​Osteoporosis

Osteoporosis is a common bone abnormality. Bones are living tissue and act as storage for calcium and other minerals. At any time your body needs calcium, it simply extracts it from your bones by breaking them down. Simultaneously, new bone is built to replace the parts utilized. The constant process of dissolving and reforming bone persists throughout life and is termed as “bone remodelling”. Osteoporosis develops when this balance is disturbed; disintegration occurs faster than creation of fresh bone, resulting in decrease of bone mass. If you take a look at the inside of a healthy bone, it looks just like a sponge. In osteoporosis, more and more holes begin to appear and enlarge in this ‘sponge-like’ interior, as the removal of bone is greater than the build-up. Consequently, bones become fragile and susceptible to fracture.  ​

There are two types of osteoporosis: primary and secondary. Primary osteoporosis reveals itself as we get older, particularly after menopause in females. The hormone oestrogen plays an important role in regulating bone turnover and healthy growth and maturation of bones. Lower oestrogen levels at the advanced stage of life highly increase bone resorption, bringing about general bone loss. For this reason women are four times more likely to be afflicted with osteoporosis than men in general. Other risk factors that you cannot control are having a small body frame or a parent/sibling with osteoporosis. These elevate chances of disease in both males and females. 

Secondary osteoporosis crops up due to the effect of an agent or other diseases. These may include the following:

  • Vitamin D or calcium deficiency. Any underlying pathology meddling with the absorption or processing of this vitamin and mineral can be related. Examples include kidney disease and certain gastrointestinal diseases/surgery.

  • A diet deficient in fruits and vegetables and excessive intake of caffeine or alcohol. 

  • Some bone marrow disorders, joint diseases and medications (steroids).

  • Hormonal pathologies, for example high levels of thyroid promote bone loss. Parathyroid and adrenal gland hormones are also associated.

  • Eating disorders such as anorexia increase risk of weaker bones by lowering the levels of female and male sex hormones. 

  • An inactive lifestyle and prolonged immobilization can have problematic effects. 

  • Cancer treatment medications.

In osteoporosis your bones become brittle and prone to fractures. Even mild stress such as coughing or bending, or falling from standing position can crack your bone. Common sites which fall prey to this are the hips and spine. Your risk is higher especially if your mother or father has experienced a hip fracture. Post-operative complications of hip fractures are quite serious and may cause significant disability or death. Bones in the spine simply crumple and make you appear shorter. At times the disease is present silently and you will not know you have osteoporosis until a fracture shows up.​

Often, no symptoms arise until a complication occurs. It may come forth as back pain, loss of height over time and/or a forward hunched (stooped) posture.​

The discreet nature of osteoporosis highlights the importance of regular health check-ups for early identification of various disorders and medical advice to avoid preventable disease. It is recommended that you register with the Family Health Service Line at The Aga Khan University Hospital to access long-term quality care.

It is a good idea to talk to your doctor about osteoporosis if you went through early menopause or are currently at menopause, have taken steroids over a period of several months or one your parents ever had a hip fracture. This will facilitate an early detection and your family physician will be able to diagnose and treat osteoporosis before it causes a broken bone. Even after a fracture, further problems can be dispelled by taking the right steps. If necessary, you may be referred to the Musculoskeletal and Sports Medicine Service Line at The Aga Khan University Hospital.​​

Your time with your doctor maybe limited, so make sure to prepare for your visit beforehand. Here are some tips to help get you started.​​​

To help diagnose osteoporosis your doctor may conduct a few tests. These may include a special x-ray test. The x-ray will gauge the amount of mineral in your bones.

Bone Mineral Density (BMD) test might also be performed through a DEXA scan, to examine commonly affected sites including the wrist, spine or hip. This bone measurement technique may be warranted particularly in females above sixty five years or males over seventy years of age.

Some blood and urine tests may be ordered as well.​

Managing osteoporosis involves prevention of fractures, strengthening your weak bones and dealing with consequences. Your physician will work with you to come up with a treatment plan that suits your needs. Your doctor may choose from:

Lifestyle changes:

  • Include common foods with good calcium and vitamin D content 

  • Schedule weight-bearing exercises every week

  • Stop smoking and reduce caffeine/alcohol intake

  • Stop any osteoporosis inducing medications

  • Avoid falls by wearing appropriate footwear and making your house hurdle-proof

Medicinal therapy: 

  • Special oral tablets to prevent the dissolution of bone (bisphosphonates, calcitonin). 

  • Pain killers

  • Calcium and vitamin D supplements

Hormonal Therapy: 

  • Parathyroid hormone: for a few months, especially if you have had a fracture

  • SERMs (Selective Estrogen Receptor Modulator) for women: selective oestrogen receptor modulator prevents fractures, improves blood lipid levels and decreases the risk of breast cancer

  • HRT (Hormone Replacement Therapy) for women: a combination of female hormones can help in the cessation of bone loss, thus lowering your chances of fracture

  • Testosterone Replacement Therapy (for men): may help to improve bone density 

Biologic Therapy:

Certain biologic agents available as injections, reduce bone loss ​

The Aga Khan University Hospital offers various support services to help with managing or recovering from the disease or condition. These include but are not limited to nutrition, physiotherapy, rehabilitation, specialized clinics and some patient support groups. Your doctor or nurse will advise you accordingly.

 The Aga Khan University Hospital offers financial assistance to those who are in need and fulfil the eligibility criteria. For further information, you can contact the Patient Welfare Department. You can find the contact number of the Patient Welfare Department in the 'Important Numbers' section on the website homepage.

 The financial counselling staff is available during office hours, at the main PBSD (Patient Business Services Department), to answer your financial queries on treatments' costs and authorize admissions on partial deposit as per hospital policies allow. The financial counsellor in the emergency room is open 24/7. You can find the contact number of the Patient Business Services in the 'Important Numbers' section on the website homepage.​

Your doctor and or nurse will give you specific instructions about the prescribed medication. Please ensure that you take or use the prescribed medicine as advised. It can be dangerous to your health if you self-prescribe. Please inform the doctor or nurse beforehand if you have experienced any adverse reactions to any medications in the past. If you experience any symptoms of drug poisoning, overdose or severe reaction please contact the Pharmacy Service at The Aga Khan University Hospital immediately. You can find the contact number of the Pharmacy Services in the 'Important Numbers' section on the website homepage​
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​​The information provided on our website is for educational purposes and not intended to be a substitute for medical advice, diagnosis or treatment. You should always seek the advice of your doctor or other healthcare professional provider.