As we age, if sufficient precautions are not undertaken, our bones become fragile due to loss of bone mass. This is called osteoporosis ("Osteo" is bone; "porosis" is the act of becoming porous.) As the bone become porous, people do not feel stable on their feet, and the fear of falling is big in their minds. The "polished tiles" at home and shopping malls pose a bigger risk for them, with increased chances of slipping and falling. This leaves the elderly with not enough option other than staying in their rooms most of the time. However, this is not the case for those who had been smart enough in their young age to lead a healthy lifestyle, that includes a balanced diet and regular exercise.
Types of Osteoporosis
There are two types of osteoporosis seen, primary and secondary.
Primary Osteoporosis
- Post-menopausal osteoporosis: This mainly occurs in women aged between 50 and 70, due to the estrogen depletion in postmenopausal period. Here, the trabecular bone (this is the spongy-looking bone inside the vertebra) is affected.
- Age-related osteoporosis: This happens in people above 70 years of age and affects both trabecular and cortical bone (this forms the cortex, or outer shell, of most bones), 80% affecting the cortical bone.
Secondary Osteoporosis
When the bone loss is due to some other disease, lifestyle factors, or medications, it is called secondary osteoporosis. Unlike primary osteoporosis, it affects both men and women. There are numerous conditions that could cause secondary osteoporosis, such as:
- Intake of glucocorticoid medications.
- Alcohol abuse
- Smoking
- Gastrointestinal disease
- Hypercalciuria (high levels of calcium in the urine)
- Hypogonadism (low levels of testosterone)
- Intake of immunosuppressive drugs
- Hyperparathyroidism
- Intake of anticonvulsant medications
- Cystic fibrosis
- COPD (Chronic obstructive pulmonary disease) and asthma
- Liver disease
- Vitamin D deficiency
Non-modifiable Risk Factors
- Sex: Women are at a greater risk compared to men.
- Age: Bone becomes weaker as you age, putting you at greater risk.
- Body Size: Slender and taller women are at greater risk.
- Race: Among women, Caucasian and Asian women are at higher risk; among men, Caucasians are at higher risk.
- Family History: You are at a greater risk if your parents had history of fractures due to osteoporosis.
Modifiable Risk Factors
- Diet: Diet low in calcium and vitamin D from childhood.
- Inactive Lifestyle: Sedentary lifestyle or prolonged periods of bed rest.
- Alcohol: Excessive intake of alcohol.
- Smoking: Although the effect of tobacco on bone health is not clear, excessive smoking is considered a risk factor for osteoporosis.
Diagnostic Tests for Determining Osteoporosis Risk
The first step in diagnosing osteoporosis is detailed physical exam, understanding medical history, routine urine and blood tests. Following this, some specific diagnostic tests that are carried out are:
- Bone Mineral Density Test (BMD): The strength of your bones is determined by the amount of mineral deposited. The lower your BMD, the more porous your bone is, and the higher the risk of fractures. BMD test is conducted as a guide to determine whether to take preventive measures. It is also used to determine the efficacy of the treatment.
- Dual-energy X-ray Absorptiometry (DEXA): The procedure uses low levels of x-ray passed via a scanner. BMD of the entire skeleton can be taken via this method as well as the site that are more prone to fractures like the hip, spine, and wrist. In this method, T-score is the measurement for the determination of osteoporosis. T-score denotes the extent of difference of your bone density from the average bone density of a young healthy person.
Treatment Methodology for Osteoporosis
When it comes to treatment of osteoporosis, emphasis is laid on prevention of falls to prevent fractures. Apart from that, the importance of the following is stressed upon:
- Proper nutrition: A healthy balanced diet, including fresh fruits and veggies, that is rich in calcium, vitamin D, vitamin K. Good sources of calcium are dark green leafy vegetables, soy and soy products, broccoli, tofu, turnip greens, and calcium-fortified foods. Vitamin D is required to absorb calcium from the intestine. Our body makes vitamin D from the sun rays, but in elderly, during winter, and in people who stay indoors most of the time, production of vitamin D decreases.
- Exercise: Regular exercise is a must to maintain bone health. Total bed rest leads to phenomenal bone loss. Experts say that the exercises that are beneficial for bone health are the ones that involve strength training. Exercise not only helps in maintaining bone mineral density, but also improves the person's coordination and strength of muscles to prevent falls. People already afflicted with osteoporosis should avoid high-impact exercises. Your physiotherapist will suggest appropriate exercises for you.
- Intake of Prescribed Medications: The prescribed medications should be taken at the proper time.
- Intake of Calcium and Vitamin D supplements: Apart from the prescribed medications, calcium and vitamin D supplements should be taken.
Some Tips to Prevent Falls
If you come under the osteoporosis risk bracket or are already diagnosed of osteoporosis, taking precautions at home and outside helps.
Indoors
- Keep rooms clutter free
- Use skid-proof carpets and rugs
- Use rubber rug in the bathroom to prevent skidding
- Have a good lighting system
- Fix holding rails in the bathroom
- Keep your mobile phone or a cordless phone next to you
Outdoors
- Wear a good quality shoes with non-slippery soles
- Use a cane or walker
- Avoid sidewalks that are slippery during rain
- If possible, avoid places that have highly polished floors
Taking the necessary precautions is always better than cure. All efforts should be taken to prevent falls, because falls could result in fractures, fractures in long periods of immobility, and immobility again leads to brittle bones. As some wise man said, "a stitch in time saves nine," timely precaution can indeed save you a lot of discomfort later on.
