Dwindling bone health, disruption of bone architecture and reduced bone mass, are major health concern worldwide. Developing countries face the worst consequences of Osteoporosis. An increasing prevalence of Osteoporosis among the aging population affects approximately 200 million people. Related risk factors and low bone mineral density (BMD) affects both genders, with increasing prevalence among mid aged population. It is estimated that 46 million women in India suffer from osteoporosis, despite of the scarcity of community based studies. Postmenopausal women and elderly men are among those who face fracture as a commonest complication involving hip and spine.
The prevention and treatment based programmes have been designed worldwide for screening those who are at risk and treating those who suffer. 20th October annually is celebrated as World Osteoporosis Day, aiming at educating the younger generation about promotion of lifelong bone health. The educational programmes are been undertaken by the regulating bodies and non-profitable organizations for spreading the prevention at early stages among rural and urban Indian population. Many researches have been taken up to fill the lacunae in the epidemiological data and various treatment and prevention modalities. The screening for osteopenia and osteoporosis can be done by bone profile which include the assessment of biochemical blood parameter and bone mineral density. Effective and economical measure for assessment of bone mass is done using bone densitometry. Diagnosis is done usingT-score, standardized scoring system, based on a comparison with reference values of young healthy women. An additional fracture risk score questionnaire, FRAX,is used for determining the 10-year probability of fracture.
To address osteoporosis, essential factors to be looked upon are diet,good schematic exercise and medication. Prevention at an early stage and in early years of life is useful in overcoming the existing risk factors. Modifiable risk factors that play role in prevention are the nutritional status and body morphology. Two important factors that influence the future risk of osteoporosis are Blood Calcium and Vitamin D levels. Insufficient dietary consumption of dairy products among Indians leads to retarded bone remodelling, thus increasing the risks for poor bone health. Despite being among tropical countries with abundant sunlight, Indian population reflects a vitamin D deficient blood profile. Inadequate sun exposure due to indoor working hours and poor dietary intake of vitamin D fortified food can be the tabulated reasons. Exposure to sunlight along with diet rich in vitamin D (800–1,000 IU/day) and calcium (1,000–1,200 mg/day), even in the form ofsupplements, has shown proven benefits in overcoming the ongoing bone loss. Abstinence from smoking and chronic alcohol consumption reduces the osteoporosis related complication and helps in better prognosis.
A well-structured rehabilitation program for osteoporotic patients is complimented with generous diet covering all essential elements. Rehabilitation includes self-indulgingin regular muscle-strengthening and weight-bearing exercises. Strengthening core, improving posture and balance reduces the injury risk and incidence of fall. Participation in proper conditioning, weekend sports and leisure physical activities helps maintaining the bone health and better psychological profile of the patient. A moderate exercise program will reduce/halt the progress of osteoporosis. To improve bone density a progressive and schematic exercise program, initially under supervision, is required. This includes either high intensity or high impact training. Various regimes have been formulated for different age groups and have shown effective training and conditioning of osteoporotic patients at AktivOrthoTM. Earlier the commencement of physical activity in life better is the future bone health.
The pharmacological treatment plays a role in bone remodelling and prevention of future osteoporosis related fractures. Apart from lifestyle modifications, hormonal replacement therapy and other classes of drugs has shown effects by increasing BMD and reducing bone resorption. Recent drug advances in this field of medicine has evidently affected postmenopausal women and elderly men.
Lifestyle modifications alone have shown reduction in economic burden as well as reduction in the symptoms and disabilities. Spreading awareness by educating the affected and young will help in maintenance of bone health and a healthy well-being.
Inputs by Dr Sumiran Passey, Consultant, Sports Medicne and Rehabilitation, AktivOrtho