Understanding Osteoporosis: A Guide to Bone Health

Osteoporosis, which translates to "porous bones," is a condition that causes bones to become fragile and more likely to break. Our bones are the hardest structures in the body, but as we age, they can become weaker. Osteoporosis occurs when the bone mineral density (BMD) decreases, disrupting the internal structure of bones and altering the proteins that keep bones strong. Sadly, over 300 million people in India are affected by osteoporosis, many of whom are unaware of the significant risks, such as increased likelihood of fractures and a higher risk of death following an osteoporosis-related bone fracture.

What Happens to Your Bones with Osteoporosis?

Our bones are in a constant state of turnover: old bone is broken down, and new bone is formed. However, this balance changes with age. Bone loss begins around the late 30s and accelerates for women after menopause, when estrogen levels drop. This loss often goes unnoticed until a bone fracture occurs, highlighting the importance of early detection and preventative care. Women are more likely to develop osteoporosis than men due to several factors, including smaller bone mass, a longer lifespan, and lower calcium intake. Post-menopausal women, in particular, experience a rapid rate of bone loss.

Risks of Falls and Fractures

Osteoporosis significantly increases the risk of fractures, especially in the long bones, spine, and hip. Hip fractures are particularly serious, requiring immediate surgery to avoid complications like deep vein thrombosis or pulmonary embolism, which can increase mortality. As people age, the risk of falling rises, and osteoporosis makes bones more vulnerable. Conditions such as impaired vision, balance issues, and age-related muscle loss (sarcopenia) also contribute to a higher risk of falls. Simple changes, like removing obstacles from the home, can help reduce the risk of falling.

Symptoms and Warning Signs

Often, osteoporosis goes unnoticed until a fracture occurs. Common signs include:

• Frequent bone fractures
• Chronic back pain or a hunched posture
• Gradual loss of height due to vertebral compression

If you notice any of these symptoms or have a history of fractures, it’s important to talk to your doctor about testing and treatment options.

What Increases Your Risk of Osteoporosis?

Several factors can increase the likelihood of developing osteoporosis, some of which are beyond your control:

• Gender: Women are at higher risk.
• Age: Osteoporosis is more common in those over 65.
• Family history of osteoporosis.
• Low body weight (under 58 kgs).
• Ethnicity: White or Asian populations are more prone.
• Menopause or early removal of ovaries.

Certain medications can also increase the risk, such as:

• Steroids used for conditions like arthritis or asthma
• Some antiseizure medications
• Cancer treatments and thyroid hormone replacement

On the other hand, some risk factors are within your control, including:

• Smoking
• Excessive alcohol consumption
• A diet low in calcium and vitamin D
• Lack of exercise

If you are over 45 or post-menopausal and suffer a bone fracture, or if you develop a slumped posture or unexplained back pain, consider discussing osteoporosis testing with your healthcare provider.

Diagnosis of Osteoporosis

Often, osteoporosis is first suspected after a bone breaks. If you have persistent back pain or notice changes in posture, such as a bent spine, these may also signal osteoporosis. A bone density test, such as a dual-energy X-ray absorptiometry (DEXA) scan, is commonly used to assess bone strength. This test measures bone density in areas prone to fractures, like the spine, hip, and wrist. Early stages of osteoporosis might not show up on regular X-rays, which is why a bone density test is key for detecting it early.

Preventing and Treating Osteoporosis

While osteoporosis can’t always be reversed, there are effective ways to manage and prevent further bone loss. A strong foundation of bone health starts in childhood and continues through adulthood. It’s never too late to start taking steps to maintain bone strength.

Diet and Nutrition

Calcium and vitamin D are crucial for healthy bones. Aim to get calcium from food sources, as they also provide other beneficial nutrients. Calcium-rich foods include dairy products, leafy greens, nuts, and certain fruits like guava and bananas. Vitamin D helps the body absorb calcium and can be obtained through sunlight exposure (10-15 minutes a few times a week) and foods such as milk, eggs, and fortified cereals.

Exercise

Physical activity plays a vital role in building and maintaining bone mass. Weight-bearing exercises like walking, jogging, and climbing stairs help stimulate bone formation. Even simple activities, such as carrying groceries or taking the stairs, can help keep bones strong. If you're already diagnosed with osteoporosis, consult your doctor before starting a new exercise routine to avoid injury.

Medications

In some cases, medication may be prescribed to help slow bone loss and improve bone density. Your doctor will work with you to determine the best treatment plan, which may include calcium and vitamin D supplements.

Hormone Replacement Therapy

For women approaching menopause, hormone replacement therapy (HRT) can help slow bone loss by replacing estrogen, a hormone that helps maintain bone density.

Creating a Safe Environment

One of the best ways to reduce your risk of falling is to make your home safer. Consider adding grab bars in the bathroom, using non-slip mats in the shower, and removing tripping hazards like loose rugs. These simple adjustments can help prevent falls and the fractures associated with osteoporosis.

Final Thoughts

Osteoporosis is a manageable condition, and with the right care and lifestyle changes, you can maintain strong bones throughout your life. Building bone health early and taking preventative measures later in life is key. Whether it’s through diet, exercise, or medical treatment, there are plenty of ways to protect your bones and reduce the risks associated with osteoporosis. If you're concerned about your bone health, consult with your doctor for guidance on how to best prevent or manage osteoporosis.

Citations:

• A comprehensive overview on osteoporosis and its risk factors - PMC
• Osteoporosis | Postgraduate Medical Journal | Oxford Academic
• Full article: Osteoporosis and fractures in women: the burden of disease
• Osteoporosis | National Institute on Aging
• Osteoporosis: What You Need to Know as You Age | Johns Hopkins Medicine

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