Breaking Bad: Osteoporosis, or the silent sound of India’s crumbling bones

Osteoporosis literally means ‘porous bone.’ It is a condition where bones become thin and lose strength as they become less dense

India had the highest number of deaths due to low bone mass density-related fractures in 2019, according to the Global Burden of Diseases Study on osteoporosis. Experts say that India will have a lot more undiagnosed osteoporosis patients as the disease is painless and silent.

On World Osteoporosis Day on October 20, Moneycontrol spoke to experts about factors contributing to the disease's prevalence in the nation. The International Osteoporosis Foundation has marked the day with the theme "Build Better Bones."

Osteoporosis literally means ‘porous bone.’ It is a condition where bones become thin and lose strength as they become less dense. This disease does not immediately cause pain and is often called a ‘silent disease’ as most people are diagnosed with the condition only after they suffer a fracture.

“We are looking at the tip of the iceberg. People do not pay attention unless they develop a fracture. By that time, it is very late,” said Dr. Shaival Chandalia, consultant endocrinologist at Jaslok Hospital, Mumbai.

According to the International Osteoporosis Foundation, worldwide, one in three women and one in five men aged 50 and above will sustain a fragility fracture (fracture from a minimal trauma) due to osteoporosis in their remaining lifetimes.  The Foundation also notes that even after sustaining a fragility fracture, around 80 percent of patients are still not diagnosed and treated for osteoporosis, the underlying disease that caused the fracture.

“Osteoporosis often goes unnoticed until a fracture occurs, as it is a silent disease without obvious symptoms. Many people in India may not be aware of the importance of bone health, especially in younger age groups,” said Dr. Vikas Gupta, director, orthopedics, and head, hand & shoulder surgery, Max Smart Super Specialty Hospital, Saket.

Vitamins and bone health

Osteoporosis is often referred to as a pediatric disease with geriatric consequences, because the development of strong and healthy bones largely occurs during childhood and adolescence.

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“During childhood, bones are constantly growing and remodelling. Proper nutrition and physical activity play a vital role in this process, ensuring the formation of strong and dense bones,” Dr. Gupta explained. Thus, experts say that the consequences of osteoporosis are more commonly observed in older adults, as bone mass naturally declines with age, and the effects of reduced bone density become more significant.

Children without adequate intake of essential nutrients like calcium, vitamin D, and regular exercise, or those grappling with health conditions that impede bone development, are at risk of failing to achieve optimal bone mass. Consequently, these individuals face a heightened likelihood of developing osteoporosis in later life.

“Even if we are a sunlit country, we have so much pollution that the ultraviolet rays required to form Vitamin D in the skin do not reach us,” Dr . Chandalia said. “Vitamin D is not present in most foods, except maybe in fish oil. Also, in a few other countries, milk products are fortified with Vitamin D. This is not done in India and the deficiency prevails,” Dr. Chandalia added.

Early onset
“In the Indian population, the age of onset of osteoporosis is a few years earlier than in the western population. Thus, we are noticing more and more cases,” Dr Chandalia notes. Practitioners add that 70 percent of their patients are female and 30 percent male. A study published in the International Journal for research in Osteoporosis in 2021 found that the prevalence of osteoporosis was slightly higher in females than males (19.4 vs 17.3 percent) in the nation.

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Experts concur that awareness of this silent disease remains limited in India, but there's a gradual uptick in voluntary check-ups as awareness campaigns gain traction. However, the awareness of and opportunity to detect osteoporosis still remains low in many parts of the nation. “Scans like DEXA (dual x-ray absorptiometry), which are used to detect osteoporosis, may not be available in rural areas, increasing the undetected numbers further,” Dr. Chandalia adds.

Enhancing awareness and fostering initiatives to increase the intake of essential vitamins and minerals during formative years are crucial, say experts. Dr. Gupta underscores the necessity of greater awareness regarding bone health, improved nutrition, regular exercise, and screening and treatment options for at-risk individuals.