Understanding Osteoporosis: Causes, Symptoms & Prevention

What is Osteoporosis?

Osteoporosis is a skeletal disorder characterised by reduced bone mass and deterioration of bone tissue, leading to increased bone fragility and a higher risk of fractures. Our bones are constantly being remodelled, with old bone tissue being replaced by new. In individuals with osteoporosis, the creation of new bone doesn't keep up with the removal of old bone, resulting in porous and weak bones. While often associated with ageing, especially in post-menopausal women, it can affect anyone.

Osteoporosis Causes: Why Bones Become Fragile

Several factors contribute to the development of osteoporosis. Understanding these osteoporosis causes can help in identifying at-risk individuals and implementing preventative strategies:

• Age: Bone density naturally decreases with age. After peak bone mass (around age 30), bone loss slowly begins, accelerating significantly in women after menopause.

• Gender: Women, particularly post-menopausal women, are at a higher risk due to a drop in estrogen levels, a hormone vital for bone maintenance. In fact, women account for about 80% of osteoporosis cases.

• Hormonal Imbalances: Besides estrogen deficiency in women, low testosterone in men, overactive thyroid (hyperthyroidism), and overactive parathyroid glands can contribute to bone loss.

• Dietary Deficiencies: Inadequate intake of calcium and Vitamin D, crucial for bone health, significantly increases the risk. Studies show that a majority of Indian adults have Vitamin D insufficiency, directly impacting bone health.

• Lifestyle Factors:

  • Sedentary Lifestyle: Lack of physical activity, especially weight-bearing exercises, weakens bones.

  • Smoking: Nicotine and other toxins in tobacco can interfere with bone formation. Smokers typically have lower bone density.

  • Excessive Alcohol Consumption: Impairs the body's ability to absorb calcium and can interfere with hormone production.

• Certain Medical Conditions: Conditions like celiac disease, inflammatory bowel disease, kidney disease, liver disease, cancer, and rheumatoid arthritis can increase osteoporosis risk.

• Medications: Long-term use of corticosteroids (e.g., prednisone), some anti-seizure medications, and certain cancer treatments can impact bone density.

• Genetics: A family history of osteoporosis, especially hip fractures in parents, can increase your own risk by up to 50-80%.

Osteoporosis Symptoms: The Silent Threat

One of the most concerning aspects of osteoporosis is its "silent" nature. Often, there are no noticeable osteoporosis symptoms in the early stages. The disease progresses without pain or other signs until a bone becomes so weak that a sudden strain, bump, or fall causes a fracture. Common indicators that might suggest advanced osteoporosis include:

• Back Pain: Caused by a fractured or collapsed vertebra. This is a common symptom, with vertebral fractures occurring in about 700,000 individuals annually.

• Loss of Height Over Time: Multiple vertebral fractures can lead to a gradual reduction in stature, sometimes several inches.

• Stooped Posture (Kyphosis or "Dowager's Hump"): The collapse of vertebrae in the upper back can cause a curvature of the spine.

• Easily Fractured Bones: Fractures that occur from minor trauma, such as a fall from standing height, are a hallmark sign. These fractures are the most common complication of osteoporosis, affecting 1 in 3 women and 1 in 5 men over the age of 50 globally.

Diagnosing Osteoporosis: Uncovering the Truth

Early diagnosis is key to preventing severe complications. At Manipal Hospitals, our diagnostic approach is thorough and patient-centric:

• Medical History and Physical Exam: Your doctor will review your risk factors and conduct a general physical assessment.

• Bone Mineral Density (BMD) Test: The most common and accurate test is the Dual-energy X-ray Absorptiometry (DXA or DEXA) scan. This non-invasive test measures bone density, typically in the hip and spine, and provides a T-score to compare your bone density to that of a healthy young adult. A T-score of -2.5 or lower indicates osteoporosis. DEXA scans can detect bone loss as low as 1-2%, making them highly effective for early diagnosis.

• Blood and Urine Tests: These may be performed to rule out other medical conditions that cause bone loss or to check for levels of calcium, vitamin D, and hormones

Osteoporosis Treatment: Rebuilding Strength

While there's no cure for osteoporosis, effective osteoporosis treatment options can significantly reduce the risk of fractures, slow bone loss, and even rebuild bone. Our expert orthopaedic specialists at Manipal Hospitals in Patiala and across our network develop personalised treatment plans:

• Medications:

  • Bisphosphonates: The most commonly prescribed medications, they slow down bone loss. They have been shown to reduce the risk of vertebral fractures by 30-70% and non-vertebral fractures by 15-20%.

  • Hormone-related Therapy: Estrogen therapy for post-menopausal women can help maintain bone density, but is typically considered for those with severe symptoms due to potential risks.

  • Bone-Building Medications (Anabolics): For severe cases, these drugs stimulate new bone formation.

• Lifestyle Modifications:

  • Nutritional Support: Ensuring adequate intake of calcium (e.g., dairy, leafy greens, fortified foods) and Vitamin D (e.g., sunlight, fatty fish, supplements). Most adults need 1,000-1,200 mg of calcium and 600-800 IU of Vitamin D daily.

  • Regular Exercise: Weight-bearing exercises (e.g., walking, jogging, dancing) and strength training help build and maintain bone density. Even moderate exercise, like 30 minutes of brisk walking most days of the week, can improve bone health and reduce fall risk by 10-15%.

  • Avoiding Harmful Habits: Quitting smoking and reducing alcohol consumption are vital.

• Fall Prevention: For individuals with osteoporosis, preventing falls is paramount. This includes improving home safety, vision checks, and addressing balance issues.

Difference between Osteoporosis and Osteomalacia

It's important to distinguish between osteoporosis and osteomalacia, as they are distinct conditions affecting bone health:

• Osteoporosis: This involves a decrease in both bone mineral and bone matrix, meaning the bone tissue itself becomes less dense and porous, but its composition is normal. Think of it as having less bone substance overall.

• Osteomalacia: This is a condition where there is a defect in the bone mineralisation process. The bone matrix is present, but it's not properly hardened due to insufficient calcium and phosphate. This often results from severe Vitamin D deficiency, leading to soft, flexible bones that are prone to bending and pain, rather than just breaking.

While both can lead to weakened bones, their underlying pathology and often their treatment approaches differ significantly, highlighting the importance of accurate diagnosis by a medical professional.

Care Essentials: Do's and Don'ts

• Do's:

  • Consume Calcium-Rich Foods: Include dairy products, fortified cereals, spinach, and almonds in your diet.

  • Get Sufficient Vitamin D: Spend time in sunlight (10-15 minutes daily), consume Vitamin D-rich foods, or take supplements as advised by your doctor.

  • Engage in Regular Weight-Bearing Exercise: Walking, jogging, dancing, and lifting light weights help strengthen bones.

  • Undergo Regular Health Check-ups: Especially if you have risk factors for osteoporosis. Early detection is key.

  • Follow Your Doctor's Prescribed Treatment Plan: Adhere to medication schedules and lifestyle recommendations diligently.

• Don'ts:

  • Don't Smoke: Smoking significantly harms bone health and impedes recovery.

  • Don't Consume Excessive Alcohol: Limit alcohol intake to support bone density.

  • Don't Neglect Fall Prevention: Remove trip hazards at home, use handrails, and wear supportive footwear.

  • Don't Self-Medicate: Always consult a healthcare professional before taking any supplements or medications for bone health.

  • Don't Ignore Symptoms: If you experience persistent back pain, height loss, or unexpected fractures, seek medical attention promptly.

Prevention of Osteoporosis: A Proactive Approach

Prevention is always better than cure, especially with a condition like osteoporosis. Starting early can significantly impact your bone health later in life:

• Optimise Peak Bone Mass: Building strong bones during childhood and adolescence is critical. Up to 90% of peak bone mass is acquired by age 18 in girls and 20 in boys.

• Balanced Diet: Ensure a diet rich in calcium and Vitamin D throughout your life.

• Regular Exercise: Maintain an active lifestyle with a mix of weight-bearing and strength-training exercises.

• Avoid Smoking and Excessive Alcohol: These habits are detrimental to bone health.

• Early Screening: For individuals with risk factors, especially women approaching menopause, discussing bone density screening with a doctor is highly recommended. Many individuals with osteopenia (pre-osteoporosis) can prevent progression to full osteoporosis with early intervention.

Conclusion

At Manipal Hospitals, including our facility in Patiala, our dedicated team of orthopaedic specialists and endocrinologists is committed to providing comprehensive care, from prevention and diagnosis to advanced osteoporosis treatment. We are proud to have some of the best orthopaedic surgeons in Patiala who are experts in managing bone health conditions. 

Your bone health is our priority.
If you are experiencing these symptoms or have concerns about your bone health, it's crucial to seek timely medical advice. Book an appointment with our expert orthopaedicians at Manipal Hospitals today!