26 Mar Osteoporosis in India – under diagnosed and under-treated!!!
Recently one of my relative, lady in her sixties, fell down at home few weeks back and kept complaining of back pain – mostly while changing positions (like getting up from bed or chair, turning in bed etc). She was being treated for the usual back pain by many of her doctors with painkiller medicines without any progress. Further tests at my clinic showed that she indeed had fractured a bone in her spine. This is the usual story for many ladies after their menopause…
This is the story of OSTEOPOROSIS.
Osteoporosis was thought to be the problem of the western world. More and more studies from world over & India, studying effect of ethnicity have shown conclusively that osteoporosis happens a decade earlier in Indian women than their western counterparts. This is due to abundance of calcium and vitamin deficiency amongst us.
A common myth amongst our patients is that osteoporosis means less amount of calcium only…and your mother/relative/grandmother takes calcium regularly. So she wouldn’t have osteoporosis. But that’s not the whole truth…Osteoporosis is morelike non-availability of a smooth roads when you have a Porsche….(poor bonearchitecture in-spite of availability of calcium). Simply put, osteoporosis is adisturbance in the bony architecture. It is, as the word itself says it… porous bones (osteo= bone).
Most common cause of osteoporosis is after menopause, thus more in females. More bone is lost than it is being made. Men too can suffer osteoporosis but generally after the age of 70. The other causes can be secondary to a pathology elsewhere in the body or due to tablets (tablets for epilepsy or ‘fits’ and steroids)
The predominant complaint is extreme tiredness with aches and pains in the back hips and different joints of the body. Even a minor slip or fall in the house can send you down to the emergency department with severe pain in the back and hips due to a fracture.yes FRACTURE of your spinal vertebra or hip bone…that needs a surgery.
Bone density is one of the way to assess your risk of developing a fracture. The machine using your foot to measure bone density is not the best way to measure it. It is good as a screening tool. If it shows weak bones you should always follow it up by a proper DEXA machine.( see image)
So get yourself (if you are a female who has had a menopause), your mom, grandmother, aunt or whoever close to you who has attained menopause to get yourself evaluated for osteoporosis (bone density test and some blood checks). Meet your orthopedic spine specialist.
HOW TO PREVENT THE OSTEOPOROSIS SHOCK?
UNDERSTAND THE CONCEPT OF PEAK BONE MASS
As we grow we start accumulating bone strength. Unfortunately it is a time bound process. So it is up to the age of 30 that you have the potential to gather as much bone mass as possible. This is called PEAK BONE MASS. After that we start losing bone gradually year by year and is more pronounced in the twilight years of our lives.
This happens equally in males and females up-to 45 years. In ladies, as menopause sets in, this loss of bone mass is even more pronounced which sets the stage for OSTEOPOROSIS. It wrecks havoc if unnoticed, untreated – fractures of spine, hips keep you bed-bound for months and is fatal in many cases. One definitely doesn’t want one more variable apart from diabetes and hypertension which is very common at that age.
START EARLY
Accumulating and improving your bone balance (like bank balance) happens if you start early in life. This happens by activities, importantly sports, which stress or impact the bones (rope skipping, basketball, gymnastics, dancing, jogging etc). Encouraging any outdoor sport has beneficial effect on the body and especially the
bones.
FOR THE REST, ALL IS NOT LOST……
In women as in men any weight training exercises do positively impact the muscles and bones. The training has to be supervised to avoid injury. We do encourage some weight training in women with osteoporosis too, apart from medicines (Calcium & vitamin supplements is NOT the treatment for osteoporosis.) Please encourage your girls to participate in outdoor sporting activities for the simplereason – Its fights Osteoporosis better. Getting the Smartphone generation to do that is a challenge!
LETS RISE TO THE CHALLENGE!!
Treatment- The one important thing to understand is that Calcium and vitamin D
supplements is NOT the treatment for severe osteoporosis. The main treatment involves a daily injection treatment for 2 years (Injection Teriparatide) or a drug from the bisphosphonates group for 7-10 years.(tablet or injection) This should be supplemented with Vitamin D and calcium medications.Weight training, maintaining an active lifestyle and the routine use of back and neck exercises help most of the patients. Lets educate ourselves of this entity and keep it at bay!
Key points
1) Osteoporosis is very much a Indian problem too..it sets in earlier in Indian women
2) Calcium and vitamin supplements is not the treatment for osteoporosis
3) Untreated can cause debilitating fractures of spine and hip bones.
4) DEXA scan is one of the ways to know the risk of such a fracture.
5) Developing good bones by outdoor activities early in life helps fight
osteoporosis better.
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