OSTEOPOROSIS, WHAT IS IT AND HOW TO PREVENT IT?
Osteoporosis just meant “NOT ENOUGH BONE IN THE BONES.” Bone is an active tissue. It breaks down and is being reformed constantly. But when the break down occurs faster than new bones are being formed, then you get this condition where the bone gets thin, and hence osteoporosis.
While X Rays of the bone can show that it is ‘thin’, a more accurate and objective way is to measure bone density. The most common method being the use of XR to determine what we call BMD or Bone Mineral Density.
Bone loss is affected by estrogen deficiency (like in post-menopausal women), low body weight, physical inactivity and sedentary lifestyle, poor nutrition and low calcium intake, cigarette smoking and alcohol consumption. Unfortunately, having a family history of osteoporosis also increases the risk. Consumption of certain drugs (like steroids, thyroid medicine) or having certain medical conditions may also be a cause of osteoporosis.
So when the bone mass is low, the risk of fractures increases. There were even instances where individuals fracture their spine or ribs just by sneezing or coughing. The sites that are common for fractures associated with osteoporosis are at the wrists, spine (vertebral bodies) and hip. Rib fractures are also common, but they do not bear the same complications as fractures in these parts of the body.
Treatment is dependent on the cause. But there are some general principles involved, like optimizing nutrition (increasing calcium and Vitamin D supplementation), removing the offending drugs if that was possible, increasing weight bearing exercises and use of medications.
There are many medications that can be used and the most appropriate to the person should be chosen. This may include estrogen replacement, nasal calcitonin spray, oral or intravenous bisphosphonates, subcutaneous denosumab or teriparatide. Depending on the medications, they may be daily, weekly, monthly, 6-monthly or yearly dosing, according to the indication and preference.
Since osteoporosis is associated with fractures, management of osteoporosis should also involve falls prevention and pain management as well. Again, it may require a multidisciplinary team approach. Many specialists like the orthopedic surgeon, endocrinologist, geriatrician, rheumatologist, rehabilitation physician and pain specialist also have an interest in osteoporosis. Physiotherapist and occupational therapists may also be involved in the care as well.
Prevention of osteoporosis starts when the person is young, because that is when the bones are growing actively. Having an active lifestyle, regular physical activities especially the weight bearing ones, will help. Getting lots of sunshine for Vitamin D helps. Drinking milk, eating cheese, yogurt, green leafy vegetables, sardines and salmon which are rich in calcium, the building blocks for bones, is important. Avoid things that are harmful for the bones, like excessive consumption of alcohol and smoking if that was a habit. All these will go a long way towards building up good bones for the future when we are old.