By: Dr. Puneet Mishra
Osteoporosis or “porous bones” is a silent disease without any symptoms, which leads to increased loss of bone mass and strength that causes bone aches and pains and may result in fractures resulting from trivial injuries especially in lower back, hip and wrist. One in two women may suffer an osteoporotic fracture in their lifetime.
Influence of menopause on bone strength
The greatest amount of bone an individual can attain in his lifetime is referred to as “peak bone mass”, which is maximum in 18 to 20 years of age and keeps increasing until around age of 30. Once peak bone mass is attained, bone loss occurs gradually with aging in both genders with women on an average losing more bone than men of their age due to hormonal factors. After menopause, women lose 1-2% of their bone density each year. Oestrogen is the female hormone produced by the ovaries that plays an important role in maintaining bone strength. Oestrogen levels drop during menopause (since ovaries cease to produce most of its oestrogen). Hence, at around the age of 50 years, deficiency of oestrogen causes accelerated bone loss. So, if peak bone mass that is attained before menopause is suboptimal, then bone loss may result in osteoporosis.
Diagnosis of osteoporosis
Dual energy X-ray absorptiometry (DEXA or DXA) or DEXA scan is a special radiological technique that measures bone density and hence is used to best diagnose osteoporosis. This is usually measured in the lower spine and the hip to predict whether the individual is at an increased risk of sustaining a fracture due to osteoporosis.
This scan gives a Z-score and a T-score. The Z-score compares bone mass of a person with ideal bone mass for a person of same age, whereas T-score shows variation of bone mass with respect to that of a young person with peak bone mass. T-scores are then interpreted as follows:
- Score between 1 and -1: Normal bone density
- Score between -1 and -2.5: Indicates osteopenia – meaning there is some bone density loss, but that is not enough to be defined as osteoporosis, thereby indicating that despite bones being less dense, fracture risk with trivial trauma is very low
- Score less than -2.5: Indicates osteoporosis i.e. substantial loss of bone density that carries a much higher risk of having a fracture with trivial trauma
Steps to prevent osteoporosis
Women who are about to reach menopause need to take certain necessary steps to avoid osteoporosis. The results of these measures are extremely beneficial if these measures are taken early in lifetime, especially in teens and adolescent age.
- Healthy Diet: Women older than 50 need up to 1200 mg per day of calcium. One should take sufficient amount of calcium through dairy products, green leafy vegetables, nuts, beans, tofu etc. This can be taken in divided amounts over meals spread over the day.
- Exercise: Regular exercise drastically improves bone health by increasing the strength of bones and muscles and improving muscular co-ordination. Weight-bearing exercises (i.e. exercises done against gravity), for 30 minutes each day, done three to four times a week, are best for preventing osteoporosis. Activities like walking, jogging, playing tennis, and dancing are examples of weight-bearing exercises. Better muscular co-ordination prevents the tendency to fall and thereby prevents an osteoporotic fracture.
- Vitamin D intake: Vitamin D is needed to absorb calcium. Skin exposure to sunlight for 20 minutes every day produces enough vitamin D. In addition, other sources of vitamin D are eggs, fish like salmon, cereals and milk fortified with vitamin D, as well as from supplements. It is recommended that most people over age 50 need 400-2,000 IU of vitamin D a day. However, excess intake of vitamin D also can be harmful since it affects liver function and may even increase bone loss. It is advisable to consult a doctor to assess regarding the need of supplements.
- Supplements. Inadequate dietary intake needs to be supplemented with calcium supplements (usually two tablets of 500 mg at separate intervals, twice a day). Women reaching menopause should take calcium supplements to prevent osteoporosis after consulting a doctor. People who are vegan or are on high protein or high sodium diet or suffer from bowel disease that limits calcium absorption or are on corticosteroids or have osteoporosis, then calcium and vitamin D supplements are important. Calcium carbonate and calcium citrate are two common forms of calcium supplements. However, doses or intake in excess of 2,000 mg of calcium a day can increase chances of developing kidney problems; hence avoid self-medication.
- Avoid alcohol, smoking & caffeine: Stop smoking (as it increases the risk of developing osteoporosis) and avoid excessive caffeine and alcohol intake.
- Identify risk factors and check your bone density: Women who develop early menopause, have lean and thin built body frame, family history of osteoporosis or have sustained an osteoporotic fracture in the past, then bone density by DEXA scan should be evaluated. If found to be osteoporotic, then in addition to the above lifestyle measures, one should strongly consider anti osteoporotic medications only after advice of a doctor who can choose which type or class of such medication is most appropriate for you.
About the author
Dr. Puneet Mishra has over 18+ years of experience in orthopaedics and over a decade of experience in complex fractures of Acetabulum and Pelvis and has treated more than 500 such cases over last 15 years. As a pioneer in India in hip preservation, he has successfully used “Prof. Ganz’s Safe Surgical dislocation of the hip approach” in various conditions such as Femoroacetabular impingement, slipped capital femoral epiphysis, sequalae of childhood Perthes disease, sequalae of childhood septic arthritis, and complex acetabular fractures.