Osteoporosis is a silent disorder of our bones that draws attention when a fracture occurs. With increasing life expectancy, the disorder is common. In contrast to fractures due to injury where a dramatic event, such as road traffic accidents takes place, fractures due to osteoporosis are unique. The fracture is caused by a minor injury or without any antecedent cause. It’s worthwhile therefore to understand and prevent the complications of osteoporosis, than to treat them.
Till recently, osteoporosis was considered to be an inevitable consequence of ageing; we now know that other forms of osteoporosis exist, as in pregnancy, or sometimes without any known reason in a younger age group. One out of every three women, older than 50 years will have at least one osteoporotic fracture during her life time. Certain medicines predispose to osteoporosis, such as steroids, or anti-epileptic drugs. Osteoporosis co- exists with certain diseases such as Diabetes, Rheumatoid Arthritis or Hyperthyroidism. Prolonged immobilization may cause osteoporosis. Medharbour family clinic provides osteoporosis treatment in Gurgaon, with the one of the best orthopaedic and spine doctors along with a team of highly trained physiotherapist offering various alternatives for the best treatment for osteoporosis in Gurgaon.
FACT: Three main types of osteoporosis fractures are wrist fracture, vertebral fracture and hip fracture.
PRESENTATION
Osteoporosis is often called the ‘silent disease’ because bone loss occurs without symptoms. There is reduction in the amount (mass) of bone. This means that bones actually become weak and frail, that in many cases, the first “symptom” is a broken bone. In fact the name given to fractures in osteoporosis is “fragility fracture”. Patient with osteoporosis may not know that they have the disease until their bones become so weak that a sudden strain, bump, or fall causes a hip fracture or a vertebra, in the spine to collapse. A collapsed vertebra may be silent or become evident as severe back pain, loss of height, or as severely stooped posture. In the hip, a minor fall can result in a fracture, requiring major surgery. A similar fall on the outstretched hand may break the wrist.
FACT: Many people above 50 are not aware they may have osteoporosis, still fracture takes place.
STATS
1 in 3 women over 50 will suffer a fracture due to osteoporosis; this increase to 1 in 2 over 60. One in 5 men over 50 will suffer a fracture due to osteoporosis; this increases to 1 in 3 over 60. Approximately 1.6 million hip fractures occur each year worldwide; the incidence is set to increase 6.3 million 2050. The highest risk of hip fracture is seen in Norway, Sweden, and Iceland, Denmark and the USA. Currently there is an increasing incidence of hip fractures in the developed cities in Asia. 1 out of 4 hip fractures occur in Asia and Latin America. The number of hip fractures will increase to 1 in 2 by 2050. In the Middle East, the burden of osteoporosis in the general population is expected to increase, following worldwide trends. All this is putting a heavy financial burden on individuals and on healthcare systems.
FACT: The annual incidence rate of osteoporotic fractures in women is greater than the combined incidence rates of heart attack, stroke and breast cancer.
INDIA UPDATE
The incidence of hip fractures was approximately 50,000 in 1987 and 80,000 in 1992 in India. One out of 8 males and 1 out of 3 females suffer from osteoporosis, making India one of the largest affected countries in the world. Expert group peg the number of osteoporosis patients at approximately 26 million (2003 figures) with the numbers projected to increase to 36 million by 2013.
FACT: once a woman suffers a first vertebral fracture, there is a fivefold increase in the risk of developing a new fracture within one year.
DIAGNOSIS
Osteoporosis can easily be assessed and quantified by undergoing a bone mineral density test also called DEXA scan. The test measures bone density in the spine, wrist and hip (the most common sites of fractures due to osteoporosis). Certain other kinds of tests, measure bone density in the heel or hand. These tests are painless, non-invasive and safe.
Bone density tests can:
- Detect low bone density before fractures occur.
- Confirm a diagnosis of osteoporosis if you have already fractures.
- Predict your chances of fractures in the future.
- Determine your rate of bone loss and /or monitor the effects of treatment if the test is conducted at intervals of a year or more.
PREVENTION
Maintaining a healthy lifestyle means greater protection against fractures in later life. Taking a balanced diet achieves adequate calcium and vitamin D intake.
Avoid smoking and high intakes of alcohol as these weaken bones. After the age of 50, the body requires 1,300 mg of calcium daily. Milk, dahi, paneer, green vegetable is good sources of calcium. One glass (200 ml) of buffalo milk contains 300 mg of calcium. 280 IU of Vitamin A, 28 IU of Vitamin D, 8.6 gm of protein.
Exposure of bare body to sunlight for 30 minutes per day produces similar biochemical changes as are observed with 400 to 800 IU vitamin D administered per day.
Take regular, weight-bearing exercise. Good bone building exercises include running, skipping, aerobics, tennis and brisk walking. School level PT is an excellent exercise. Medharbour family clinic provide trainings to individuals which helps in fighting osteoporosis and boosts self-confidence in patients by making them fit for a regular life.
MEDICAL TREATMENT
- Calcium and vitamin D supplements are beneficial.
- Calcium intake of 1200 mg and vitamin D should be taken in dose 800 IU per day.
- Bisphosphonates are non- hormonal drugs, which help maintain bone density and reduce fracture rates. There is a whole range of medications available which primary reduce bone breakdown, indirectly improving the bone quality.
- Selective Estrogen Receptor Modulators (SERMs) are drugs which act in a similar way to estrogen on the bone, helping to maintain bone density and reduce fracture rates specifically at the spine. This group of medication os especially meant for post menopausal women.
- Synthetic parathyroid hormone stimulates new bone formation and significantly increases bone mineral density and reduce fracture rates.
- Calcitonin is specifically meant for bone pain of osteoporosis. It is available in nasal spray as well as injectable form.
SURGICAL TREATMENT
In the presence of vertebral fracture which is either not getting better with rest or medications or there is worsening pain or paralysis of the legs, difficulty in controlling urine; surgery may be needed. Pain in Vertebral compression fractures (VCF) can be treated with simple procedure called Balloon Kyphoplasty which involves injecting high viscosity bone cement under low pressure into the fractures vertebra.
In the fracture has rendered the spine unstable or there is a neurological deficit open surgery is required to decompress, reconstruct and stabilize the fracture.
Are you are at risk for osteoporosis and a fragility fracture?
93% of women acknowledge seriousness of ospeoporis but 8 out of 10 do not believe they are personally at risk. 80% of women with osteoporosis were not aware of their risk before diagnosis.
Ask yourself these simple questions and find out! Answer yes or no to the questions given below. Each affirmative answer increases the chances of osteoporosis.
- Menopause prior to the onset of 45 years?
- Surgical removal of ovaries?
- Fragility fracture in a first degree relative?
- BMI which is less than 19? To calculate BMI, divide (weight in kg) by (the square of height in metres).
- Medications like steroids, anti – epileptic drugs?
- Smoking or use of tobacco in any form?
- Sedentary lifestyle (lack of regular physical exercises)?
- Associated medical problems – diabetes mellitus, hyper- parathyroidism, hyperthyroidism, osteomalacia, and mal-absorption syndrome, rheumatoid or similar arthritis?
The presence of any of these factors increases the risk of osteoporosis and it is worthwhile to consult your doctor for advice.
FINAL TAKE HOME Osteoporosis is a treatable disease which is reaching epidemic proportions affecting quality of life directly leading to fractures and pain, and indirectly leading to loss of man hours as well loss to society at large. This menace should be aggressively dealt with by spreading knowledge available so that people can be saved from completely avoidable situations. For any help please contact the best physiotherapy centre in Gurgaon and the best orthopaedics-spine clinic in Gurgaon, Medharbour Family Clinic at info@medharbour or +91-9650030500. www.medharbour.clinic