World Osteoporosis Day: Bones Can Weaken At An Earlier Age In Women Than In Men, Exercising Can Help, Experts Say

World Osteoporosis Day: The levels of oestrogen in women suddenly decline after menopause. This leads to accelerated loss of bone mass, and is the main reason why women are more prone to osteoporosis

Osteoporosis is of two types. The first kind is the one in which females experience bone loss after menopause due to hormonal changes. The second type of osteoporosis is seen in populations suffering from medical illnesses.

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World Osteoporosis Day is observed annually on October 20. Osteoporosis is a bone disease that develops when bone mineral density and bone mass decrease, or when the quality or structure of the bones changes, leading to a decrease in bone strength. This can increase the risk of fractures or broken bones. According to the United States National Institutes of Health (NIH), osteoporosis is a "silent" disease because one typically does not have symptoms, and may not even know they have the disease until they break a bone. Bones can weaken at an earlier age in women than in men, according to experts. 

Why females are more prone to osteoporosis than men

Oestrogen is a hormone that plays an important role in maintaining bone health in females. However, the levels of oestrogen suddenly decline after menopause. This leads to accelerated loss of bone mass. "This is the main reason that females are more prone to osteoporosis, and that too at an earlier age. The second reason that contributes to this is the fact that peak bone mass is less in women compared to men," Dr Sahil Gaba, Consultant, Department of Orthopaedics, Amrita Hospital, Faridabad, told ABP Live. 

After menopause, there is a change in hormone levels in the blood. Oestrogen, which prevents the resorption of bone, declines after menopause. "Lack of nutrition and care also makes them more prone to develop Osteoporosis," Dr Ramkinkar Jha, Head, Orthopaedics Unit, Artemis Hospital, Gurugram, told ABP Live. 

Age after which bone density starts declining

In most cases, peak bone mass, or highest bone density, is usually formed by 30 to 35 years of age. After that, bone mass declines, Dr Jha said. Therefore, a balanced and healthy diet rich in calcium should be promoted in young age groups, he added. 

According to Dr Gaba, peak bone mass is usually achieved at around 25 years of age. "It is achieved earlier in females compared to males. Genetics plays a big role in this, with some contribution of external factors like nutrition and physical activity. After the age of around 40 years, the bone mass starts to decline slowly in both males and females. In females, the rate of bone loss is accelerated after menopause (45 – 50 years) because of the deficiency of the hormone estrogen. As ageing occurs, another time period when accelerated bone loss occurs in both men and women is after the age of 65 years," he said.

How the bones of people with osteoporosis break

In a person with osteoporosis, bones are so weak that they break even with very minor injuries. 

"This is due to the fact that bone mineral density (minerals available per square millimetre) are reduced so much that the bone cannot withstand any amount of force exerted over it," Dr Jha explained.

"The structural quality of bones in osteoporosis is compromised as a result of altered microarchitecture and reduced bone density. This leads to fragile bones, leading to a higher risk of fractures after relatively low energy injuries such as a fall. Such fractures are also called fragility fractures," Dr Gaba said. 

"A simple fall which is not expected to cause a fracture in a healthy young adult, can lead to Fragility fractures in patients with osteoporosis. Sometimes, fractures can occur even without any recognized trauma or fall (spinal fractures). Other common areas of fragility fractures include wrist, hip and shoulder," he added. 

Types of osteoporosis and factors that lead to it

Osteoporosis is of two types. The first kind is the one in which females experience bone loss after menopause due to hormonal changes. "One subset of this category is senile Osteoporosis, seen in male population after 65 years of age," Dr Jha said. 

The second type of osteoporosis is seen in populations suffering from medical illnesses. These include people suffering from kidney, liver, thyroid diseases or taking medications like steroids, Dr Jha added.

"The two broad categories of osteoporosis are primary and secondary osteoporosis. Primary osteoporosis is the most common form and includes both post-menopausal osteoporosis (occurs after menopause in females only) and age-related osteoporosis," Dr Gaba said. Age-related osteoporosis occurs in both males and females after 65 years of age.

A number of factors can be linked to secondary osteoporosis. Some common ones include medications (corticosteroids, anti-epilepsy drugs, chemotherapy drugs, etc), kidney failure, malignancies (cancers), rheumatoid arthritis, malnutrition, alcoholism, certain hormonal and genetic disorders," Dr Gaba added. 

"Certain lifestyle habits that can increase the risk of osteoporosis include smoking, alcoholism, lack of physical activity and exercise. Important dietary factors include Vitamin D deficiency, Calcium deficiency and protein deficiency," he said. 

At what age does the bone density of men decrease at the same rate as that of women?

The onset of senile osteoporosis in men is slightly late as compared to women. The onset of senile osteoporosis in men takes place after 65 to 70 years of age. In females, the onset can be seen as early as 50 years of age, Dr Jha said. 

Diagnosis of osteoporosis

Osteoporosis can be diagnosed using tests to measure bone density. The Dual Energy X-ray Absorptiometry (DEXA) scan measures bone density of the spine and at the hip. 

"The measured value is compared to a standard reference value which is the normal bone density of a young adult of same sex and ethnicity. 'T – score' is calculated," Dr Gaba said. 

"WHO defines osteoporosis as T score of minus 2.5 or lower and severe osteoporosis if this is accompanied with a Fragility fracture. A T score between minus 1 and minus 2.5 is referred to as osteopenia, and minus 1 and above is normal. Apart from the DEXA scan, your surgeon may get additional tests done like spine xray if there is a backache, and blood tests to look for Vitamin D levels," Dr Gaba added. 

How can osteoporosis be prevented?

Consumption of a healthy and balanced diet can help prevent osteoporosis. According to Dr Jha, one should maintain a healthy lifestyle and perform weight-bearing exercises. He also said that one should treat medical issues and take calcium and vitamin supplements. Specialised medications are also available, and people should consult physicians for the same. 

“Loss of bone mass will happen in all men and women. Attaining a higher peak bone mass in younger age means that there is more reserve, thereby reducing the risk of osteoporosis. This can be done by paying attention to nutrition (mainly Calcium, Vitamin D intake, and protein), identifying and treating any secondary causes of osteoporosis, healthy lifestyle, involving regular physical activity, and avoiding smoking and alcohol intake,” Dr Gaba said.

Exposure to sunlight around noon also helps in Vitamin D production in skin. Paying attention to all these things later in life is also helpful in reducing the risk of osteoporosis. Calcium-rich foods include green leafy vegetables, milk, cheese, yoghurt, tofu, etc. Vitamin D rich foods include eggs, fish (especially oily fish like sardines and mackerel), liver, and fortified foods (eg. morning cereal), among others,” Dr Gaba added.

How can osteoporosis be treated?

Two categories of specialised medicines, in addition to calcium and vitamin D supplements, are available for the treatment of osteoporosis. The first category of treatment is one in which medicines are given to prevent bone resorption. For this, antiresorptive medications like bisphosphonates are given, Dr Jha said. 

The other category of specialised treatment is the one in which bone formation is increased through injectables. 

“There are many forms of exercises which help with both prevention and treatment of Osteoporosis. The best form of exercise for a particular patient depends on multiple factors like presence of fragility fractures, level of physical fitness, weight, co-existent cardiac problems, etc.For the best form of exercise that suits you, please consult your orthopaedic surgeon,” Dr Gaba said.

Exercises to prevent osteoporosis

Walking, jogging and running are the exercises which prevent osteoarthritis, Dr Jha said. 

“Generally, aerobic exercises like walking, brisk walking, dancing, jogging, skipping, etc are good exercises. You may choose the one which suits your physical status. These exercises cause force transfer through the bones, which is beneficial in slowing the loss of bone mass. Muscle strengthening exercises (resistance bands or light weights) at home or gym are also beneficial for increasing muscle strength, building up bones, and improving balance. Remember, any form of exercise is better than no exercise,” Dr Gaba said.

Health complications, disease and conditions osteoporosis can lead to

Fragility fractures are the main health effect of osteoporosis. "The most common sites of these include spine, wrist, hip and shoulder. These usually occur secondary to trivial trauma, commonly falls. Spine fractures can occur even in the absence of injury, and can lead to a hunchback deformity of spine, loss of height, and chronic backache. Osteoporosis is also called 'silent disease' as it does not usually become apparent until a fracture occurs," Dr Gaba said.

"Spinal fractures are compression fractures that result in loss of height of vertebral bones. They can be treated conservatively most of the time, but sometimes acutely painful fractures may need interventions like vertebroplasty or kyphoplasty," he added.

"Wrist fractures occur as a result of fall on an outstretched hand, and are usually managed by plaster application. On the other hand, hip fractures will need some form of surgical treatment. Occurrence of a hip fracture increases morbidity and also carries a significant risk of mortality if not managed in a timely fashion," Dr Gaba further said.   

The main aim of medical treatment of Osteoporosis is to reduce the risk of fractures.