Osteoporosis:Causes and treatment

Our bones are made up of a framework of strong, tough bone proteins, which form a dense network. This network is intertwined with the help of bone minerals, of which bone calcium is most important. Activated form of vitamin D is required for this deposition in layers of various minerals, including calcium, in the bone protein matrix. 

Osteoporosis is a disease in which the bones become brittle and weak to the extent they are not even able to bear normal body weight. The bones tend to collapse and get compressed even under normal stress. Bones might develop micro fractures or even gross fractures with trivial trauma.

Osteoporosis occurs due to depletion of bone proteins and minerals like calcium or vitamin D.

Deficiency of either one or all of them in any form, be it dietary (decreased intake or absorption), decreased formation of bone proteins or decreased deposition of minerals and calcium, can lead to severe bone depletion or osteoporosis. Age-related osteoporosis is a universal phenomenon, but is seen in its most severe form in menopausal women who are overweight. Thus, a typical patient with severe osteoporosis is a fat female in her fifties (3fs).

The bones of our spine, pelvis and hip are mainly involved in osteoporosis because they are the major weight-bearing bones. Typically, the patient will have generalised, diffused bone or body pains, severe back pain and stiffness. When multiple vertebral bones get compressed because of severe osteoporosis, the patient might not be able to keep her back straight while sitting or standing, thus, losing posture. The back keeps on bending and stooping forward and the spine becomes deformed or kyphotic. Some patients become bedridden and are not even able to lie on their back. Collapse of vertebral bones can lead to impaired blood circulation of the spinal cord and its branching nerves leading to pain radiating down the legs like an electrical sensation (sciatica), tingling, numbness, heaviness, stiffness and cramps in the legs. In extreme cases, the patient may develop weakness or even paralysis of legs with loss of bladder and bowel sensation. Many such patients die a premature death.

If we look carefully, in our country, unfortunately, bone depletion in women starts from childhood. “A girl child is a girl child” and there is a certain level of deficiency and neglect in her care, including nutrition, compared to boys. Thus, their bones probably are never able to grow and develop to their full potential. Women are supposed to be more home-bound and restricted to household activities. Thus, they are not exposed to sunlight, leading to a deficiency of vitamin D. Again, pregnancy, lactation and child rearing pose an immense load on a woman's body, which is very rapidly depleted of its proteins, calcium, minerals and vitamins. The hormonal changes that occur during  pregnancy and lactation also play an important role in depletion of bones. Neglect of a woman's care and nutrition is common in Indian households and, in general, women are negligent about themselves. Multiple pregnancies within a short span of time eat into the body's reserves. In a primarily vegetarian country, the only source of good quality proteins is milk and milk products. Physical activities like exercising, swimming, cycling, gymming and aerobics are not considered to be a woman's domain, so their bones and muscles always remain weak. Women are continuously losing proteins, iron and minerals through their monthly cycles, so their requirement is more than of men. There is no concept of essential physiotherapy and exercise schedule during and after pregnancy required to keep muscles toned up and bones strong. There is no serious attempt to exercise and lose extra weight gained during and after pregnancy and slowly bones become weak and hollow. A homebound and sedentary lifestyle leads to weight gain, so our women are obese by the time they reach menopause. Hormonal changes at the time of menopause act as a final blow to their bones. The concept of hormone replacement therapy (HRT) in menopausal women is not very popular in India. Thus, a woman's bone ages at least 10-15 years before that of their male counterparts.

Spinal osteoporosis can be prevented with proper care right from childhood. Balanced nutrition with milk and milk products along with eggs and meat and encouraging a girl child to be physically active will go a long way. A single child norm would act as a boon for a woman's health in particular and nation's prosperity in general. Good protein, iron, calcium, vitamin D-rich diet and nutritional supplements are required during child-bearing and lactation. Proper physiotherapy and exercises during and after pregnancy will prevent weakening of bones. Any excess weight gain should be avoided as obesity is the beginning of many diseases. Menopausal weakness of bones due to hormonal deficiencies can be tided over by HRT. In patients with multiple collapsed vertebral bones and deformity of the spinal cord, an injection of bone-like material called bone cement into their vertebral bones can correct the deformity. This latest and state-of-the-art injection is called kyphoplasty and is an absolutely safe, non-surgical procedure without any known side effects administered in the OPD without the need of admission or hospitalisation. This kyphoplasty cement settles in hardly 10 minutes and the patient is immediately back to work without any bed rest. This is a one-time procedure as the kyphoplasty cement does not elute with time and stays in the body for life.