleton in humans. Like any other tissue or organ in our body,
it can also be affected by medical conditions which include fractures, signs of wear and tear,
inflammations and cancer. Injuries and fractures are common in younger people but as we
grow older, diseases like osteoporosis and osteoarthritis are more likely to develop.
Bone markers are blood and urine tests that detect products of bone remodeling which
in turn aids in determining if the rate of bone resorption and/or formation has increased
abnormally, suggesting a potential bone disorder. These markers can be used to determine
a person's risk of bone fracture and to monitor drug therapy for people receiving treatment
for bone disorders, like Osteoporosis and Paget disease. One such test is the bone profile
blood test which assesses the proteins, minerals and enzymes present in the blood which
are essential for a healthy bone structure and its development.
Testing Bone Profile @ Thyrocare
The Bone Profile at Thyrocare consists of fundamental tests for screening the health
status of your bone and evaluates the following 13 parameters:
25-OH Vitamin D
Vitamin D Total helps the body absorb calcium and maintain strong bones throughout
life. It is converted to a chemical known as 25-OH Vitamin D Which is a major circulating
from of Vitamin D and this test thereby aids to monitor vitamin D levels. It serves as an
important indicator of osteoporosis and rickets.
Intact Parathyroid Hormone (PTH)
Parathyroid Hormone aids to regulate calcium levels in the blood and bones.
Calcium
Calcium is important for the formation, density and maintenance of bones, and is
usually measured to screen or monitor bone diseases or calcium-regulation disorders
like diseases of the parathyroid gland or kidneys.
Phosphorus
phosphorus is a mineral needed for building strong bones. Several bone
diseases can result in abnormal phosphorus levels.
Alkaline Phosphatase
Alkaline Phosphatase is an enzyme which aids in diagnosing problems with bones
including cancers that have spread to your bones, Paget's disease and issues caused by
vitamin D deficiency.
Serum Zinc
Zinc is an essential nutrient required for the growth, development, and maintenance
of healthy bones. Low plasma zinc is often associated with low bone mass and disorders
such as osteoporosis.
Vitamin B-12
Vitamin B-12 may support your bone health and studies link Vitamin B-12 deficiency
with low Bone Mineral Density and bone formation markers.
Magnesium
Magnesium is a mineral vital for the maintenance of strong bones and the proper
utilization of vitamin D and calcium. Prolonged magnesium deficiency can lead to
weakening of bones and has been associated with increased risk of osteoporosis
and related bone fractures. Furthermore, abnormally low magnesium levels can
inhibit vitamin D and calcium homeostasis in bones.
Rhematoid Factor
Rheumatoid Factor is a protein made by the immune system that can attack healthy
tissues in the body Therefore, presence of RF in the blood maybe an indication of
autoimmune diseases like Rheumatoid Arthritis. Studies have shown an increased
risk of bone loss and fracture in individuals suffering rheumatoid arthritis, and are at increased
risk of osteoporosis.
Uric Acid
High levels of uric acid in the blood often lead to high levels of uric acid in the joints,
resulting in the formation of uric acid crystals in the joint tissue and the fluid within
the joints.
Serum Copper
Copper is critical for building strong bones and its deficiency can lead to bone abnormalities
and fractures in children, and osteoporosis.
Anti Nuclear Antibodies (ANA)
Sometimes the immune system malfunctions and produces autoantibodies like
ANA that attack body's own cells and tissues which can damage the joints and
muscles, resulting in an autoimmune disease such as systemic lupus erythematosus.
Anti-Cyclic Citrullinated Peptide (ACCP)
ACCP is another autoantibody which is usually associated with Rheumatoid Arthritis.
As all these factors play an important role in strengthening and maintaining the bone
mass and their imbalances may lead to severe bone abnormalities. Therefore, it is
important to monitor these parameters on a regular basis for optimum bone health.
This bone profile would help the individual to take preventive steps well before the
condition worsens and thereby, keep common bone disorders such as osteoporosis,
osteomalacia, etc. at bay.
