OsteoporosisThe term osteoporosis is synonymous with women > low calcium > weak bones > fractures. But there is more to the osteoporosis story than just calcium deficiency. Osteoporosis is the weakening of bones such that they are at high risk to fracture.

In 2008, an estimated 25 million Indians were affected by osteoporosis, mainly because of vitamin D deficiency caused by low exposure to sunlight and low dietary vitamin D. Last year, Dr S Rajasekaran (President, Association of Spine Surgeons of India, ASSI) predicted that 36+ million Indians will have osteoporosis by 2013. Nearly 20% women and 10%-15% men aged > 50 years have osteoporosis, which is the cause of 83% (or 500,000) of all spinal fractures, 300,000 hip fractures, 200,000 broken wrists, and 300,000 fractures of other bones.

The bone mass density (BMD) varies such that men have a higher BMD than women and African Americans have a higher BMD than Caucasian or Asians. Plus, BMD naturally decreases after the age of 30-35 years at the rate of 0.3%-0.5% every year. Estrogen is important for BMD maintenance in women and decrease in its levels (post-menopause) leads to accelerated BMD loss (2%-4% per year). The risk factors that increase the probability of developing osteoporosis are:

  • Gender and Race (women, Asian descent > risk)
  • Age and Genetics (50+, family history of osteoporosis > risk)
  • Physical inactivity
  • Calcium deficiency
  • Vitamin D deficiency
  • Smoking (5%-10% extra BMD loss)
  • Excess alcohol
  • Low weight
  • Rheumatoid arthritis
  • Medications (e.g. heparin, prednisone)

Osteoporosis is often asymptomatic until a bone fractures, then an X-ray and bone density measurement confirms the diagnosis. 

The normal bone is made up of protein, collagen, and calcium. When the bones begin to lose their density, and become more-than-normal porous, they are more easily compressed – making them more likely to crack (e.g. hip fracture) or collapse (spinal fracture). The loss of BMD occurs on a scale such that the first-level of BMD loss is known as osteopenia which, if undetected and untreated, proceeds to osteoporosis. Other common areas at high risk for fractures are ribs and wrists.

Spine fractures result in long-lasting lower back pain, loss of height and a curved spine (vertebrae collapse). Hip fractures generally occur after a fall, require surgery and are slow to heal. Bone fractures lead to continuous pain, low quality of life, loss of ability to do routine tasks and hence, decreased productivity.  Often, hip fracture patients need long-term care.

A brief review of bone metabolism will help understand factors affecting BMD. During childhood, the skeleton uses and stores calcium such that bone density continually increases until age 25 and remains constant until 30-35 years. The level of calcium in the bone depends on balanced availability of calcium, phosphorus, magnesium and Vitamin D. Vitamin D is critical for proper dietary calcium absorption from the intestine, while phosphorus and magnesium regulate the amount of calcium absorbed by the bones. In addition, excessive protein and fluorine can hinder calcium absorption. The nutrition guidelines for good bone health are:

Nutrient

Daily Requirement

Source

Calcium

1,200-1,500 mg

Milk products, tofu, green leafy vegetables, fish

Vitamin D

800-1,000 international units

Fortified cereals and milk products, fish, sunlight

Phosphorus

1250 mg (9-18 years old),

700 mg (for adults > 19 years)

Milk products, whole grains, peas, beans, lentils, nuts, meat

Magnesium

300-750 mg

Green leafy vegetables, whole grains, seeds, nuts, fermented soy products, meat, fish

Osteoporosis prevention and treatment choices include lifestyle changes such as no smoking, minimizing alcohol intake, regular (weight-bearing) exercise, maintaining healthy weight, low-salt and calcium plus vitamin D-rich diet. Available medications aim to stop bone loss and increase bone strength or bone formation. The use of hormone (estrogen) replacement therapy (HRT) after menopause was popular until recent times when its benefits have been questioned. There are 2 surgical options that can reduce pain caused by spinal compression – vertebroplasty and kyphoplasty. These surgeries use “bone cement” that is injected into the damaged spinal bones (vertebrae) to make them denser and stronger.

Until recently, obesity (and excess fat) was considered to protect against developing osteoporosis because of higher BMD. However, current research shows that excess fat (or adipose tissue) negatively influences the skeletal system through hormonal signals that disrupt remodeling of bone cells. Bone remodeling, a continuous cycle of replacing mature bone with new bone tissue, is critical in maintaining bone health during normal activities and repairing bone damage caused by injury (fractures).

A Canadian research study, published in Renal Physiology, indicates that sodium and calcium metabolism is interlinked. Hence, excess sodium (from dietary salt) may cause urinary excretion of, not only higher levels of sodium, but higher-than-normal calcium as well. Removal of more-than-usual calcium leads to decreased calcium levels in the body and potentially higher risk of low BMD, osteoporosis and fractures.

Often people, in particular women, take calcium and vitamin D supplements to reduce the risk of osteoporosis and fractures – but this course of preventive action is now discouraged. For one, the prevention of osteoporosis and fractures with calcium supplementation is not well-established. On the other hand, excess calcium raises the risk for kidney stones and heart attack. A German study found that people, aged 35-64, taking regular calcium supplements were at 86% higher risk for heart attack. While, people whose entire daily calcium requirements was dependent on supplements had a 139% higher risk for heart attack.  

A word of caution: over-exercising (e.g. marathon running), especially in young women, increases osteoporosis risk because of excessive weight loss and early termination of menstruation. In general, Indians have a low BMD which can be improved by low-cost measures such as increasing dietary calcium, vitamin D, exercise and time spent outdoors.

Read more about causes, symptoms, diagnosis and treatment of osteoporosis.

Learn more about Osteoporosis at:

For more articles on osteoporosis, visit our osteoporosis section. Follow us on Facebook and Twitter for all the latest updates! For daily free health tips, sign up for our newsletter. And to join discussions on health topics of your choice, visit our forum.

  • Dinesh Trivedi

    I am 71. Have mild reduction in disc space of L3-L4 & L4-L5. Anterior & lateral marginal osteophytes seen.

    have stopped exercise. Please suggest whethr i can bend forward or not. This gives relief to my back pain. Suggest some more ecercises.

  • dhananjay singh

    low bon pain