970x125
Savithri is a high-spirited septuagenarian who lives with her husband in a high-rise apartment in Chennai. Her morning routines include: rising before the dawn, sharing coffee time with her husband and then a short walk around the sprawling apartments. One day, she tripped over the pavement during her stroll. Though she believed it was a simple fall, she could not get up from the ground and her right leg could not be moved. Her elderly husband called for a ambulance and with the help of neighbours, she was taken to a nearby hospital.
970x125
Savithri broke down when the doctor showed her the fracture in her hipbone on x-rays, and explained the need for a surgery. She could not quite understand how a simple fall could break her bone. She had been eating well, does her morning walks religiously and does not suffer from any other illnesses. The doctor explained to her that her bones were very weak and brittle due to osteoporosis, a term that the elderly couple were hearing for the first time.
Osteoporosis is a silent disease. Unlike other old age conditions like arthritis or ligament tears, osteoporosis does not manifest itself overtly until a fracture happens.
What is osteoporosis?
The bone is one of the most active tissues in the body, with old bone being resorbed, and new bone laid over, continuously. This process helps keep the bone strong, in order to bear daily physical stresses. However, this bone turnover becomes slower with increasing age, and more bone is resorbed compared to new bone formation. Consequently, the bones of the body become weaker with ageing, and this condition is called osteoporosis, meaning ‘bones with pores’.
Though 20 to 30% of the elderly have osteoporosis, most do not know that they have it, as it is not symptomatic until the person develops a fracture, like in Savithri’s case. When people less than 50 years of age sustain a trivial fall, their strong bones do not give away. However, when elderly people with osteoporotic bones sustain an injury, as trivial as slipping in the washroom or bending down to lift an object from the floor, they incur a fracture. Since the elderly also have poor coordination, less visual acuity and weaker muscles, the chances of sustaining simple injuries leading to osteoporotic fractures are higher with increasing age.
How common is it?
Roughly, one in three post-menopausal women and one in five men over the age of 50 are at risk of experiencing osteoporotic fractures. An estimated 2 million new osteoporotic fractures are diagnosed annually, a figure exceeding the annual incidence of myocardial infarction (heart attacks) and breast cancer.
As most families have become nuclear, the management of elderly people sustaining osteoporotic fractures, who require hospitalisation and surgery, is a significant problem. Their restricted ambulation, need for repetitive hospital visits and prolonged nursing care required, pose difficult socio-economic problems. India is also experiencing a significant demographic shift with its ageing population, which is growing faster than those of younger age groups. This trend is expected to continue, with the number of elderly individuals projected to be around 20% of our total population in 2050. This means that unless osteoporosis is prevented or diagnosed early, a significant chunk of our population is likely to suffer from these fractures in the near future.
Risk factors and prevention
Osteoporosis is a consequence of old age. Post-menopausal women, due to decreasing oestrogen levels, are more susceptible than men. Obesity, sedentary lifestyles, smoking, alcoholism, regular steroid usage and poor dietary habits are important avoidable risk factors. With regular physical activity as simple as regular walking, aerobic training, low weight training and exercises, the bone mass can be kept optimal.
Similar to systematic financial investments, it is essential that such activities be started in young adulthood itself so that adequate bone mass is available during old age. Apart from this, sufficient calcium intake (dairy products, green leaves) and exposure to sunlight for Vitamin D would keep the bones enriched with minerals.
If there are old people at home, it would be prudent to ensure that the environment is fall-free. Rooms should be adequately lit; large obstacles should be avoided; railings should be provided near stairs; washrooms should be dry, and wall supports should be available for safety. Beds and couches should not be too high and nightwear should be loose and above the ankles.
Treatments and consequences
Osteoporotic fractures commonly occur in the spine, wrist, shoulder and the hips. While many of these fractures heal with rest and splints, the occurrence of one fracture portends the future possibility of further fractures. These fractures affect the individual’s quality of life; result in chronic pain, disability and morbidity. Longevity is also significantly reduced with the occurrence of osteoporotic fractures. The mortality rate within the first year following an osteoporotic fracture is estimated to be 20%, and the risk of mortality increases 3 to 4 times over five years following these fractures. Some of these fractures require surgical intervention, which is a major undertaking in elderly patients. So, prevention of fractures should be the main aim.
Early diagnosis
It is recommended that women after menopause and men above 70 years of age undergo bone density assessment. This assessment is performed through CT BMD scans, DEXA scans and foot ultrasounds, which are available in many government and private hospitals. Those with bone density scores of less than -1 will require medications (anti-osteoporotic therapy) along with calcium and Vitamin D to rebuild their bone strength. Regular evaluation of bone strength and timely initiation of anti-osteoporotic treatment have been shown to reduce the incidence of fractures and its resultant morbidity/ mortality.
Osteoporosis has been highlighted by the World Health Organization as a “global health problem” and the silent epidemic of the 21st century due to its impact on public health. August 4 is celebrated as National Bone and Joint Day every year, and orthopaedic specialists across the country join hands to raise awareness about osteoporosis among the common public. Simply put, ‘If there are three elderly women around you, one is likely to be osteoporotic and requires your help to prevent it from snowballing into a bigger problem’.
(On behalf of the Tamil Nadu Orthopaedic Association.Dr. Rishi Kanna is a consultant spine surgeon at Ganga Hospital, Coimbatore. rishiortho@gmail.com)
Published – August 04, 2025 01:42 pm IST
970x125
