Osteoporosis: The Silent Disorder: Part-1

what is Osteoporosis

Words: Dr Rajgopal NIDAMBOOR

Osteoporosis is a bone disorder. It presents with the clinical portrait of a gradual decrease in the density of bones that weakens them and makes fractures possible. Bones, as you know, contain minerals, like calcium and phosphorus; they are essential to make bones hard and dense.

The body requires an adequate supply of calcium and other minerals in order to maintain bone density; besides, it needs to produce appropriate amounts of several hormones, such as parathyroid hormone, growth hormone, calcitonin, oestrogen, and testosterone. Not only that. All of us need adequate amounts of vitamin D to absorb calcium from food and integrate it into the bones.

Osteoporosis, in simple terms, is a metabolic bone disorder — it is one of the most common too. It is essentially the most difficult to treat. In the disease, the mass of bone is reduced; its composition, however, remains normal, or unaffected.

The reduction results in imbalance between the formation and resorption [loss] of bone. While the loss of balance most often occurs with increasing age, osteoporosis is of clinical significance when it leads to structural collapse, or fracture — most commonly of the vertebrae, femur [thigh bone], or radius [one of the two bones in the forearm]. Ironically though, the fracture rate in osteoporosis is not closely related to the incidence of the disorder, as much as frequency of falls is.

Osteoporosis is a disease in which bones become brittle too and are likely to crack. If the disorder is not prevented, or left untreated, it can advance painlessly until a bone fractures.

Women are four times more likely than men to develop the disease. Technically speaking, osteoporosis, or porous bone, is a disease characterised by low bone mass and structural deterioration of bone tissue. It is, in other words, a condition denoted by bone fragility and increased susceptibility to fractures, especially of the hip, spine and wrist, as already cited. However, the disorder can affect any bone.

Symptoms

The overall symptoms of osteoporosis are deformity, localised pain, and fracture — characteristically seen in age-related bone loss. While the commonest deformity is loss of height due to vertebral collapse, this is hardly ever noticed by the patient because one rarely measures one’s original height.

In younger patients, affected by osteoporosis, most of the pain occurs in the back. This is often accompanied by deformity of the chest and protrusion of the manubrium sterni — the upper segment of the sternum. This is, at first, related to acknowledged strain — moving heavy furniture, for example — with the pain being severe and localised.

In addition to this, the vertebrae may be sensitive to touch. Also, anaemia and general ill-health may be present. Most patients have more than one cause of osteoporosis. That osteoporosis is classified as an age-related bone disorder is passé, because it occurs most frequently in post-menopausal and elderly women.

Implications

A hip fracture is often a cause for concern; it almost always requires hospitalisation and/or major surgery. Besides, it can mess up the individual’s ability to walk unaided and lead to long-lasting, or permanent disability, and also death in certain cases. In addition, fractures of the spine and vertebrae can lead to serious consequences, including loss of height, severe back pain, and deformity.

While significant risk has been reported in people of all ethnic backgrounds, osteoporosis can strike at any age. Statistics suggests that the disorder is responsible for more than five million fractures worldwide annually — and, over 300,000 hip fractures; approximately 700,000 vertebral fractures; 250,000 wrist fractures; and, 300,000 fractures at other sites.

No wonder, osteoporosis is called the ‘silent’ disorder, or disease, because the bone loss can occur without symptoms, or warning signs. Besides, people may not know that they have osteoporosis until their bones become so weak that a sudden strain, bump, or fall, causes a fracture, or vertebra to collapse. The collapsed vertebrae may initially be felt, or seen, in the form of severe back pain, loss of height, or spinal deformities, such as kyphosis, or stooped posture.

Clinicians suggest that certain people have a predisposition to develop osteoporosis than others. This is referred to as risk factors.

Osteoporosis: Risk Factors

  • Personal history of fracture after age 50
  • Current low bone mass
  • History of fracture in a close relative
  • A family history of osteoporosis
  • Female
  • People with thin, or small frame
  • Advanced age
  • Oestrogen hormone deficiency as a result of menopause; or, profuse periods
  • Women who lose up to 20 per cent of their bone mass in 5-7 years, following menopause, are more likely to develop the disease
  • Low testosterone levels in men
  • Loss of appetite
  • Low lifetime calcium intake
  • Vitamin D deficiency
  • Long-term use of medications, like corticosteroids and anti-convulsants
  • Chronic medical conditions
  • Sedentary lifestyle
  • Cigarette smoking
  • Alcohol excess.

Caucasians and Asians are at significant risk; African Americans and Hispanic Americans are also not exempt from developing the disorder.

Diagnosis

Clinicians often suspect osteoporosis in individuals with a history of bone fracture — especially from falls, or minor trauma, including bone loss, or abnormality, when present on X-ray, besides other significant risk factors, for example, long-term use of steroidal medications. Structural collapse often provides the most convincing X-ray sign of osteoporosis. If osteoporosis is suspected, your physician/therapist often orders a dual energy X-ray absorptiometry [DEXA] scan and conducts a BMD [bone mass density] measurement, preferably of the hip and spine. While a complete survey of drug history, lifestyle habits and dietary intake are conducted, certain laboratory tests to measure certain hormone levels, calcium and thyroid function, are also performed.

Prevention

Prevention is often more successful than treatment — besides, it makes sense to prevent loss of bone density than restore bone density, once it is lost. A simple plan of preventative action would involve maintenance, or enhancement, of bone density. This may often be achieved by consuming adequate supplemental amounts of calcium and vitamin D, getting engaged in weight-bearing exercises, and taking medications on a regular basis.

Yet, just ensuring adequate amounts of calcium and vitamin D intake — at random — is not always effective. This must be incorporated before maximum bone density is reached — by age 30. The regimen should, of course, not exclude people above age 30. Clinicians recommend an intake of 1,500mg of calcium and 800-1,200 international units of vitamin D daily.

Drinking two 8-ounce glasses of vitamin D-fortified milk and eating a balanced diet, along with the intake of a vitamin D supplement, are just as important — even though many women would also need to take a good calcium supplement.

It is an established fact that weight-bearing exercises — walking and climbing staircases — increase bone density. It must, however, be remembered that non-weight-bearing exercises, like swimming, do not increase bone density. Needless to emphasise, physical exercise is important to improve balance. Balance often helps to prevent a fracture that may occur from falling. All the same, a high degree of exercise capability, in pre-menopausal women, can actually cause a small reduction in bone density, primarily because heavy exercise represses the production of the hormone oestrogen by the ovaries.

[To read the concluding Part-2 of this article, go to ThinkWellness360, February 13, 2022]

Dr RAJGOPAL NIDAMBOOR, PhD, is a wellness physician-writer-editor, independent researcher, critic, columnist, author and publisher. His published work includes hundreds of newspaper, magazine, web articles, essays, meditations, columns, and critiques on a host of subjects, eight books on natural health, two coffee table tomes and an encyclopaedic treatise on Indian philosophy. He is Chief Wellness Officer, Docco360 — a mobile health application/platform connecting patients with Ayurveda, homeopathic and Unani physicians, and nutrition therapists, among others, from the comfort of their home — and, Editor-in-Chief, ThinkWellness360. 

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