Osteoporosis in India: Under-diagnosed and under-treated!

Recently, one of my relatives, a lady in her sixties, fell down at home a few weeks back, and she kept complaining of back pain – mostly while changing positions, like getting up from bed or a chair, or turning in bed. She was being treated for the usual back pain by many of her doctors with painkiller medicines, without any progress. Further tests at my clinic showed that she indeed had fractured a bone in her spine. This is the usual story for many ladies after menopause. This is the story of osteoporosis.

Osteoporosis was thought to be a problem of the western world. While studying effect of ethnicity on osteoporosis, more and more studies from throughout the world and in India have shown conclusively that osteoporosis happens a decade earlier in Indian women than in their western counterparts. This is due to their abundance of calcium and vitamin deficiency amongst us.

Normal Bone - Osteoporotic Bone

Key Points:

  1. Osteoporosis is very much a Indian problem, too – it sets in earlier in Indian women
  2. Calcium and vitamin supplements are not the treatment for osteoporosis
  3. If untreated, it can cause debilitating fractures of the spine and hip bones
  4. A DEXA scan is one of the ways to know the risk of such a fracture
  5. Developing good bones by outdoor activities early in life helps fight osteoporosis better

A common myth among our patients is that osteoporosis means only a lower amount of calcium—and if your mother/grandmother/relative takes calcium regularly, she wouldn't have osteoporosis. But that's not the whole truth. Osteoporosis is more like non-availability of smooth roads when you have a Porsche. That is, poor bone architecture, in spite of the availability of calcium. Simply put, osteoporosis is a disturbance in the architecture of the bones. It is, as the word itself says, porous bones. (The prefix osteo- means bone).

The most common cause of osteoporosis is after menopause, when more bone is lost than the amount being made, thus it is more common in females. Men too can suffer osteoporosis, but generally it is after the age of 70. The other causes can be secondary to pathology elsewhere in the body, or due to certain tablets, for example, tablets for epilepsy or “fits” and steroids.

The predominant complaint is extreme tiredness with aches and pains in the back, hips, and different joints of the body. Even a minor slip or fall in the house can send you down to the emergency department with severe pain in the back and hips, due to a fracture. Yes, a fracture of your spinal vertebra or hip bone, which needs surgery.

Dexa machineBone density is one of the ways to assess your risk of developing a fracture. The machine using your foot to measure bone density is not the best way to measure it, but it is good as a screening tool. If it shows weak bones, you should always follow it up by a proper DEXA (Dual-Energy X-ray Absorptiometry) machine scan. (See image.)

So get yourself (if you are a female who has reached menopause), your mom, grandmother, aunt, or whoever is close to you, who has reached menopause, evaluated for osteoporosis, with a bone density test and some blood checks. Meet with your orthopedic spine specialist.

How to Prevent the Osteoporosis Shock!

Understand the Concept of Peak Bone Mass

Not only old age but osteoporosis tooAs we grow, we start accumulating bone strength. Unfortunately, it is a time-bound process, and it is only up to the age of about 30 that you have the potential to gather as much bone mass as possible. This is called peak bone mass. After that, we start losing bone gradually year-by-year, and the loss is more pronounced in the twilight years of our lives. This happens equally in males and females, up to 45 years of age. In ladies, as menopause sets in, this loss of bone mass is even more pronounced, which sets the stage for osteoporosis. It wreaks havoc if unnoticed and untreated – fractures of the spine or hips keep you bed-bound for months, and this is fatal in many cases. One definitely doesn't want one more variable to worry about, apart from diabetes and hypertension, which is very common at that age.

Start Early

Outdoor sports a mustAccumulating and improving your “bone balance” (like a bank balance) happens if you start early in life. This happens by activities, most importantly sports, which stress or impact the bones, such as rope skipping, basketball, gymnastics, dancing, jogging, etc. Encouraging any outdoor sport has beneficial effects on the body, and especially on the bones.

 

For the Rest, All Is Not Lost

In women, as in men, any weight training exercises do positively impact the muscles and bones. The training has to be supervised to avoid injury. We do encourage some weight training in women with osteoporosis too, apart from medicines.

Please encourage your girls to participate in outdoor sporting activities for one simple reason – it fights osteoporosis better.

Getting the smartphone generation to do that is a challenge! LETS RISE TO THE CHALLENGE!!

Treatment

The one important thing to understand is that calcium and vitamin D supplements are NOT the treatment for severe osteoporosis. The main treatment involves a daily injection treatment for 2 years (Teriparatide) or a drug from the bisphosphonates group for 7-10 years, available in tablet or injection forms. This should be supplemented with vitamin D and calcium.

Weight training, maintaining an active lifestyle, and the routine use of back and neck exercises helps most patients.

Let’s educate ourselves about this disease and keep it at bay!

Pawar Dr. Uday Pawar is a spine surgeon, marathon runner, and a trekker. He was recently attached to Global Hospitals, Mumbai, bringing almost 10 years of only spine-related consulting and surgical expertise. His areas of interest are minimally-invasive spine surgery and day care spine surgery. He is also interested in the use of technology to help patients and doctors alike.
Educating patients, and thus helping them to arrive at an informed decision-making process, is what he likes. He also writes spine related blogs to help spine patients to this end.
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