Calcium is the main mineral found in bone, and having enough calcium as part of a healthy, balanced diet is important for maintaining healthy bones.
Dr. Pankaj Dwivedi
Orthopedic and Joint Replacement Surgeon
Medical Director
Horizon Hospital
Raipur
What is osteoporosis?
A bone disease that develops when bone mineral density and bone mass decreases, or when the structure and strength of bone reduces to such an extent that it leads to an increased the risk of fractures (broken bones).
What are the primary risk factors of developing osteoporosis?
A. Factors that may increase your risk for osteoporosis include:
Sex : Your chances of developing osteoporosis are greater if you are a woman. Women have lower peak bone mass and smaller bones than men. However, men are still at risk, especially after the age of 70.
Age : As you age, bone loss happens more quickly, and new bone growth is slower. Over time, your bones can weaken and your risk for osteoporosis increases.
Body size : Slender, thin-boned women and men are at greater risk to develop osteoporosis because they have less bone to lose compared to larger boned women and men.
Race : White and Asian women are at highest risk. African American and Mexican American women have a lower risk. White men are at higher risk than African American and Mexican American men.
Family history : Researchers are finding that your risk for osteoporosis and fractures may increase if one of your parents has a history of osteoporosis or hip fracture.
Changes to hormones : Low levels of certain hormones can increase your chances of developing osteoporosis. For example:
l Low estrogen levels in women after menopause.
l Low levels of estrogen from the abnormal absence of menstrual periods in premenopausal women due to hormone disorders or extreme levels of physical activity.
l Low levels of testosterone in men. Men with conditions that cause low testosterone are at risk for osteoporosis. However, the gradual decrease of testosterone with aging is probably not a major reason for loss of bone.
Diet : Beginning in childhood and into old age, a diet low in calcium and vitamin D can increase your risk for osteoporosis and fractures. Excessive dieting or poor protein intake may increase your risk for bone loss and osteoporosis.
Other medical conditions : Some medical conditions that you may be able to treat or manage can increase the risk of osteoporosis, such as other endocrine and hormonal diseases, gastrointestinal diseases, rheumatoid arthritis, certain types of cancer, HIV/AIDS, and anorexia nervosa.
Medications : Long-term use of certain medications may make you more likely to develop bone loss and osteoporosis, such as:
l Glucocorticoids and adrenocorticotropic hormone, which treat various conditions, such as asthma and rheumatoid arthritis.
l Antiepileptic medicines, which treat seizures and other neurological disorders.
l Cancer medications, which use hormones to treat breast and prostate cancer.
l Proton pump inhibitors, which lower stomach acid.
l Selective serotonin reuptake inhibitors, which treat depression and anxiety.
l Thiazolidinediones, which treat type II diabetes.
Lifestyle : A healthy lifestyle can be important for keeping bones strong. Factors that contribute to bone loss include:
l Low levels of physical activity and prolonged periods of inactivity can contribute to an increased rate of bone loss. They also leave you in poor physical condition, which can increase your risk of falling and breaking a bone.
l Chronic heavy drinking of alcohol is a significant risk factor for osteoporosis.
l Studies indicate that smoking is a risk factor for osteoporosis and fracture. Researchers are still studying if the impact of smoking on bone health is from tobacco use alone or if people who smoke have more risk factors for osteoporosis.
How does a sedentary lifestyle contribute to osteoporosis?
Overall, the current consensus is that sedentary lifestyles and habits have a negative impact on bone mineral density and lead to an increase in the total fat percentage of the body. This is largely due to a lack of feedback stimulation of bones via gravity demanding of them to keep up the mineral density.
What are early warning signs of osteoporosis and how can they be identified?
n Losing an inch or more of your height.
Changes in your natural posture (stooping or bending forward more).
Shortness of breath (if disks in your spine are compressed enough to reduce your lung capacity).
Lower back pain (pain in your lumbar spine).
How is osteoporosis diagnosed?
Your bone density can be measured by a machine that uses low levels of X-rays to determine the proportion of mineral in your bones this is called as a DEXA scan, which stands for dual-energy X-ray absorptiometry.
During this painless test, you lie on a padded table as a scanner passes over your body. In most cases, only certain bones are checked — usually in the hip and spine.
Can osteoporosis be mistaken for any other condition, if so, which ones?
These conditions are
Homocystinuria
Hyperparathyroidism
Imaging in osteomalacia and renal osteodystrophy
Mastocytosis
Multiple myeloma
Paget disease
Scurvy
Sickle cell anemia
What are the most effective treatment options for osteoporosis?
Before osteoporosis has set in i.e. in the stage of osteopenia a lot of things can help alog with calcium and vit D3 supplementation such as
Exercise : Weight-bearing physical activity and exercises that improve balance and posture can strengthen bones and reduce the chance of a fracture. The more active and fit you are as you age, the less likely you are to fall and break a bone.
Good nutrition : Eat a healthy diet and make sure you are getting enough calcium and vitamin D.
Quit smoking : Smoking cigarettes speeds up bone loss.
Limit alcohol : If you choose to drink alcohol, do so in moderation. But once osteoporosis has set in a number of medications in combination therapy would be required these are as follows
A number of different medicines are used to treat osteoporosis (and sometimes osteopenia).
Bisphosphonates
Bisphosphonates slow the rate that bone is broken down in your body. This maintains bone density and reduces your risk of a broken bone.
There are a number of different bisphosphonates, including:
l alendronic acid
l ibandronic acid
l risedronate
l zoledronic acid
They are given as a tablet, a liquid that you swallow, or an injection.
Always take bisphosphonates on an empty stomach with a full glass of water. Stand or sit upright for 30 minutes after taking them. You will also need to wait between 30 minutes and 2 hours before eating food or drinking any other fluids.
Bisphosphonates usually take 6 to 12 months to work, and you may need to take them for 5 years or longer.
You may also be prescribed calcium and vitamin D supplements to take at a different time to the bisphosphonate.
Selective oestrogen receptor modulators (SERMs)
SERMs are medicines that have a similar effect on bone as the hormone oestrogen. They help to maintain bone density and reduce the risk of fracture, particularly of the spine.
Parathyroid hormone
Parathyroid hormone is produced naturally in the body. It regulates the amount of calcium in bone.
Parathyroid hormone treatments (such as teriparatide) are used to stimulate cells that create new bone. You take them as an injection once a day.
While other medicines can only slow down the rate of bone thinning, parathyroid hormone can increase bone density.
Biological medicines
Biological medicines are made from proteins or other substances produced by the body.
Biological medicines that can be used to treat osteoporosis include denosumab and romosozumab. They may be recommended if you cannot take other medicines such as bisphosphonates, or if you have severe osteoporosis.
They work by slowing down the rate at which your bones are broken down and speeding up the rate at which your cells build bone. They are given by injection every month or every few months.
Calcium and vitamin D supplements
Calcium is the main mineral found in bone, and having enough calcium as part of a healthy, balanced diet is important for maintaining healthy bones.
For most healthy adults, the recommended amount of calcium is 700 milligrams (mg) of calcium a day, which most people should be able to get from a varied diet that contains good sources of calcium.
However, if you have osteoporosis, you may need more calcium, usually as supplements. Ask your GP for advice about taking calcium supplements.
Vitamin D helps the body absorb calcium. All adults should have 10 micrograms of vitamin D a day.
HRT (hormone replacement therapy)
HRT can be taken by women who are going through the menopause, to help control symptoms.
HRT has also been shown to keep bones strong and reduce the risk of getting osteoporosis. If you already have osteoporosis it can strengthen your bones and reduce your risk of breaking a bone.
How important is exercise in managing osteoporosis and which type is recommended?
A person with osteoporosis can improve their health with exercise in valuable ways, including:
l reduction of bone loss
l improved bone mass
l conservation of remaining bone tissue
l improved physical fitness
l improved muscle strength
l improved reaction time
l increased mobility
l better sense of balance and coordination
l reduced risk of bone fractures caused by falls
l reduced pain
l better mood and vitality.
Types of exercises to be done and types to be avoided are as follows
Recommended exercises for people with osteoporosis
Exercises that are good for people with osteoporosis include:
l weight-bearing, impact loading exercise such as dancing
l resistance training using free weights such as dumbbells and barbells, elastic band resistance, body-weight resistance or weight-training machines
l exercises to improve posture, balance and body strength, such as tai chi.
l Ideally, weekly physical activity should include something from all three groups.
Swimming and water exercise for people with osteoporosis
Swimming and water exercise (such as aqua aerobics or hydrotherapy) are not weight-bearing exercises, because the buoyancy of the water counteracts the effects of gravity. However, exercising in water can improve your cardiovascular fitness and muscle strength.
People with severe osteoporosis or kyphosis (hunching of the upper back) who are at high risk of bone fractures may find that swimming or water exercise is their preferred activity. Consult with your doctor or healthcare professional.
Walking for people with osteoporosis
Even though walking is a weight-bearing exercise, it does not greatly improve bone health, muscle strength, or balance. However, for people who are otherwise inactive, walking may be a safe way to introduce some physical activity.
Exercises that people with osteoporosis should avoid
A person with osteoporosis has weakened bones that are prone to fracturing. They should avoid activities that:
l involve loaded forward flexion of the spine such as abdominal sit-ups and toe touches
l increase the risk of falling
l require sudden, forceful movement, unless introduced gradually as part of a progressive program
l require a forceful twisting motion, such as a golf swing, unless the person is accustomed to such movements.
How does prolonged screen time contribute to osteoporosis risk?
Well not directly and more indirectly and in an implied fashion..i.e. the more is the time spent in front of screen lesser is the time available for exercise and outdoor activities leading to a lesser sun exposure both contributing to lack of feedback bone stock maintenance as well as reduced levels of Vitamin D3.
Can wearable devices and mobile apps help monitor and manage osteoporosis?
At present no, all that is available is “fall alerts” which alerts the person that they are out of balance and also alerts being sent to friends and relatives ,who have been previously nominated for it, about the fall if it happens.
How can osteoporosis impact mental health and quality of life?
Aches, pains, repeated fractures and a constant anxiety of impending fractures can lead to a loss of social roles, failure in social reciprocity, social isolation, loneliness, depression, anxiety, reduced self-worth, and a feeling of hopelessness.
What are the economic implications on healthcare system?
The economic implications of osteoporosis are enormous due to fresh fractures, non healing of existing fractures, failure of implants in operated osteoporotic fractures due to inherently poor bone quality.
What are the facilities at Horizon hospital for treatment of orthopedic diseases and what is your success rate?
At Horizon hospital we are treating the entire spectrum of orthopedics with gratifying results and success, from joint replacements to spine surgery , from Arthroscopic ligament reconstructions to complex trauma reconstructions and bone cancer surgeries we are treating all orthopedic problems with a phenomenal success rate offering a deep satisfaction level for both the patient and the treating doctors alike.
You are the director of Horizon Hospital what other facilities are available at your hospital?
We have all the departments of super specialty and specialty care at our hospital namely Orthopedics, Joint replacement, spine surgery, neurosurgery, critical care, plastic surgery, cancer surgery, vascular surgery, Urology, Nephrology, Neurology, Gastroenterology, General Medicine, General surgery, Obstetrics and Gynecology, oral and maxillofacial surgery.
What role does nutrition play in preventing osteoporosis?
Proper nutrition and a good exposure to sunlight on a daily basis is sufficient to prevent osteoporosis. Here we share a list of foods and the type of nutrition derived from them that helps in maintaining a good bone health.
FOOD NUTRIENT
Dairy products such as low-fat and non-fat milk, yogurt and cheese Calcium. Some dairy products are
fortified with Vitamin D.
Fish
Canned sardines and salmon (with bones) Calcium
Fatty varieties such as salmon, mackerel, tuna and sardines Vitamin D
Fruits and vegetables
Collard greens, turnip greens, kale, okra, Chinese cabbage,
dandelion greens, mustard greens and broccoli. Calcium
Spinach, beet greens, okra, tomato products, artichokes, plantains,
potatoes, sweet potatoes, collard greens, prunes and raisins. Magnesium
Tomato products, prunes, raisins, potatoes, spinach, sweet potatoes,
papaya, oranges, orange juice, bananas and plantains. Potassium
Red peppers, green peppers, oranges, grapefruits, broccoli,
strawberries, brussels sprouts, papaya and pineapples. Vitamin C
Prunes. Dark green leafy vegetables such as kale, collard greens,
spinach, mustard greens, turnip greens and brussel sprouts. Vitamin K
