~By Dr Raghavendra KS, Consultant Joint Replacement & Spine Surgeon, Fortis Hospital Kalyan ~
Osteoporosis is commonly known as a ‘’Silent Disease’’ which is characterized by low bone mass, associated with deterioration of bone, causing fragility and increases fracture risks. Osteoporosis in men and women often goes under recognized, under diagnosed and under treated. In India, men and women seem to be more prone to Osteoporosis and sustain fractures about 10-20 years earlier than their western counterparts. This is probably due to their genetic make-up, poor Calcium and Vitamin D intake.
Women are 5 times more likely to suffer than men and it is reported that 50% of all women over the age of 45could be affected by Osteoporosis. A lot of it is to be blamed on lifestyle habits, many people do not venture into the sun as much as they should. It is reported that 70% Indians in rural and 94% in urban areas are faced with Vit-D deficiency. Women especially consume only 260mg/day calcium as per the required 1000 mg/day.
Incidence of Osteoporotic fractures in Women after the ageof 50:
- Shortly after menopause (45-50yrs), the incidence ofwrist fracture increases and continues up to 60yrs atwhich it plateaus
- The incidence of hip fracture increases slowlywith age and undergoes steep rise later in life
- The incidence of vertebral fracture clearly begins to riseshortly after Menopause and continues with agewithout reaching a plateau
- 1/ 5 patients does not survive after Hip Fracture (10-20% mortality rate)
- 1/ 3 patients end up with a permanent disability
- 40% patients cannot walk independently
- 3/ 5 patients cannot carry out daily activities and will bedependent on others rest of their life.This leads to social disability, economic disability andmental disability.
People at Risk:
- People with advancing age (more than 50yrs)
- People who are short, thin and small bone framed
- Smokers are at very high risk.
- Women after Menopause due to Estrogen hormonedeficiency
- Old fractures and limited daily activity
- Excessive intake of alcohol
- Prolonged use of certain medications like Steroids (in Asthma), Thyroid medicines, Estrogen (for hormone supplementation).
Steps for evaluation and treatment:
Step 1: Identify patients at risk for Osteoporotic fractures byclinical assessment and Bone Mineral Density test
Step 2: Measures to minimize the rate of bone loss
- a) Regular physical activity.
- b) Avoiding alcohol and smoking
- c) Judicious use of medicines like Steroids, Thyroidhormones & Estrogen
Step 3: Consider therapeutic agents to increase bonemass, which can be explained by an Orthopedic Surgeon
Step 4: Counsel patient’s to avoid falls and mechanical stressthat may contribute to fractures
Step 5: Addressing the complications of OsteoporoticFractures withsurgical and non-surgical means
Step 6: Food supplements(Calcium rich Vit-D rich)
- Milk & milk products, Raagi(cereal), green Leafy vegetables, almonds, Soya bean, Chicken Liver, fish (Sardines, Mackerel), eggs, Orange juice
Take Home Message:
- More awareness of Osteoporosis
- Supplementation of Vit-D & Calcium, as the natural intake isvery low
- Fortification of food with milk, Soya bean, bread, juices enriched withVit-D
- Regularly exercise
- Avoid smoking and alcohol consumption
- Judicious use of medication
- Early & proper management of fractures
- Regular follow up with orthopedicdoctor
- Periodically undergo BoneMineral density and other relevant tests