Dr Shriharsha R V, a specialist orthopaedic surgeon at Burjeel Hospital in Al Khuwair, on why osteoporosis is a “silent” disease.
We all are familiar with the word “osteoporosis”. It sounds like a mild, simple disorder.
Many of us think of it as a common, age-related change, just like the greying of hairs.
Yes, we are partially right but the fact is one can easily see greying hairs. Osteoporosis creeps up on people undetected. Most people don’t realise it until they have their first fracture.
Here, I have tried to answer some basic questions on this “silent” disease:
What is osteoporosis?
It’s a condition where your bones become weak and can easily become fractured even with a small force that otherwise would not cause a fracture in a normal adult eg sudden coughing or a small jolt while travelling in a car. These fractures are mainly seen in your back bones, hip bones and in your wrist bone. In women, they are commonly seen after the menopause and about 15-20 years later in men. Osteoporosis is a major cause of illness and death in old people. It’s estimated that, of the people surviving to 80 years of age, one in three women and one in five men will suffer from a hip fracture due to osteoporosis.
Why does it occur?
Bone is not an inert tissue, a continuous process of bone building and destruction will be taking place at a microscopic level. In adulthood, this process is balanced. However, some factors can temporarily or permanently change this balance and shift it more towards destruction. Over several cycles this leads to a significant loss of bone, making it fragile.
What are the causes of osteoporosis?
As mentioned above, the change in balance can be due to an increase in age or it can be aggravated by some other causes such as general nutritional deficiency, ill-health, a lack of calcium, vitamin D deficiency, longstanding illness, a high consumption of alcohol, smoking, physical inactivity and some long-term medications.
Is the age-related bone loss the same for everybody?
No. It depends on the highest level of strength the bones have reached during early adulthood. During childhood one’s bone strength gradually increases to attain a peak. This peak is usually reached by around 20-30 years of age. Later, the bone gradually starts to become weaker and this weakness accelerates as women reach menopause. If the peak bone strength is high, it takes longer to become osteoporotic. If the peak strength is low then it becomes osteoporotic sooner. So the prevention of osteoporosis should start from childhood.
What are the symptoms?
It rarely produces any symptoms in early stages. However, symptoms such as bone pains, back pain, loss of height or a stooped back can occur in later stages.
How to diagnose osteoporosis
Conventional X-ray radiographs cannot detect the early stages. You need to undergo special tests. The commonly-used test is DEXA (Dual Energy X-ray Absorptiometry). Apart from this, there are other tests like Single Energy X-ray Absorptiometry, Quantitative CT and Quantitative Ultrasound etc. There are also some blood and urine tests that can detect the biochemical markers of bone turnover.
What should you do when you have symptoms?
Consult your doctor. They will initially try to find out whether your problem is purely age-related or due to some other cause, as mentioned above. These causes will be treated simultaneously. Along with that, your doctor will also start you on some medications for osteoporosis and some general treatment methods.
Is there a specific, single medicine to treat osteoporosis?
No. There are various groups of medications that can be taken orally or in injectable form. Even the dosage can vary (daily, weekly, monthly or annually) depending on the type of medication. The commonly-used groups include Bisphosphonates, calcium and vitamin D. There are other groups of drugs such as selective oestrogen receptive modulators, hormone replacements etc. Some new groups of medications are believed to increase the bone formation. Your doctor will decide which combination will suit you.
What are the general measures one can follow?
These include adequate dietary calcium intake, vitamin D status maintenance, avoidance of tobacco and alcohol and appropriate levels of physical activity. There are many simple changes that can reduce the chances of a fall and hence the likelihood of fractures in the elderly.
Some of these include:
• Wearing low-heeled shoes with rubber, firm soles;
• Avoiding slippery surfaces both indoors and outdoors;
• Using carpets wherever possible;
• Using hand rails while going up and down stairs or escalators;
• Maintaining adequate light in regular walking areas, avoiding walking in the dark;
• Avoiding slopes, steps, bumps and uneven surfaces;
• Installing grab bars in shower stalls or in the bath;
• Keeping hands free by using shoulder bags, waist pouches while outdoors;
• Wearing hip protectors or hip pads for added protection in case of a fall.
No doubt, improvements in medical science and technology have added years to the average lifespans of people. Let’s add more life to those added years by observing a few simple changes to avoid osteoporotic fragility fractures.