Fifty-five-year-old Jane bent to pick up an object on the ground, after which she suddenly felt severe backache, and found it difficult to stand straight. On consulting an orthopaedic specialist, she was advised to get an X-ray done of the backbone. The X-ray revealed that she had osteoporosis and a fracture in the backbone, hence the severe pain. Osteoporosis is a disease of the bones that develops when bone strength decreases and the bones become weak. Bones become so fragile that they may break spontaneously, without injury (pathological fracture) or with minimal injury or stress like coughing or lifting a small weight. It occurs in both genders, but is more common in women, around and after middle years. In women, oestrogen—the feminising hormone—plays an important role in building and maintaining the bones. After menopause, oestrogen levels are reduced, resulting in loss of bone density. This results in the weakening of the bones. Bone strength develops from adolescence when half of the skeletal mass is obtained. Correct diet, and regular physical activity, are factors that help in making the bones strong and minimising the risk of osteoporosis later in life. Risk factors for osteoporosis include being female and over 50, being underweight, smoking, alcohol use, a family history of osteoporosis, insufficient weight-bearing exercise, and certain medical conditions. Corticosteroids, some anti-clotting drugs, anti-cancer drugs, thyroid hormones, can weaken the bones, causing osteoporosis. Besides, demand for calcium increases during phases of life in a woman when hormonal changes occur, i.e., during puberty, pregnancy, lactation and menopause. Mostly there are no symptoms of osteoporosis and it is detected only when a bone is broken. Sometimes there may be mild to moderate pain on movement. In case of a fracture, one feels severe pain on the affected part. The back, wrists, hips and knees are most commonly affected by osteoporosis. Diagnosis is by age and clinical symptoms. X-rays of affected areas show loss of density of bones. DXA scan is like X-ray that measures calcium and other mineral contents in the bone. Once it develops, there is no cure for osteoporosis. Painkillers are used in case pain occurs and supplements of calcium and vitamin D3 are given. Women should be aware of it and adopt preventive measures from a younger age. Some lifestyle measures are useful. Young girls should be encouraged to be physically active. Physical activity strengthens the bones. Even when it develops after middle age, regular physical activity can reduce the severity. Brisk walking, light jogging, climbing stairs, racket games like tennis, badminton, etc., are beneficial. However, physical activity should be done as per one’s physical stamina and considering any other morbidity if present. Any exercise initiated should be increased gradually in number and severity. A diet rich in calcium and minerals helps in preventing osteoporosis. Taking fish, flax seed oil, olive oil, fresh fruits, vegetables, whole grains, milk, and milk products, is very useful in this regard. Smoking and alcohol use have multiple health hazards and, therefore, should be best avoided. Young girls should be told about the risk of osteoporosis in the future with advancing age and how they should adopt measures to prevent it, when young. It is useful to take supplements of calcium and vitamin D, during phases of hormonal changes in life, as during menarche, pregnancy, lactation, menopause. However, it should be started after seeking advice from a medical practitioner. If osteoporosis has set in, one should be careful to avoid falls. Lifting heavy weights or any such strenuous work should be avoided. Women should realise that to assert themselves, good physical health is the first step. Awareness about osteoporosis and keeping bones strong is one of the important measures for it. Dr Rachna Pande is a specialist in internal medicine. rachna212002@yahoo.co.uk
