Osteoporosis is a systemic disease characterized by low bone mass and micro architectural deterioration of bone tissue leading to increased fragility of bone and consequently increased fracture risk. Commonly affected bones which are vulnerable to fracture are the vertebral column, hip bone and wrist. Fractures of these bones can be painful, debilitating and life threatening and have a profound effect on mobility and health.

Who are affected by Osteoporosis?

Osteoporosis commonly affects postmenopausal women and older men, but can occur in younger patients especially those having other chronic medical conditions.

What are the symptoms?

Osteoporosis, initially does not cause any symptoms and is called the silent killer. In some patients it may cause back pain or loss of height of 2 to 3 cms, or a deformity (curvature) of the spine. Mostly osteoporosis becomes apparent when the weakened bones fracture. This can happen with very Low Energy Trauma (trivial trauma) - like bending, coughing or sneezing or getting jolted by a vehicle going across a speed breaker.

Who are at risk?

1. Postmenopausal women
2. Women and Men older than 65 years
3. Can also occur in younger patients who have medical disorders like Kidney disorders, thyroid disorders, Cushing’s syndrome, chronic liver disorders, Intestinal mal absorption problems, Rheumatoid Arthritis. Patients on certain medications like steroids, anti-epileptics are also at risk.

What are the risks?

1. Genetic or family history
2. Hormonal
3. Diet
4. 4. Environmental or Lifestyle related eg: smoking and excessive alcohol consumption
   

How is it diagnosed?

Not diagnosed on Xrays. Test called DEXA scan is performed to determine Bone Mineral Density (BMD)
Special imaging technique called Dual Energy Xray Absorptiometry ( DEXA Scan)

Who should have a BMD test?

1. Men and women over 65 years of age
2. Men and women over 50 who have fragility fracture or have symptoms
3. Patients who have risk factors like smoking, alcohol consumption, poor diet, long term steroid treatment, kidney disorders etc.

Prevention and Management

Aim of the treatment is to reduce loss of Bone mass and to enhance new bone formation.

1. Calcium and Vitamin D supplementation
2. Adequate quantity of Calcium 1000 to 1200 mgs and Vitamin D 400 to 1000 IU per day is prescribed. This reduces loss of Bone mass.
3. Nutritious Diet - Diet containing adequate protein, calcium and Vitamin D is advised Some Calcium rich foods are: Dairy products, green leafy vegetables, Nuts, fish like Sardines. Vitamin D rich foods are: eggs, Liver, Butter, fatty fish and fortified foods like milk.
4. Exercise - Weight bearing and muscle strengthening exercise are extremely important as they help in maintaining Bone Mass. They also improve balance and agility which help in preventing falls which are a common cause of fracture.
5. Lifestyle Modification - Stopping smoking and reducing alcohol consumption.

Treatment

Medications for treatment include medications which reduce bone loss like Bisphosphonates, Calcitonin Hormone and Medications which increase Bone formation like Teriparatide, Denosumab.
Hormonal treatment is now not commonly used because of its risks like increased incidence of breast and Uterine cancer and deep vein thrombosis and strokes.