OSTEOPOROSIS: When bones become brittle

Osteoporosis is a disorder in which your bones become weak and snap at the drop of a fall, or minor stumble

Elderly coupleOsteoporosis is a bone disorder – a disease in which your bones become brittle, and are likely to crack. If the disorder is not prevented or left untreated, it can advance painlessly until a bone fractures. Women are four times more likely than men to develop the disease.

The best way to treat osteoporosis is to prevent it in the first place.

Osteoporosis represents a gradual decrease in the density of bone mass which weakens the bones, and makes fractures possible. Bones, as you know, contain minerals, like calcium and phosphorus; they are essential to make bones hard and dense.

Also, in order to maintain bone density, the body requires an adequate supply of calcium and other minerals. Besides, it needs to produce appropriate amounts of several hormones, such as parathyroid hormone, growth hormone, calcitonin, oestrogen, and testosterone to maintain bone function. Not only that. An adequate supply of vitamin D is further required to absorb calcium from food and integrate it into the bones. Vitamin D, as you know, is absorbed from diet, and manufactured in the skin by sunlight.

The most common among metabolic bone disorders, osteoporosis is essentially also the most difficult to treat. In the disease, the mass of bone is reduced, although its composition remains normal, or unaffected. This reduction results in imbalance between the formation and resorption [loss] of bone.

While the loss of balance often occurs with increasing age, osteoporosis is of clinical significance when it leads to structural collapse, or fracture – most commonly of the vertebrae, femur [thigh bone], or radius [one of the two bones in the forearm].

Ironically though, the fracture rate in osteoporosis is not closely related to the incidence of the disorder as much as frequency of falls is.

From a technical point, osteoporosis, or porous bone, as it’s sometimes called, is a disease characterised by low bone mass and structural deterioration of bone tissue. It is, in other words, a condition highlighted by bone fragility and an increased susceptibility to fractures, especially of the hip, spine and wrist. Nevertheless, the disorder can affect any bone.


The overall symptoms of osteoporosis are localised pain, deformity, and fracture – characteristically seen in age-related bone loss.

While the commonest deformity is loss of height due to vertebral collapse, it is hardly ever noticed by the affected person because one rarely knows one’s original height!

In less older patients, affected by osteoporosis, most of the pain occurs in the back. This is often accompanied by deformity of the chest and protrusion of the manubrium sterni – the upper segment of the sternum. This is, at first, attributed to acknowledged strain – moving heavy furniture, for example – with the pain being severe and localised.

In addition to this, the vertebrae may be sensitive to touch. Also, anaemia and general ill-health may be present in some patients diagnosed with the problem.

Most patients have more than one cause of osteoporosis, although the disorder is classified as an age-related bone disorder. It occurs, as you may have seen, most commonly in post-menopausal and elderly women.


A hip fracture – one of the common outcomes of osteoporosis – is a cause for concern; it often requires hospitalisation and/or major surgery. Besides, it can mess up the person’s ability to walk unaided and may lead to long-lasting or permanent disability, and also death in certain cases.

In addition, fractures of the spine and vertebra, caused due to brittleness of bones, can lead to serious consequences, including loss of height, severe back pain, and deformity.

While significant risk has been reported in people of all ethnic backgrounds, osteoporosis can strike at any age. Statistics suggests that the disorder is responsible for more than 1.5 million fractures worldwide annually, including over 3,00,000 hip fractures; and, approximately 7,00,000 vertebral fractures; 2,50,000 wrist fractures; and, 3,00,000 fractures at other sites.

No wonder, osteoporosis is called the “silent disease,” because bone loss can occur without symptoms, or warning signs.

Besides, people may not know that they have osteoporosis until their bones become so weak that a sudden strain, bump, or fall, causes a fracture, or a vertebra to collapse. Collapsed vertebrae may initially be felt or seen in the form of severe back pain, loss of height, or spinal deformities such as kyphosis, or stooped posture.

Therapists suggest that certain people have a predisposition to develop osteoporosis than others. This is referred to as risk factor/s.


Experts often suspect osteoporosis with a history of bone fractures – especially from falls, or minor trauma, including bone loss, or abnormality, when present on X-ray, besides those who have a significant risk factor – for example, long-term use of steroidal medications.

Structural collapse often provides the most convincing X-ray sign of osteoporosis. If osteoporosis is suspected, your therapist orders a dual energy X-ray absorptiometry [DEXA] scan and conducts a BMD [bone mass density] measurement, preferably of the hip and spine. Bone density is the amount of bone tissue in a certain volume of bone. It can be measured using a special X-ray called a quantitative computed tomogram.

While a complete survey of drug history, lifestyle habits and dietary intake are conducted, certain laboratory tests to measure testosterone, calcium and thyroid function, are also performed.

Prevention better than treatment

Prevention is often better, or more successful, than treatment – besides, it makes sense to prevent loss of bone density than restore bone density once it is lost.

A simple plan of preventive action would involve maintenance or enhancement of bone density. This may often be achieved by consuming adequate amounts of calcium and vitamin D, getting engaged in weight-bearing exercises, and taking medications on a regular basis.

Ensuring an adequate amount of calcium and vitamin D intake is effective. However, this must be incorporated before maximum bone density is reached – by age 30. This regimen should, of course, not exclude people above age 30.

Therapists recommend an intake of 1,500-2,000 mg of calcium and 500-1,000 international units of vitamin D daily. Drinking two 8-ounce glasses of vitamin D-fortified milk and eating a balanced diet, along with the intake of a vitamin D supplement, 4-5 servings of fruits and vegetables, daily, are just as important, even though many women would also need to take a calcium supplement.

Exercise useful

It is an established fact that weight-bearing exercises – including walking and climbing staircases – increase bone density. It must, however, be remembered that non-weight-bearing exercises, like swimming, do not increase bone density.

Needless to emphasise, exercise is important to improve balance.

Balance can often help prevent a fracture that may occur from falling. It may also be mentioned that a high degree of exercise, in pre-menopausal women – just as much as it happens in athletes – can actually cause a small reduction in bone density, mainly because heavy exercise represses the production of the hormone, oestrogen, by the ovaries.


  • The older you are, the greater is the risk of osteoporosis
  • Calcium deficiency is a key trigger of the disorder
  • Tendency to fracture may be, in part, a result of genetics [heredity/family history]
  • Key symptoms include: constant backache, wrist, forearm, neck, and hip fractures, especially from falls, or minor stumbles
  • Loss of height, a result of reduction of the spine
  • Hunched shoulders. This is characteristically called “dowager’s hump” in elderly women
  • Apart from calcium and vitamin D tablets/capsules, medications, physical therapy, and remedial exercises, your therapist may recommend medications that help bones reabsorb [bone] fibre and calcium
  • Adjunct therapies such as yoga, reflexology, osteopathy, chiropractic, acupuncture, and light therapy have been suggested to be useful in managing osteoporosis.

Lifestyle Changes

Once a diagnosis of osteoporosis is made, your therapist may prescribe lifestyle changes along with medication. These may include –

  • Giving up smoking
  • Ensuring adequate calcium and vitamin D intake [1,500-2,000 mg per day of calcium, preferably through diet and/or supplements; 500-1,000 IU {international units} of vitamin D, especially in adults aged 70+]
  • Limit alcohol consumption; best to avoid completely
  • Regular exercise
  • Additional measures – avoid falls, or change room layouts, correct visual defects and take precautions with medications that may cause giddiness
  • Hip padding may be used for protection from falls
  • Though research data on the effectiveness of medications to treat men with osteoporosis are lacking, doctors prescribe bisphosphonates and calcitonin because, in theory, they should have the same positive effects as in women
  • While alendronate sodium is prescribed for use in certain men with osteoporosis, some therapists recommend the use of testosterone [hormonal replacement therapy] in certain patients.

Osteoporosis: Risk Factors

  • Personal history of fracture after age 50
  • Current low bone mass
  • History of fracture in a close relative
  • Female
  • People with thin or small frame
  • Advanced age
  • Oestrogen hormone deficiency as a result of menopause; or, periods
  • Women who lose up to 20 per cent of their bone mass in 5-7 years, following menopause, are more likely to develop the disease
  • Low testosterone levels in men
  • Loss of appetite
  • Low lifetime calcium intake
  • Vitamin D deficiency
  • Long-term use of medications such as corticosteroids and anti-convulsants
  • Chronic medical conditions
  • Sedentary lifestyle
  • Cigarette smoking
  • Alcohol excess
  • Caucasians and Asians are at significant risk; African Americans and Hispanic Americans are not exempt from developing the disorder no less.

Note: A woman’s risk of hip fracture is equal to her combined risk of breast, uterine and ovarian cancer. Besides, the rate of hip fracture is 2-3 times higher in women than men; also, the one-year mortality rate following a hip fracture is nearly twice as high for men as for women.

Dr Subhash Dhiware, MS, is a Navi Mumbai based orthopaedic surgeon.


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