How many times have you seen a wrinkled, grey-haired, elderly lady walking about with a stooped posture? Did you assume that she always had a bent back from younger days or it is just an aging thing? So many myths are associated with aging that preventable conditions like the above are often labelled as ‘part of growing old.’ The elderly lady in question is most likely to be suffering from an extremely rampant yet preventable condition called osteoporosis.
No factor has an impact on the severity and complications of a disease greater than the prevention of its occurrence in the first place. Osteoporosis is no exception. We will attempt to explain the nature and complications of osteoporosis in this two-part series.
What is osteoporosis?
The term osteoporosis is made up of two words, ‘osteo’ (bone) and ‘porosis’ (porous). Bones of the body after a certain age gradually lose their strength and become fragile, and hence are more likely to break or fracture. This loss of strength is also referred to as loss of bone density.
Throughout life minerals like calcium and phosphate are deposited in the bone and are resorbed at the same time, depending on a number of factors. If the deposit is slow and resorption is faster, the strength of the bone lessens.
To understand this better, imagine your bone as a savings account- the bone bank. This bone bank constantly receives deposits and gives away withdrawals like any ordinary bank. During the younger half of your life the deposits of minerals are far more frequent than the withdrawals, but with increasing age the withdrawals are the ones which become more frequent and the deposits meagre. This tilts the balance of the bone towards the low density side, rendering it fragile and susceptible to fractures.
How common is osteoporosis?
Fifty per cent of women over the age of 45 years and 90% over age 75 are affected.
A million and a half hip fractures occur worldwide every year due to osteoporosis;
24% with osteoporotic hip fractures die within the first year and 40% end up permanently in nursing homes.
Every 30 seconds someone in the European Union suffers an osteoporotic fracture.
Out of three patients with such fractures only one returns back to a full level of independence.
Eighty per cent of all patients are women.
Four out of five patients with osteoporosis are unaware of its existence.
Can I get osteoporosis?
There are well-defined reasons for developing osteoporosis. Unfortunately you can control and prevent only half of these. The risk factors, when present, make you susceptible to the disease. We have divided these factors into the ones you can control and the ones you cannot.
The risk factors you cannot change include:
Gender: Women get osteoporosis more often than men.
Menopause: Low female sex hormone levels due to menopause cause osteoporosis in women. Low male sex hormone levels can bring on osteoporosis in men.
Advancing age: The older you are, the greater your risk of osteoporosis.
Body size: Small, thin women are at greater risk.
Ethnicity: White and Asian women are at highest risk. Black and Hispanic women have a lower risk.
Family history: Osteoporosis tends to run in families. If a family member has osteoporosis or breaks a bone, there is a greater chance that you will too.
The risk factors you can change are:
Dieting: Over zealous dieting to lose weight has become an important emerging cause of osteoporosis.
Inadequate calcium intake: A diet low in calcium and vitamin D makes you more prone to bone loss.
Medication use: Certain medicines like steroids increase the risk of osteoporosis.
Activity level: Lack of exercise or long-term bed rest causes a weakening of the bones.
Smoking: Cigarettes are damaging for the bones, heart, and lungs.
Alcohol: Excessive alcohol intake causes bone loss in the long run.
How do I know if I have osteoporosis?
Osteoporosis is a completely asymptomatic disease until you land up with a broken bone and visit a doctor. It is the complications of this condition that make you aware of its existence as you may feel nothing wrong with your bones throughout the disease until a strain, bump, or fall causes a bone to break. It is this nature of osteoporosis that makes it a ‘silent epidemic.’
The awareness of the existence and the will to prevent osteoporosis should move you to have a consultation with a specialist.
Your doctor will obtain a relevant personal and family history and conduct a detailed examination to ascertain the factors responsible for osteoporosis in you.
Although X-rays are the traditional tests done for the bones, they are insufficient for the diagnosis of osteoporosis.
There is a simple, painless cheap, fast and accurate test that needs to be performed for diagnosing and documenting osteoporosis. It is called a DEXA scan, which is performed in a few minutes in the office itself. This is a scan which takes a picture of one of your bones and calculates its density using a computer. It can be done at any age and for anyone except pregnant women. After your scan it is advised that it is repeated every two years throughout life.
The following are the advantages of a DEXA scan:
* Detects low bone density before a fracture occurs.
* Confirms a diagnosis of osteoporosis if you already have one or more fractures.
* Predicts your chances of fracturing in the future.
* Determines your rate of bone loss, and monitors the effects of treatment if the test is conducted at intervals of a year or more.
Controlling ‘the silent epidemic’: Mission possible!
A comprehensive osteoporosis treatment programme includes a focus on proper nutrition, exercise, and safety issues to prevent falls that may result in fractures. In addition, your physician may prescribe a medication to slow or stop bone loss, increase bone density, and reduce fracture risk. We shall discuss the details of each of the above in the next Sunday edition of this column to guide and guard the aging population against the disabling morbidity and mortality of osteoporosis.
