A staggering 61 million people in India suffer from osteoporosis, a disease that makes bones brittle, thus increasing the chance of fractures, which are not only painful, but decrease mobility, and bring down the quality of life. The term osteoporosis, derived from Latin, means porous bones. Out of those estimated 61 million people, 80% are women. Furthermore, the World Health Organisation’s (WHO) estimates suggest that 30% of postmenopausal women suffer from osteoporosis.
So, what is this disease that disproportionately affects women?
“Osteoporosis is a disease that causes weakened bones and an increased risk of fractures due to low bone mass and disruption of bone microarchitecture,” explains Dr Vivek Dahiya, director, Institute Of Musculoskeletal Disorders and Orthopaedics, Medanta, Gurugram.
Among women, osteoporosis primarily develops due to hormonal imbalance post-menopause. In men, old age is a risk factor, according to Dr Harish Ghoota -additional director, orthopedics, Fortis Escorts Hospital, Faridabad. However, age does not matter much as “those as young as 10-14 years can also suffer from it,” explains Dr Ashok Rajgopal, mentor and consultant Orthopaedic surgeon at Sir HN Reliance Foundation Hospital and Research Centre. “However, postmenopausal women are at a greater risk,” he says.
Secondary causes include prolonged use of steroids, diseases like hyperthyroidism, rheumatoid arthritis, and those of the liver, along with certain types of cancers. Young women who have undergone hysterectomy, especially their ovaries removed, are also at risk. A diet that lacks protein and low calcium intake, too, plays a role here,” the doctors explain.
“Other risk factors include a sedentary lifestyle, alcohol intake, tobacco use, and antiepileptics medication,” they add.
Apart from these, “people must realise that vitamin D is a critical ingredient for bones and the richest source of it is the sunlight. So, the more people are outdoors, the less their risk of osteoporosis,” explains Dr Rajgopal.
The disease is more prevalent than one thinks. “Worldwide, it is almost an epidemic,” the doctor says. An estimated 200 million suffer from it worldwide. Not just that, “post 50, almost one in two women and one in four men will possibly have some sort of an osteoporosis-related issue,” Dr Rajgopal adds.
Osteoporosis & menopause
Menopause is the most common cause of osteoporosis, according to the Endocrine Society, an international medical organisation that focuses on endocrinology and metabolism. Estrogen, the female sex hormone, plays a role here. During menopause, the estrogen level fluctuates before dropping altogether. As this hormone helps prevent bones from weakening by slowing the natural breakdown process, a drop in estrogen levels during menopause accelerates bone loss.
“Osteoporosis is mostly a silent disease affecting menopausal females and elderly males. It might not be painful initially,” says Dr Ghoota. However, here are some signs to help identify:
- Back pain, especially in the lower back
- Decrease in height
- A stooping posture
“Some patients come to us with fractures after a trivial fall, especially of the wrist, hip, or vertebra,” the doctor adds.
Undertaking spontaneous activities can lead to fractures in osteoporosis patients. However, in some cases, the activity can be as trivial as turning over in bed or bending over to pick something off the floor. “Most of these are what we call insufficiency fractures, and you do not need a lot of injuries or trauma to cause fractures in osteoporosis patients,” explains Dr Rajgopal.
“Yes, there is a pre-stage where you can get to know if you would develop osteoporosis,” says Dr Rajgopal. For that, “people need to realise they are at risk. Let us take an example of a 35-year-old woman who has undergone a hysterectomy, which puts her at a risk for osteoporosis. Similarly, those with an altered calcium metabolism need to be on calcium and vitamin D supplements. For getting checked at a pre-osteoporosis stage, there is a procedure called bone densitometry. It is an ultrasound test where doctors can ascertain the amount of mineral content in the skeleton. It is an easy way to know if the person is at risk,” the doctor explains. Other regular checkups for vitamin D and calcium-phosphorus help, he adds.
As per Mayo Clinic, the diagnosis involves measuring bone density with a machine that uses “low levels of X-rays to determine the proportion of mineral” in the bones. It is a painless test, which largely involves checking the bones in the hip and spine.
Once diagnosed and the level of bone loss assessed, “the doctor starts the treatment to stop the bone loss and enable the rebuilding of the bone to prevent breaks. Additionally, the doctor may advise making healthier lifestyle changes, suggest a diet rich in calcium and vitamin D, and do weight-bearing exercises that help in bone-strengthening,” says Dr Dahiya.
Diet & exercises
“When it comes to diet and osteoporosis, there are two things to keep in mind: getting enough calcium and vitamin D and avoiding foods that can promote bone loss,” says Nawaz Shaikh, wellness expert and founder of FITX Transformation.
“Some good sources of calcium include dairy products, leafy green vegetables, and fish with edible bones, such as sardines or salmon. If you do not eat these foods regularly, you may need to take a calcium supplement,” the expert recommends.
But for your body to absorb calcium, vitamin D is essential. And what is better than getting enough sunlight? Foods rich in vitamin D include “egg yolk, oily fishes such as salmon, trout, mackerel and tuna, cheese, mushrooms exposed to UV light, margarine, along with dairy and orange juice fortified with vitamin D,” he recommends.
Although disputed, some bodies of research have found a link between less calcium intake and greater bone loss and hip fractures in older adults. They found that enough protein and calcium intake benefits bone mineral density (BMD). “Protein-rich foods include eggs, meat, fish, dairy and soy products, beans, lentils and legumes, nuts, and seeds,” Shaikh says.
Apart from these, “consuming fats such as in the form of avocado and full-fat cheese help. Eating green peas, mushrooms, asparagus, spinach, almonds, walnuts beans, and sea kelp also help,” says Yash Patel, celebrity fitness expert, nutritionist and founder of Askknatural.
Now coming to exercise, “some specific workouts can help improve bone health among osteoporosis patients, such as weight-bearing exercises, which include walking, running, and other low impact bodyweight exercises. Resistance training, which helps increase muscle mass and strengthen bones, also helps. These can be done with free weights, resistance bands, etc,” says Shaikh. Also important are balance and coordination exercises that help prevent any falls, thus reducing the risk of fractures.
“Prevention is the key to dealing with any medical condition,” comments Dr Dahiya. “In the case of osteoporosis, a healthy diet and physical activities beginning in childhood are critical to building strong bones. It can be accomplished by consuming calcium-rich foods such as milk and dairy products, which promote optimal bone formation,” he adds.
Here’s what the doctor recommends:
- Calcium: 1,000 mg daily for those between the ages of 18 and 50 years. Then, 1,200 mg for women over 50 and men over 70.
- Vitamin D: 600 units per day for those below the age of 70 years, and 800 units a day after that
- For stronger legs and lower spine, do weight-bearing exercises like walking, jogging, and skipping
- To improve balance and prevent falls, do balance training exercises like Tai chi
- Consume dairy products like tofu, salmon/ sardines Calcium-fortified cereals, and orange juice are good for bone health
- Strength training exercises for stronger muscles and bones in the arms and spine
— Dr Vivek Dahiya, director, Institute of Musculoskeletal Disorders and Orthopaedics, Medanta, Gurugram