On October 20th, World Osteoporosis Day is observed globally, bringing attention to osteoporosis, a condition that weakens bones and makes them more susceptible to fractures. This year’s theme is “Say No to Fragile Bones,” emphasizing the importance of taking proactive steps to improve bone health and reduce the risk of osteoporosis. Often overlooked, osteoporosis can develop silently, without early signs or symptoms—like a thief in the night. The aim of this campaign is to educate people about the risks, prevention strategies, and steps needed to maintain strong, healthy bones.
Osteoporosis is generally symptom-free until a fracture occurs; hence, the nickname “The Silent Disease” Even though it is common in elderly people, particularly postmenopausal women, it can also affect men and younger individuals. Several factors, including genetics, lifestyle, and certain health conditions, contribute to its development.
Following are a few important risk factors:
Age: The likelihood of developing osteoporosis rises with age, especially after menopause.
Genetic Background: Family history of osteoporosis will increase the chance of developing the condition.
Poor Nutrition: A lack of consumption of calcium and vitamin D will, in fact, weaken the bones.
Inactivity: A sedentary lifestyle, particularly without weight-bearing exercise, contributes to a gradual loss of bone density.
Smoking and Alcohol: Smoking and intake of alcohol too, accelerate the deterioration in bones besides affecting general health.
Common Indicators Before a Fracture Occurs
Loss of Height: Gradual loss of height may indicate vertebrae fractures.
Unexpected Fractures: Fractures, especially in the wrist, hip, or spine, may occur with minimal force.
Posture Changes: A stooped or hunched posture often results from vertebrae fractures or a loss of bone density.
World Osteoporosis Day is not just another date on the calendar —but a reminder to create awareness about the importance of bone health. The campaign centers around three crucial goals:
1.Education: Sharing information about osteoporosis, its causes, and its complications.
2.Prevention: Fostering a lifestyle that promotes bone health through adequate nutrition and regular physical activity.
3.Early Detection: Encouraging people to get bone density tests and highlighting the benefits of early diagnosis.
MedBound Times contacted Dr. Arghya Chattopadhyay, MD, DM (Rheumatology), Assistant Professor, Department of Rheumatology, at Institute of Post Graduate Medical Education & Research, Kolkata for insights on gender differences in osteoporosis.
Why do women have a significantly higher prevalence of osteoporosis compared to men?
Dr. Arghya Chattopadhyay: One of the most striking differences between men and women with osteoporosis is its prevalence. Women are significantly more likely to develop osteoporosis than men. In fact, about 80% of osteoporosis cases occur in women. This disparity stems largely from hormonal changes that women experience, particularly during menopause. Estrogen, a hormone that protects bones, drops sharply during menopause, leading to rapid bone loss.
In contrast, men experience a slower, more gradual decline in bone density as they age. Testosterone, which helps maintain bone strength in men, decreases slowly over time. However, osteoporosis in men often goes underdiagnosed and untreated because it is traditionally viewed as a 'women’s disease.'
Why do women begin losing bone density earlier than men, and how does menopause accelerate this process?
Dr. Arghya Chattopadhyay: Women generally begin losing bone density earlier than men. For most women, bone mass peaks around their mid-20s to early 30s, and after menopause, bone loss accelerates. Men, on the other hand, tend to maintain their bone density for a longer period. The age-related bone loss in men starts later, typically after the age of 65 or 70.
The initial bone density of men also tends to be higher than that of women, which gives them a buffer against bone loss. However, when men do develop osteoporosis, they are at a higher risk for severe complications, particularly because the diagnosis is often delayed until a fracture occurs.
How do the roles of estrogen and testosterone differ in maintaining bone density for women and men?
Dr. Arghya Chattopadhyay: Estrogen and Testosterone play significant roles in bone health. Estrogen is critical for maintaining bone density in women, and the sharp drop in estrogen levels during menopause leads to accelerated bone loss. Postmenopausal women can lose up to 20% of their bone mass in the five to seven years following menopause.
For men, testosterone is converted into estrogen in small amounts, which helps in maintaining bone density. While men don’t experience a hormonal event as dramatic as menopause, the gradual decrease in testosterone over time can lead to bone loss. In men, conditions that cause a more rapid loss of testosterone, such as hypogonadism or prostate cancer treatment, can increase the risk of osteoporosis.
How do the outcomes of osteoporotic fractures differ between men and women?
Dr. Arghya Chattopadhyay: Women are more likely to suffer osteoporotic fractures, particularly in the spine, wrist, and hip. Hip fractures are especially concerning because they often lead to long-term disability and even increased mortality. One in three women over the age of 50 will experience an osteoporotic fracture.
While men are less likely to fracture their bones due to osteoporosis, when they do, the outcomes are often worse. Studies show that men who suffer hip fractures have a higher mortality rate compared to women. This could be because osteoporosis in men is usually detected later, when the disease is more advanced, or because men tend to have more comorbidities, such as heart disease, at the time of fracture.
MedBound Times also reached out to Dr. Katyayani Chinnamaraju and Dr. Madeshwaran Mani, both experts in the field of Rheumatology, to emphasize the critical role of awareness and prevention in managing this silent condition.
What are the clinical features and radiological findings of osteoporosis in asymptomatic patients?
Dr. Katyayani Chinnamaraju: While many patients with osteoporosis may be asymptomatic, common clinical features include fragility fractures, back pain, height loss, and kyphosis. Radiologically, osteopenia is a common finding, indicating reduced bone density that can lead to further complications if not addressed.
How would you evaluate a patient’s clinical history for risk factors associated with osteoporosis?
Dr. Katyayani Chinnamaraju: In evaluating a patient’s clinical history, important factors to consider include early menopause, excessive alcohol intake, smoking, long-term corticosteroid therapy, a family history of osteoporosis, low body weight, and a history of low trauma fractures. These factors increase the risk of developing osteoporosis and are critical in assessing a patient’s likelihood of the condition.
What diagnostic tests and evaluations are necessary to exclude osteoporosis, and what is the preferred method for assessing bone mineral density (BMD)?
Dr. Katyayani Chinnamaraju: To exclude the diagnosis of osteoporosis, a Bone Mineral Density (BMD) test is necessary, with Dual-energy X-ray Absorptiometry (DXA) being the preferred method. Additionally, blood tests for serum calcium, phosphate, thyroid function tests, erythrocyte sedimentation rate (ESR), immunoglobulins, vitamin D, and parathyroid hormone (PTH) levels should be checked to rule out other potential causes of bone loss or associated conditions.
Why is it important to focus on preventing osteoporosis rather than just treating it?
Dr. Madeshwaran Mani: Prevention is better than cure or palliation. Treating osteoporosis significantly reduces mortality, morbidity, and healthcare expenses and burdens.
Osteoporosis often catches people off guard due to its silent progression and widespread impact. Here are some key facts:
Global Prevalence: Around 200 million people worldwide are living with osteoporosis, with postmenopausal women being particularly affected.
Fracture Statistics: Roughly one-third of women and one-fifth of men aged 50 and above are at risk of suffering fractures due to osteoporosis.
Peak Bone Mass: The majority of people reach their maximum bone mass by their late twenties. Following this period, a decline in bone density usually starts to occur.
Calcium Sources: While dairy is a well-known source of calcium, other great sources include leafy greens, almonds, tofu, and fortified plant-based milk.
Bone-Building Exercise: Weight-bearing activities like walking, dancing, and resistance training can help maintain bone density.
Silent Progression: Many individuals discover they have osteoporosis only after a fracture, underscoring the need for regular screening.
If you receive an osteoporosis diagnosis, there’s no need to lose hope. Fortunately, effective treatments are available that can enhance bone density and lower the likelihood of fractures. Here’s a brief overview:
Slowing Bone Loss: Medications can slow down bone loss, helping to keep bones stronger.
Hormone Therapy: Hormone replacement therapy can help protect against bone loss after menopause.
Bone-Strengthening Injections: Periodic injections can help reduce bone loss over time.
Dietary Supplements: Dietary supplements will also be necessary in proper bone maintenance, and particularly with increasing age.
Physical Therapy: Personalized exercise programs designed by a physical therapist can improve balance and strength, reducing the risk of falls.
Lifestyle Adjustments: Cutting down on smoking and alcohol can have a positive impact on bone health.
As the saying goes, “Prevention is better than cure.” When it comes to osteoporosis, being proactive about bone health is essential throughout your life.
Steps to Support Strong Bones:
Healthy Diet: Ensure you’re getting enough calcium and vitamin D from foods like dairy, leafy greens, fatty fish, and fortified items.
Exercise: Staying physically active -particularly with weight-bearing and resistance exercises -helps build and maintain bone density.
Screening: Regular bone density tests are recommended for women over 65 and men over 70, or earlier if risk factors are present.
Healthy Habits: Avoid smoking, limit alcohol consumption, and practice stress-reducing activities like yoga and meditation to maintain overall health.
Scientific research continues to shed light on osteoporosis, emphasizing the importance of prevention and early treatment.
Healthcare providers play a crucial role in managing osteoporosis through regular check-ups, screenings, and individualized treatment plans.
World Osteoporosis Day is a call to action. Bone health is important at every stage of life, and by spreading awareness and taking proactive steps, we can help reduce the impact of osteoporosis and promote stronger bones for the future. Your bones support you every day—let’s take better care of them.
Disclaimer: The information provided in this article is for educational and informational purposes only and is not intended as medical advice. Always consult a healthcare professional for proper diagnosis, treatment, and prevention of osteoporosis or any other medical conditions.
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5. World Health Organization. “Prevention and Management of Osteoporosis.” www.who.int
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