Osteoporosis is a condition that results from bones becoming brittle and fragile, as a result of loss of tissue, mainly due to hormonal changes and loss of vitamin D and Calcium.

Why Osteoporosis is called Silent Disease ?

Bone is a dynamic tissue that is constantly being laid down and broken daily. Under normal conditions, there is a balance between the synthesis and resorption of the bone. In Osteoporosis, the rate of being broken down is more than the rate of synthesis. It is called a ‘Silent Disease’ because often one does not know that he/she has osteoporosis until one suffers a fracture from a trivial fall/injury. It is the most common cause of fractures in postmenopausal women and old men. The most common sites involved are the hip, vertebrae and the wrist. The symptoms may include severe back pain, loss of vertebral height and stooped or hunched posture.

The risk factors for developing Osteoporosis include female gender, old age, thin and slender persons, and family history of osteoporosis. White people and Asians have a higher risk compared to Africans. Low levels of estrogen (female sex hormone) after menopause are the single most important risk factor for developing osteoporosis. Certain medicines like long-term steroid use, anti-epileptic medicines and a sedentary lifestyle also contribute to developing osteoporosis.

Preventing Osteoporosis

• Regular exercises, especially weight-bearing exercises help in preventing osteoporosis.
• Adequate exposure to the sun, especially in the morning hours.
• Avoiding Smoking and Alcohol.
• Healthy and nutritious diet.
• Taking your medication and supplements on time, when prescribed.

Diagnosis for Osteoporosis

Elderly people, especially those with unexplained pains, need to meet their doctor who, after history and examination, advises them to undergo a DEXA Scan, or Bone Densitometry test. Based on the results of this test, the patients are classified as having Osteoporosis, Osteopenia or normal bones. In low-risk patients, a Quantitative Ultrasound (QUS) of the heel can help in screening patients who may need to undergo a DEXA Scan for further diagnosis of Osteoporosis.

Additional Tests include Calcium and Vitamin D levels.

Treatment of Osteoporosis

The goals for treating osteoporosis are to slow or stop bone loss and to prevent fractures. Your health care provider may recommend:

• Proper nutrition.
• Lifestyle changes.
• Exercise.
• Fall prevention to help prevent fractures.
• Medications.

Maintaining adequate nutrition in the form of nutritious and healthy food, supplements and lifestyle changes like exercising quitting smoking, and visiting your doctor regularly for health checkups are important factors in preventing, managing and treating osteoporosis.  An important factor to consider in old age is the prevention of falls and injuries. These can be done by

• Using a Cane/ Walker while walking
• Having shoes with non-slip soles. Avoid walking in socks and slippers.
• Keeping rooms free of clutter and loose wires on the floor
• Rugs and Carpets have slip-proof backing. Use double tape to fix them to the floor.
• Having well-lit rooms and stairways
• Installing handles near the showers and toilet seats

Medication

The various medications that help in the treatment of Osteoporosis include-

• Bisphosphonates both oral and injectable
• Calcitonin
• Estrogen and Hormone Replacement Therapy
• Estrogen agonists/antagonists
• PTH analog/ PTHrP analogs like Teriparatide
• RANKL inhibitors like Denosumab
• Sclerostin Inhibitors

Depending upon the various patient factors your doctor may prescribe one or more of these drugs to decrease bone resorption and increase bone formation. These medicines need to be taken under medical supervision only and one needs to avoid self-medication with these. With proper treatment and lifestyle modifications, people with osteoporosis can lead a good, independent life, free from injuries and fractures.