Osteoporosis is a skeletal disorder characterized by reduced bone density which causes the bones to be extremely fragile.
According to World Health Organization (WHO), the diagnosis of osteoporosis is confirmed when the bone mineral density is 2.5 standard deviations or more below the average value for a healthy female. The prevalence of osteoporosis has been progressively increasing in the last decade.
Like any other non-communicable disease, several modifiable and non-modifiable factors contribute to this disorder. The modifiable factors for Osteoporosis include gender, age, race, and genetics. The disease is more common among post-menopausal women. A study shows that Indian women have lower peak bone mass compared to their Caucasian counterparts.
In addition, increasing age is a major contributory factor to the incidence of osteoporosis. This is proved by a study conducted by a group of researchers in a small locality in India where it showed that 81% of perimenopausal and postmenopausal women had osteoporosis due to several contributing factors and were at increased risk of fractures.
Women over the age of 45 years are admitted to the hospital for fractures due to osteoporosis for a prolonged stay compared to women with conditions such as diabetes, heart attack, and breast cancer. He also added that one in three women above 50 years suffers fractures due to osteoporosis, therefore it should be a global public health priority.
Hormones like estrogen and vitamin D also play a vital role in bone development. Therefore, if any estrogen or Vitamin D deficiency is detected, there is a higher chance of osteoporosis development and treatment should be initiated. Early menopause is also a contributing factor for osteoporosis which is commonly seen in Indian women when compared to Caucasian women.
Furthermore, the non-modifiable risk factors for osteoporosis such as poor nutrition, lifestyle, medication, and substance abuse have a significant impact on its prevalence.
Indian women tend to consume a diet that is calcium deficient as there is less consumption of dairy products and overconsumption of food that contains phytates which inhibits the absorption of calcium.
Most Indian women have low BMI due to gender bias as men are offered bigger dietary portions due to the prevailing traditions which have led to an increased risk of osteoporosis.
In addition, they have less sunlight exposure leading to vitamin D deficiency despite the country’s tropical climate. This could be due to the high skin pigmentation and the wearing of cultural clothing such as saris and salwar kameez. Recently more urban Indian women are leading a sedentary lifestyle and adopting practices such as smoking and alcohol consumption which have contributed to the disease. Sometimes, certain medications such as prolonged steroid intake have also contributed to an increased risk of osteoporosis.
Recently more urban Indian women are leading a sedentary lifestyle and adopting practices such as smoking and alcohol consumption which have contributed to the disease.
Several measures can be adopted to prevent the increase in the incidence and prevalence of osteoporosis. Adopting a healthy lifestyle such as consuming a calcium-rich diet, and taking Vitamin D and calcium supplements is beneficial in preventing osteoporosis.
According to Ammarah Ikram, former Physiotherapist at Re-Active Physio and Allied Hospital, Pakistan, the best exercise regimen for improving bone density in osteoporotic patients is to perform weight-bearing aerobic exercises, muscle-strengthening exercises, and resistance training which has healthily transformed their lives.
Additionally, as a public health practitioner, I would like to convey that sunlight exposure is pivotal as it increases Vitamin D levels and that curbing bad lifestyle habits such as smoking, and alcohol consumption will also be beneficial.
However, if the disease has progressed, the first-line treatment for osteoporosis must be adopted, such as bisphosphonates and hormone replacement therapy. Other drugs such as calcitonin, parathyroid hormones, estrogen agonists, and denosumab can also be used to curb the progress of the disease.
Therefore, significant morbidity, mortality rate, socioeconomic burden, reduced quality of life, insufficient research and knowledge about the disease along with difficulties in diagnosing and managing the disease has made osteoporosis to be an Indian public health challenge.
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References:
Agrawal, T., Verma, A.K. (2013). Cross sectional study of osteoporosis among women. Medical Journal of armed forces India, 69(2), pp.168-171. Doi: 10.1016/j.mjafi.2012.07.024
Khadilkar, A.V., Mandlik, R.M. (2015). Epidemiology and treatment of osteoporosis in women: an Indian perspective. International journal of women’s health, 7, pp.841-850. Doi: 10.2147/IJWH.S54623.
Kowsalya, R., Manoharan, S. (2017). Health Status of the Indian women- a brief report. MOJ Proteomics and Bioinformatics, 5(3): 00162. Doi: 10.15406/mojpb.2017.05.00162.
Marwaha, R.K., Tandon, N., Gupta, Y., Bhadra, K., Narang, A., Mithal, A., Kukreja, S. (2012). The prevalence of and risk factors for radiographic vertebral fractures in older Indian women and men: Delhi Vertebral Osteoporosis Study (DeVOS). Archives of Osteoporosis, 7, pp.201-2-07. Doi: 10.1007/s11657-012-0098-8.
Meeta, Harinarayan, C.V., Marwah, R., Sahay, R., Kalra, S., Babhulkar, S. (2013). Clinical practice guidelines on postmenopausal osteoporosis: An executive summary and recommendations. Journal of mid-life health, 4(2), pp.107-126. Doi: 10.4103/0976-7800.115293.
Mithal, A., Bansal, B., Kyer, C.S., Ebeling, P. (2014). The Asia-Pacific regional audit-epidemiology, costs and burden of osteoporosis in India 2013: a report of International Osteoporosis Foundation. Indian Journal of Endocrinology and metabolism, 18(4), pp.449-454. Doi: 10.4103/2230-8210.137485.
Shaki, O., Rai, S.K., Kashid, M., Chakrabarty, B.K. (2018). Prevalence of osteoporosis in peri and menopausal women in slum area of Mumbai, India. Journal of mid-life health, 9(3), pp.117-122. Doi: 10.4103/jmh.JMH_84_17.
World Health Organisation (2004). WHO scientific group on assessment of osteoporosis at primary health care level. Summary Meeting Report Brussels, Belgium, 5-7 May 2004, pp.1-3. Available at: www.who.int/chp/topics/Osteoporosis.pdf
