Osteoporosis - Download Now DOC

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How to increase awareness about Osteoporosis and its
consequences among general public and health
professionals in India

’Its better to light the flame
than to curse the darkness’

Osteoporosis is a disease of the bones that leads to increased risk of fractures. In
osteoporosis the Bone mineral Density is reduced and bone micro architecture is
disrupted. It is most common in women after menopause, when it is called post
menopausal osteoporosis, but may also develop in men, and may occur in anyone in the
presence of particular hormonal disorders and other chronic diseases or as a result of
medications. Osteoporotic fractures mostly involve lumbar vertebrae, hip and wrist. It is a
scourge resulting from modern day sedentary life style, lack of exposure to sun light and
unhealthy food habits.Hence it is extremely important that the awareness about this
disease is increase amongst health professionals as well as general public.

It is estimated that 1 in 3 women and 1 in 5 men over 50 years of age will experience an
osteoporotic fracture in their lifetime(1). Due to its important prevalence worldwide,
osteoporosis is considered as a serious public health concern. Currently it is estimated
that over 200 million people worldwide suffer from this disease. Although exact data are
not available, based on available data and clinical experience, an estimated 25million
Indians may be affected (2).Osteoporotic fractures occur commonly in both sexes and
may occur at a younger age than the west. Recently published data have shown a
widespread vitamin D deficiency among Indians, in all ages and both sexes, particularly
in the urban areas. Poor sunlight exposure, skin pigmentation and vitamin D deficient diet
are the obvious causes for this finding. This vitamin D deficiency is a major factor
responsible for poor bone health and low BMD in Indians

The main mechanism underlying the development of osteoporosis is an imbalance
between bone resorbtion and bone formation. In the normal bone, continuous remodeling
takes place, bone resorbtion by osteoclasts and new bone formation by osteoblasts.Till
the age of 25 years, bone formation exceeds the absorption. This leads to accumulation of
bone mass and peak bone mineral density is attained at the age of 25.This bone mass
remains constant till the age of about 35 years after which it starts declining as the rate of
resorption overtakes the rate of formation. Normal bone loss averages .7 percent per year.
It may increase to 2-5 percent at the time of menopause.

Osteoporosis develops in three conditions: inadequate peak bone mass, excessive bone
resorption and inadequate bone deposition during remodeling. Hormonal factors strongly
determine rate of bone resorption. Lack of estrogen (e.g. as a result of menopause)
increases bone resorption as well as decreases the deposition of new bone that normally
takes place in weight-bearing bones.Also,calcium metabolism plays a significant role in
bone turnover, and deficiency of calcium and vitamin D leads to impaired bone
deposition.In addition, the parathyroid glands react to low calcium levels by secreting
parathyroid hormone, which increases bone resorption to ensure sufficient calcium in the
blood.Since cancellous bone is much more active metabolically than compact bone, in
periods of accelerated bone loss, cancellous bone loss is three fold greater.Osteoporotic f
ractures therefore commonly occor in vertibrae. It is often an asymptomatic condition till
the fracture takes place. Given its influence in the risk of fragility fracture, osteoporosis
may significantly affect life expectancy and quality of life.

Medical treatment options in osteoporosis

Dual energy X-ray absorptiometry (DXA, formerly DEXA) is considered the gold
standard for the diagnosis of osteoporosis. There are several medications used to treat
osteoporosis like Bisphosphonates, Raloxifene,Hermone Replacement Therapy and
Teriparatide.In confirmed osteoporosis, bisphosphonate drugs are the first-line treatment
in women. The most often prescribed bisphosphonates are presently sodium alendronate
10 mg a day or 70 mg once a week, risedronate 5 mg a day or 35 mg once a week and or
ibandronate once a month. Oral bisphosphonates are relatively poorly absorbed, and must
therefore be taken on an empty stomach, with no food or drink to follow for the next 30
minutes. They are associated with inflammation of the esophagus (esophagitis) and are
therefore sometimes poorly tolerated

Recently, teriparatide has been shown to be effective in osteoporosis. It acts like
parathyroid hormone and stimulates osteoblasts, thus increasing their activity. It is used
mostly for patients with established osteoporosis (who have already fractured), have
particularly low BMD or several risk factors for fracture or cannot tolerate the oral
bisphosphonates. It is given as a daily injection with the use of a pen-type injection

If the goal of therapy is prevention of vertibral fractures then raloxifene and
Bisphosphonates are the choices.Hormone repacement therapy , though effective in
preventing postmenopausal osteoporosis, is not recommended unless other indications are
present, due to its estrogen related side effects.

Non pharmacological interventions in osteoporosis

Of utmost importance are non-pharmacological interventions like tobacco/alcohol
cessation, weight bearing excercises, calcium supplements. Though drugs can
sigmificantly alter the course of the disease, but          Universal public health
measures(calcium/vitamin D/exercise) are recommended to all patients regardless of their
BMD. Pharmacological agents are prescribed only to those who are at an increased risk
of fracture.

Bone once lost can never be the same again and hence prevention is of utmost
importance.The need of the hour is to increase the awareness of osteoporosis and its
consequences among the general public and health professionals.Osteoporosis is common
in india and high prevalence of vitamin D deficiency appears to be a significant
contributing factor.

A plan for increasing awarenss amongst health professionals
Introduction to the subject in the under graduate curriculum and during graduation years
of all medical, paramedical and nursing disciplines.Apart from giving knowledge about
prevention , diagnosis and treatment of osteoporosis and its complications such as
fractures, knowledge about the quality of life aspects of this disorder shold be imparted.

Education during post graduate courses and Continued medical education of the
practising Doctors is also necessary.Special sessions such as panel discussions, symposia
etc. can be conducted during conferences addressing skeletal health.These subjects are
generally discussed during orthopedic. Radiological, endocrine society meetings.however
these should also be discussed in the main stream meetings of the physicians to develop
their knowledge,skills and attitides.

Since in indians, vitamin D induced osteomalacia is very common, it should be
investigated for and treated before starting pharmacotherapy for osteoporosis.Dramatic
increase in bone density has been observed in such cases where vitamin D deficiency is
the major cause for low bone density.

Undergradute student population can be encouraged to participate in essay writing
competitions such as this one.It is indeed a very effective method in facilitating self
education about all aspects of the disease.Stalls can be put up in the college festivals
where educational material is distributed.Quiz competitions about the disease should be

Establishing clinical practice guidelines about preventive aspects of osteoporosis. Using
evidence based information specially knowledge coming from systematic reviews and
randomized controlled trials practice guidelines must be developed for prctising
physicians so that they can develop and use appropriate materils fo health education
about this condition.

Telemedicine and teleeducation tools should be used to disseminate information to the
remote practitioners to bridge the gap in knowledge and technology between urban and
rural areas.

Education of general public about Osteoporosis

A novel innovation could be the publication of a cookbook which helps people
incorporate a calcium rich diet into their daily lifestyle.Apart from the recipies, it should
also educate the people about osteoporosis and its consequences.
An interactive website should be launched on which people with queries can put up their
questions.Educational videos should be uploaded on it to facilitate the learning process.

A prominent media personality can greatly attract the masses.It was only recently that a
very effective symposium was organised by ‘FOGSI’ in our college campus regarding
awareness about polycystic ovarian disease.It was a very well attended event as it was
hosted by vj Anusha from MTV. Such methods can go a great way in attracting the
younger generation in whom preventive intervention will be most fruitful.

School children should be educated about this disease.They should be encouraged to take
up sports which they can continue throughout their life to keep their bones in good health.
Peak bone mass attained during puberty is a strong predictor of development of
osteoporosis in the later years,As a public health measure, children should be encouraged
to drink milk and play in the sun. Children can be shown educational videos about bone
muneralization and its correlation with diet and exercise. A large number of these are
available on the internet.

Mass media like television and radio can be used to spread the message among the
masses.It is perhaps one of the most effective means to reach out to people in the
remotest of areas.Documentaries should be aired which highlight the high risk criteria,
signs and symptoms of osteoporosis and when to seek medical care.

Such essay writing competitions are indeed a very effective method of getting young
people educated about the disease.Painting competitions can also be organised with
simultaneous educational sessions going on.

World osteoporosis day should be popularised in a big way.Posters, radio ,television
should all be used to make people concious about their bone health.Tie up with media
parteners like MTV, Channel V etc can help spread the word to a large population of

Socio economic burden of osteoporosis.
Osteoporosis has a severe and often underestimated impact in terms of human cost and
socioeconomic burden. Hip fractures can lead to decreased mobility and an additional
risk of numerous complications (such as deep venous thrombosis and/or pulmonary
embolism, pneumonia. The 6-month mortality rate following hip fracture is
approximately 13.5%, and a substantial proportion (almost 13%) of people who have
suffered a hip fracture need total assistance to mobilize after a hip fracture(3).

Vertebral fractures, while having a smaller impact on mortality, can lead to severe
chronic pain of neurogenic origin, which can be hard to control, as well as
deformity.Apart from risk of death and other complications, osteoporotic fractures are
associated with a reduced health-related quality of life.
Apart from being a debilitating disease with significant human cost involved,
osteoporosis also represents a major socioeconomic burden. Already, in many countries,
fractures caused by osteoporosis are responsible for more days of hospitalization among
women over 45 years of age than any other disease. The ever increasing costs for health
and hospital care are paralleled by the rising indirect costs that result when patients lose
their independence and require nursing care. As the populations of all countries are
ageing, this burden is expected to rise tremendously.

To conclude, awareness about osteoporosis must become a part of curriculum of school
children and medical students.Technology can play a great role in disseminating
information.The younger generation should be targeted because their lifestyle today will
strenthen or weaken the backbone of the country tomorrow…..literally!!!!


1. Cooper C, Campion G, Melton LJ 3rd. Hip fractures in the elderly: a world-wide
projection. Osteoporos Int. 1992 Nov;2(6):285-9.

2. Malhotra N, Mithal A, ‘Osteoporosis in indians’. Indian J Med Res 127, March 2008,
pp 263-268

3.Hannan EL, Magaziner J, Wang JJ, et al. (2001). "Mortality and locomotion 6 months
after hospitalization for hip fracture: risk factors and risk-adjusted hospital outcomes".
JAMA 285 (21): 2736