Osteoporosis A Silent Epidemic

Dr Vaijayanti Lagu-Joshi

We often came across patients in sixties suffering from fractures of hips, wrist, vertebrae following minor falls. Osteoporosis is the main cause of these fragility fractures. But it remains clinically silent for years together until the fracture occurs. Osteoporosis is a systemic skeletal disorder that leads to loss of bone mass / low bone mass, disruption of architecture of bone leading to decreased bone strength, fragility and increased risk of fracture.
In India it has been presumed that 35% of post menopausal women (stopped their menstrual cycle) are at risk of developing osteoporosis. Osteoporotic bone fractures commonly occur at the spine, hip and wrist.
The bone mass that we achieve is the result of the amount of bone achieved during growth and at maturity. The remodeling of bone is a continuous process through life. In young, normal individuals, bone mass remains constant for many years after puberty and rates of bone formation & resorption are approximately equal. But as age advances, in osteoporosis rate of bone resorption exceeds that of bone formation and results in bone loss.
Osteoporosis can be categorised into 2 main types.

1. Primary Osteoporosis
2. Secondary Osteoporosis

Primary Osteoporosis is due to old age Senile osteoporosis and postmenopausal osteoporosis in females. Normally, bone mass is lost gradually in both sexes but in women, the rate of bone loss is accelerated at time of menopause. Post menopausal osteoporosis occurs in age group of 50-70 years, there is loss of both trabecular and cortical bone, less calcium absorption but increased parathyroid function..

Bone Mass profile through life


There are many causes which lead to secondary osteoporosis. Few important causes are highlighted here.

1. Genetic disorders of bone and connective tissue. Conditions like Marfan's syndrome, osteogenesis imperfecta caused by genetic mutations making bone fragile.
2. Nutritional causes - These are common and correctable. Calcium deficiency, protein deficiency occuring in malnutrition , malabsorption lead to fragile bone strength.
3. Endocrine causes - There are few disorders of thyroid, parathyroid glands like thyrotoxicosis, Hyperparathyroidism, diabetes mellitus, hypogonadism which can interfere with bone mass remodeling and loss of bone.
4. Prolonged drug administration in form of steroids, heparin, anticonvulsants (drugs used for epilepsy) can lead to osteoporosis.
5. Few chronic inflammatory disorders like rheumatoid arthritis, fluorosis, metabolic bone diseases can contribute to accelerated bone loss.
6. Factors like alcohol, smoking, immobilization (prolonged) can lead to osteoporosis.

Most patients of osteoporosis are asymptomatic until they develop a fracture after minimal trauma. Fractures commonly occur in hip, wrist, back and ribs. Patient's complaint of back pain, deformity of spine, loss of height, restriction of movements and functioning.
The diagnosis of osteoporosis is evident when there is an obvious fracture. But now advance technique is available to measure the bone density and quantify the risk of fractures in future. Bone densitometry / DEXA Scan is a machine that calculates the bone mass of an individual and interprets them in terms of T score & Z score. Those with T score less than -2.5 are considered to have osteoporosis with increased risk of fracture.
However the testing, interpretation needs to be done by experts. Few blood investigations like serum calcium, phosphorus, alkaline phosphatase levels, hormonal levels (thyroid, estrogen, progesterone, testosterone) Vitamin D assays are also important while diagnosing osteoporosis and planning further management.
These are number of supplements (calcium, vitamin D) along with specific medications that can increase the bone density and reduce the risk of fractures. But prevention is better than cure. Taking care of calcium, Vitamin D supplements in childhood, during growth and pubertal periods is crucial for attaining good bone mass and quality. Appropriate exercises, avoidance of smoking, alcohol, proper treatment endocrinal diseases, inflammatory diseases, monitoring of drug intake can surely help in prevention of osteoporosis.