Are your bones getting weaker day by day? Let's learn about osteoporosis!

Have you ever fallen and broken an arm or leg? Or have you or someone you know noticed that you are getting thinner and thinner as you age? Perhaps the reason behind these things is a silent enemy that none of us talk about much, but which affects many people. Today we are going to talk about that silent enemy, namely osteoporosis .

What is Osteoporosis?

Simply put, osteoporosis is a disease that weakens your bones . This causes your bones to become thinner than they should be and their density to decrease. It's like the bricks used to build a wall become hollow and the wall becomes weak. So when this happens, the chances of bone fractures are much higher.

Normally, our bones are strong and dense. They can support our body weight and absorb damage from minor falls and bruises. But as we age, our bones naturally lose some of their density and the rate at which they are remodeled decreases. If you have osteoporosis, your bones are more fragile and weaker than normal.

Many people don't know they have osteoporosis until they break a bone. Although any bone can break, it most commonly affects:

• Your hip fractures.
• Wrist bones.
• Fractured vertebrae .

If a doctor detects osteoporosis early, you can greatly reduce your risk of fractures. So, especially if you are over 65 , have had a bone fracture after age 50, or if someone in your family has osteoporosis, talk to your doctor about having your bone density checked.

How common is this condition?

In fact, this is more common than you might think. In a country like America, more than 50 million people live with osteoporosis. This condition is also increasing in Sri Lanka, especially as our elderly population increases.

Osteoporosis is common among people over the age of 50. Experts say that one in two women and one in four men over the age of 50 may have osteoporosis. Just think about how many people you know may have this condition.

Studies have found that about one-third of people over the age of 50 who do not yet have osteoporosis have some degree of low bone density. This condition is called osteopenia . Osteopenia is an early sign of osteoporosis. It's like a red light. If left untreated, osteopenia can progress to osteoporosis.

What are the symptoms of Osteoporosis?

Like many diseases , osteoporosis does not have obvious symptoms. That's why doctors sometimes call it a "silent disease."

You can't feel or see anything, so tell them you have osteoporosis. If you don't have a headache, fever, or stomach ache, let them know that something is wrong with your body.

The main "symptom" of this is the sudden breaking of a bone . This can happen, especially from a small fall, or even from a minor accident that usually does not cause any harm. Just think, even if you stumble a little while getting up from a chair, or even if you bump into a door, you can break an arm or leg.

Although osteoporosis may not cause any symptoms, you may notice some changes that indicate that your bones are losing strength and density. These are the warning signs of osteoporosis:

• You may lose an inch or more of your height. This can happen gradually, so you may not notice it right away.
• Changes in your normal posture (leaning forward, hunching over). Some people say "slouching", something like that.
• Difficulty breathing (if your spinal cord is compressed and your lung capacity is reduced).
• Pain in your lumbar spine. Don't assume this is just a backache, especially if there is no other cause.

You may find it difficult to notice changes in your body. It may be easier for someone close to you or your family to notice these changes (especially in height or posture). While some people joke that you "shrink" as you get older, this could actually be a sign that you need to see a doctor for a bone density test.

Why does osteoporosis occur?

Osteoporosis develops as you age, when your bones' ability to form new ones and repair themselves decreases.

Our bones are living tissue, just like the rest of our bodies. Although it may not seem like it, they are constantly renewing their cells and tissues throughout our lives. Think of it like renovating an old house. Up until about age 30 , our bodies naturally build more bone than they lose. This means that the bone bank is growing. But after age 35, the rate of bone breakdown exceeds the rate of new bone formation. This gradually reduces bone mass. It's like taking money out of the bank faster and reducing the amount of money you deposit.

If you have osteoporosis, your bone mass is lost faster than normal. Women lose bone mass even faster after menopause , because the decrease in the hormone estrogen affects bones.

Who is at higher risk of developing osteoporosis?

Anyone can develop osteoporosis, but certain groups are more likely to develop it. These include:

• Anyone over the age of 50. This risk increases as you get older.
• Women, especially postmenopause. We've talked about this before.
• If someone in your family has osteoporosis (hereditary). If your mother, father, or siblings had the condition, you may also be at risk.
• People who are naturally thin, with "smaller frames." This is because thin people generally have less bone mass, so even a small loss affects them more.
• People who smoke and use tobacco products. Smoking is very harmful to bones.

Some diseases may also increase the risk.

Some health conditions can increase the risk of developing osteoporosis. For example:

• Endocrine disorders: Any condition that affects the parathyroid glands, thyroid gland, and hormones (e.g., thyroid disease, diabetes mellitus).
• Gastrointestinal diseases: For example, conditions like Celiac disease and Inflammatory Bowel Disease (IBD) can cause the body to not absorb nutrients properly.
• Autoimmune disorders that affect the bones: such as rheumatoid arthritis or ankylosing spondylitis.
• Blood disorders: Or cancers that affect the blood, for example, multiple myeloma.

Some medications and surgeries also carry risks.

The risk of osteoporosis may increase with prolonged use of certain medications or certain surgeries:

• Diuretics: (medicines that lower blood pressure and remove excess fluid from the body).
• Corticosteroids: (Medications used to treat inflammatory conditions such as asthma and arthritis). These are more dangerous when used long-term.
• Some medications for epilepsy.
• Weight loss surgery (Bariatric surgery).
• Hormone therapy for cancer (for breast cancer or prostate cancer).
• Anticoagulants (medicines that prevent blood clotting).
• Proton pump inhibitors ( medicines used to treat acidity, such as gastritis; these can affect calcium absorption).

You also need to look at your diet and exercise.

Your diet and exercise habits also affect the development of osteoporosis. These are things we can control:

• Not getting enough calcium or vitamin D in your diet. Calcium is the main component of bones. Vitamin D helps the body absorb calcium.
• Not getting enough physical exercise. When you don't exercise, your bones become weak.
• Regular drinking (more than twice a day).

## How is Osteoporosis diagnosed?

A doctor diagnoses osteoporosis by performing a bone density test . This measures the strength of your bones. It uses X-rays to measure how much calcium and other minerals are in your bones.

Doctors sometimes call this bone density test a DEXA scan , DXA scan, or bone density scan. These are all names for the same test.

This test uses low-level X-rays to measure the density and mineral content of your bones. It's similar to a regular X-ray. It's an outpatient procedure, meaning you don't have to stay in the hospital. You can go home after the test. There are no needles or injections involved in this test. So there's nothing to worry about.

Checking your bone density is the best way to catch osteoporosis before it causes a fracture.

If someone in your family has osteoporosis, if you are over 50, or if you have osteopenia, your doctor may suggest that you have regular bone density tests.

## What are the treatments for Osteoporosis?

Your doctor will recommend a combination of treatments that will slow down your bone loss and strengthen your existing bone tissue. The most important thing in treating osteoporosis is to prevent fractures.

The most commonly used osteoporosis treatments are:

• Exercise: Regular exercise strengthens your bones (and all the tissues that connect them, such as muscles, tendons, and ligaments). Your doctor may suggest weight-bearing exercises to strengthen your muscles and improve your balance. Anti-gravity exercises, such as walking, yoga, Pilates, and Tai Chi, can help improve your strength and balance without putting too much stress on your bones. You may need to work with a physical therapist to find exercises and movements that work for you.
• Vitamin and mineral supplements: You may need over-the-counter or prescription calcium or vitamin D supplements. Your doctor will tell you what type you need, how often you should take it, and what dosage you need. It's important to get vitamin D from foods rich in calcium, such as milk, cheese, yogurt, green vegetables, and small fish, as well as from sun exposure.
• Osteoporosis medications: Your doctor will tell you which medications are best for you and your body. Some common medications include hormone therapies, such as estrogen or testosterone replacement therapy, and medications called bisphosphonates . People with severe osteoporosis or those at high risk of fractures may need medications such as parathyroid hormone (PTH) analogs, denosumab, and romosozumab . These medications are usually given as injections.

## What to expect if you have osteoporosis?

If you have osteoporosis, you should expect to manage the condition for a long time, usually your entire life. This means it won't get better overnight. You will need to see your doctor regularly and have bone density tests. Your doctor will monitor your bone density and adjust your treatment as needed. So it's very important to follow your doctor's instructions carefully.

## How to reduce the risk of osteoporosis?

Exercising and making sure you get enough calcium and vitamin D in your diet are usually the most important things you can do to prevent osteoporosis. Your doctor can help you find the best combination of treatments for you and your bone health.

Remember these things to protect yourself from accidents:

Follow these safety tips to reduce the risk of breaking a bone in an accident:

• Always wear a seatbelt when riding in a vehicle.
• Wear appropriate safety gear for every activity and sport.
• Keep your home and workplace free of unnecessary items that could trip you or others. Be especially mindful of wires, toys, and other objects on the floor.
• Always use proper equipment to reach things from above. Never climb on chairs, tables, or counters.
• You should follow a healthy diet and exercise plan.
• If you have difficulty walking or are at high risk of falling, use a cane or walker. There is no shame in using these, it is for your safety.

## How do I take care of myself?

Following a healthy diet and exercise plan will help you maintain your bone (and overall) health. Go for regular checkups. They can help you catch any problems or symptoms that may be affecting your bones as early as possible.

If you are over 65, or if someone in your family has osteoporosis, talk to your doctor about a bone density test. Don't be afraid or embarrassed to ask about this.

## When should I see a doctor?

See a doctor if you notice any changes in your body that could be warning signs of osteoporosis (such as loss of height, frailty). Also tell your doctor about any other symptoms you're having, especially if you have bone pain or difficulty moving your body.

## When should you go to an Emergency Treatment Unit (ETU) ?

If you think you have a broken bone, or if you have any of the following symptoms, go to an emergency room (ER) immediately:

• Severe pain.
• If you can't move a part of your body.
• If a part of the body looks unusual or has changed from its original position (like being bent or stretched).
• If your skin is stretched and your bone is visible.
• Swelling.
• Along with these other symptoms, new bruises appear.

## What questions should you ask the doctor?

When you go to the doctor, don't forget to ask these questions:

• What is my risk of developing osteoporosis?
• How often will I need to have bone density tests?
• What kind of treatments do I need? What are their side effects?
• What are some good exercises I can do to strengthen my bones?
• Will I need physical therapy?
• What changes do I need to make in my diet?

## How long can you live with osteoporosis?

Osteoporosis is not a life-threatening disease, meaning it does not change your life expectancy (how long you will live). However, it does increase your risk of bone fractures. It also increases your risk of serious fractures or complications from fractures. Some studies have found that hip fractures in adults over the age of 65 are associated with reduced mobility, more frequent hospitalizations, and possibly an early death.

If you're worried about protecting yourself from falls or fractures, talk to your doctor. They can help you stay safe and healthy.

## So, what is the most important thing we need to remember from this?

Osteoporosis is a condition that makes your bones thinner and weaker than they should be. This can be dangerous because it makes you more likely to break a bone. Many people don't even know they have osteoporosis until they break a bone.

The best way to prevent fractures is to catch osteoporosis before it harms you.

So, go for regular checkups. Ask your doctor when you should have bone density tests and how often to monitor your bone health. Remember, healthy bones are essential for a healthy life! Taking care of your bones from a young age is worth it as you get older.

` Osteoporosis, bone health, fracture, bone density, calcium, vitamin D, exercise, menopause, Dexa scan