Osteoporosis
Complete Guide to Weak Bones, Fracture Risk & Bone Strengthening
What is Osteoporosis?
Osteoporosis is a medical condition in which bones gradually become weak, thin, and fragile due to loss of bone mineral density.
As bone strength reduces, even a minor fall, slip, or sudden movement can cause fractures.
Why Osteoporosis is Called a Silent Disease?
There is usually no pain or warning signs until a fracture occurs. Many patients discover osteoporosis only after a hip or spine fracture.
Causes of Osteoporosis
Increasing Age
Bone formation slows down after 30–35 years of age.
Menopause
Estrogen hormone protects bones. Its fall after menopause accelerates bone loss.
Low Calcium & Vitamin D
Poor intake or absorption weakens bone structure.
Long-term Steroid Use
Steroids reduce bone formation and increase bone breakdown.
Smoking & Alcohol
They interfere with calcium absorption and bone healing.
Symptoms of Osteoporosis
-
No Early Symptoms
Bone loss occurs silently.
-
Loss of Height
Due to spine compression fractures.
-
Stooped Posture
Forward bending of spine (kyphosis).
-
Fracture After Minor Fall
Hip, wrist or spine fractures.
Diagnosis of Osteoporosis
Early diagnosis of osteoporosis is crucial because bone loss progresses silently. Proper evaluation helps prevent fractures before they occur.
Blood Investigations
- Serum Calcium: To check calcium deficiency
- Vitamin D (25-OH): Most common deficiency in India
- Parathyroid Hormone (PTH): Rules out hormonal bone loss
- Thyroid Profile: Excess thyroid hormone weakens bones
- Renal Function Tests: Kidney disease affects bone metabolism
- ESR / CRP: Detects inflammatory causes
Radiological Investigations
- DEXA Scan: Gold standard for bone density
- X-ray Spine: Detects vertebral compression fractures
- MRI Spine: Differentiates old vs fresh fractures
- CT Scan: Used when fracture anatomy is unclear
Who Should Be Tested?
- Women above 50 years
- Men above 60 years
- Post-menopausal women
- Patients with height loss or stooped posture
- History of fracture after minor fall
DEXA Scan – Bone Density Test
DEXA scan is the gold standard test to diagnose osteoporosis. It measures bone mineral density accurately.
Understanding T-Score
- Normal: T-score above -1
- Osteopenia: T-score between -1 to -2.5
- Osteoporosis: T-score below -2.5
Treatment of Osteoporosis
Medical Treatment
- Calcium & Vitamin D supplements
- Bisphosphonates (bone strengthening medicines)
- Hormonal therapy (selected patients)
- Regular follow-up with DEXA scan
Fracture Management
- Hip fracture surgery if required
- Vertebroplasty / Kyphoplasty for spine fractures
- Physiotherapy & rehabilitation
Calcium and Vitamin D3 Supplementation
Calcium and Vitamin D3 form the foundation of osteoporosis treatment. Without them, bones cannot regain strength even with medicines.
Why Calcium and Vitamin D are Important?
- Calcium provides hardness and strength to bones
- Vitamin D helps absorption of calcium from intestine
- Deficiency increases fracture risk
Who Needs Supplementation?
- Post-menopausal women
- Elderly individuals (above 50–60 years)
- Patients with low Vitamin D levels
- People with history of fractures
- Patients on long-term steroid therapy
Recommended Daily Requirement
- Calcium: 1000–1200 mg/day (diet + supplements)
- Vitamin D3: 800–2000 IU/day (or weekly/monthly dosing as advised)
Exact dose should always be decided by your doctor.
How to Take Supplements Correctly?
- Calcium should be taken after meals
- Do not take calcium with iron tablets
- Vitamin D can be taken weekly or monthly
- Regular sunlight exposure helps natural Vitamin D
Common Mistakes to Avoid
- Taking calcium without Vitamin D
- Self-medication with very high doses
- Stopping supplements once pain reduces
Calcium and Vitamin D are supportive treatments. They must be combined with exercise, fall prevention and specific osteoporosis medicines for best results.
Common Medicines Used in Osteoporosis
Medicines for osteoporosis work by either slowing bone loss or increasing new bone formation.
| Medicine Class | Common Drugs | How It Works | Who Should Take | Common Side Effects |
|---|---|---|---|---|
| Bisphosphonates | Alendronate, Risedronate, Ibandronate, Zoledronic acid | Slows bone breakdown by inhibiting osteoclast activity | Postmenopausal women, elderly men, high fracture risk | Acidity, heartburn, jaw pain (rare), body ache |
| RANKL Inhibitor | Denosumab | Blocks bone resorption pathway | Very high fracture risk, kidney disease patients | Low calcium, joint pain, infections (rare) |
| Anabolic Agent | Teriparatide | Stimulates new bone formation | Severe osteoporosis, multiple fractures | Leg cramps, dizziness, nausea |
| Selective Estrogen Receptor Modulator (SERM) | Raloxifene | Estrogen-like effect on bones | Postmenopausal women (selected cases) | Hot flushes, leg cramps, clot risk |
| Hormone Therapy | Estrogen ± Progesterone | Prevents rapid bone loss after menopause | Early postmenopausal women | Breast tenderness, clot risk, cancer risk |
| Calcitonin | Calcitonin nasal spray/injection | Reduces bone resorption and pain | Acute vertebral fracture pain | Nasal irritation, nausea |
| Calcium Supplements | Calcium carbonate, Calcium citrate | Provides raw material for bone | All osteoporosis patients | Constipation, bloating |
| Vitamin D3 | Cholecalciferol | Improves calcium absorption | Vitamin D deficient patients | Rare – high calcium if overdosed |
Important Treatment Tips
- Bisphosphonates must be taken on empty stomach with plain water
- Remain upright for at least 30 minutes after taking tablet
- Denosumab injection requires regular follow-up and calcium supplementation
- Teriparatide is time-limited therapy
- Never stop osteoporosis medicines without medical advice
Osteoporosis treatment is long-term. Medicines reduce fracture risk but work best when combined with calcium, vitamin D, exercise and fall prevention.
Kyphosis and Vertebroplasty in Osteoporosis
Spinal fractures due to osteoporosis can lead to stooping of the back (kyphosis), chronic pain, and reduced quality of life.
What is Kyphosis?
Kyphosis is an excessive forward bending of the upper or middle spine.
- Gradual loss of height
- Hunched or stooped posture
- Chronic back pain
- Breathing difficulty in severe cases
When Should Kyphosis Be Taken Seriously?
- Sudden severe back pain after minor fall
- Rapid increase in spinal curvature
- Difficulty in walking or daily activities
What is Vertebroplasty?
Vertebroplasty is a minimally invasive procedure used to stabilize fractured vertebrae.
- Performed under local or short anesthesia
- Usually takes 30–45 minutes
- Patient walks the same or next day
Who is a Candidate for Vertebroplasty?
- Pain not controlled with medicines
- Recent vertebral compression fracture
- MRI-confirmed active fracture
Important Facts Patients Should Know
- Vertebroplasty does not cure osteoporosis
- It treats pain, not bone weakness
- Osteoporosis medicines must continue
Not all spinal fractures need vertebroplasty. Many patients improve with conservative treatment.
Prevention of Osteoporosis
Healthy Diet
Calcium, protein & vitamin-rich food
Exercise
Walking, resistance & balance exercises
Sunlight
Natural Vitamin D production
Fall Prevention in Osteoporosis
Most fractures in osteoporosis occur due to falls. Preventing falls is the most effective way to avoid hip and spine fractures.
Anti-slip Footwear
Wear anti-skid footwear, especially in bathrooms and kitchens.
Good Lighting
Ensure proper lighting at night, especially near stairs and toilets.
Support Handles
Install grab bars in bathrooms and near steps.
Clear Pathways
Avoid loose rugs, wires, and clutter on floors.
Balance Exercises
Regular balance and leg-strengthening exercises reduce fall risk.
Vision Check
Regular eye and hearing check-ups help prevent falls.
Common Myths and Facts About Osteoporosis
Only women get osteoporosis.
Men can also develop osteoporosis, especially after 60 years of age.
No pain means no osteoporosis.
Osteoporosis is a silent disease and often has no symptoms until fracture.
Calcium alone is enough.
Vitamin D, exercise, and medicines are equally important.
Exercise is dangerous in osteoporosis.
Correct exercises strengthen bones and prevent falls.
Fractures are unavoidable with age.
Early diagnosis and treatment can prevent fractures.
Elderly people should avoid activity.
Regular activity improves balance and prevents falls.
Frequently Asked Questions (FAQs)
Osteoporosis is a condition where bones become weak and fragile due to loss of bone density.
Osteoporosis cannot be completely cured, but progression can be stopped and fractures prevented.
Postmenopausal women, elderly people, smokers, steroid users and people with low vitamin D.
Yes, men can also develop osteoporosis, especially after 60 years of age.
DEXA scan measures bone mineral density and is the gold standard test for osteoporosis.
Usually every 1–2 years depending on severity and treatment response.
Yes, especially due to spine compression fractures.
Yes, weight-bearing exercises like walking help strengthen bones.
Yes, due to vertebral compression fractures.
Yes, osteoporosis requires long-term monitoring and treatment.
Strengthen Your Bones Today!
Consult Dr. Gaurav Jain – Orthopedic & Spine Specialist in Indore
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