By Seema Chowdhry Sharma

Just because your doctor is not talking about osteoporosis doesn’t mean it’s not happening to you! Lata Jaitly* had a spring in her step when she went for the final dress rehearsal of her upcoming dance recital. Years of practice, perseverance and training had seen her in contention for the best dancer award at the National School of Drama, Delhi. The world was at her feet... Or was it?

As she danced and landed on her feet after the perfect pirouette, Lata felt an excruciating pain in both her heels and collapsed. When she was unable to stand after her fall, she was rushed to Dr Avnish B Chopra’s clinic — the Delhi Osteoporosis Foundation (DOF) — and X-rays revealed fractures in both her calcaneal (heel) bones. Further tests indicated that the 22-year-old was suffering from osteoporosis, a disease she had never heard about before.

While Lata is an unusual case because this disease usually does not manifest itself so early, others like 39-year-old homemaker Maya Joshi* are one among three Indian women who are likely to suffer from osteoporosis by the time they reach their 40s. Yet they have little or no knowledge about this problem. On a visit to an ultrasound clinic for a check-up, Maya happened to pick up a brochure on osteoporosis. When she ended up saying ‘yes’ to more than three factors that put her in the high-risk group (see box: Analyse This), she signed up for a densitometry test.

The results revealed that she had low bone mineral density and was suffering from osteopenia — the stage before osteoporosis. “This is not uncommon,” says Dr Urvashi P Jha, consultant gynaecologist, Indraprastha Apollo Hospital, Delhi and president of the Indian Menopause Society. “Even though 80 per cent of pre- and post-menopausal women are affected by osteopenia and osteoporosis, not many know about it.”

The Silent Thief
So what is this disease which kills more women each year than breast and uterine cancer put together all about? “Osteoporosis is a disease in which bones become fragile due to the thinning or softening of the bone tissue,” explains Dr Chopra, MD and founder of DOF. Literally, it means ‘porous bone’ and sets in when there is a decrease in bone mass. Osteoporosis is often called the ‘silent thief’ because it robs the body of its bones mutely and the sufferer has no hint whatsoever until it is too late!

“Fractures are the most common symptoms associated with osteoporosis, with hip fractures topping the list. Simple actions like bending to pick up a book or banging against a kitchen drawer can cause broken bones in people suffering from osteoporosis,” he adds. Other symptoms include collapsing spinal vertebrae, which produces a stooped posture. “Women are more susceptible to this problem because after menopause the level of the oestrogen hormone drops in their bodies. Oestrogen is known to maintain a balance between the bone building and bone excavating cells. Lack or low levels of this hormone accelerate bone loss,” says Dr Jha.

Only Prevention, No Cure
While it is true that bones become progressively fragile with age, structural weakening begins much earlier — usually in your 20s and 30s — and almost always goes unnoticed. Unlike the rest of our body which groans and protests every time it is not feeling good, your skeleton will send no warning signals till it is too late. After all, aren’t they just inert stockpiles of calcium?

“Far from being a lifeless tissue, our bones are living and constantly build and rebuild themselves,” explains Dr R. Handa, consultant rheumatologist, All India Institute of Medical Sciences, Delhi and secretary-general of the Osteoporosis Society of India. “Peak bone mass is built between the ages of 25 and 35. If you are getting enough calcium and exercise, you build up a good bone balance and strengthen your bone matrix. It is what you gain during this period that carries you through life,” explains Dr Naveen Talwar, a consultant orthopaedic surgeon affiliated with DOF and Ganga Ram Hospital, Delhi.

“Once you are over 35, you lose more bone than you gain, meaning that your skeletal framework erodes if you don’t take constant care of your bone health,” says Dr Jha. In fact, in women who are fast losers, the bone loss can be as high as five per cent per year.

While manifestation of osteoporosis, also referred to as the brittle-bone disease, usually occurs only after menopause in women, how you take care of your skeletal structure and bones in your 20s and 30s determines whether or not you are likely to be affected by it.

“The best time to think about protecting yourself from this dreaded disease is now, because though osteoporosis is largely preventable, there is no complete cure available for it,” warns Dr Chopra. For young women who do not want to spend their later years in pain and misery, here is a four-step preventive programme.

However, all four steps must be practised in unison to snuff out the problem at its roots.

Only Prevention, No Cure >>