osteoporosis the silent epidemic

1. OSTEOPOROSIS
Dr Smarajit Patnaik
Senior Consultant Orthopaedic Surgeon
Apollo Hospitals
Bhubaneshwar

2. • Back pain is one of most common reasons people see a
doctor or miss days at work.
• Even school-age children can have back pain.
• Back pain can range in intensity from a dull, constant
ache to a sudden, sharp or shooting pain.
• It can begin suddenly as a result of an accident or by
lifting something heavy, or it can develop over time as we
age.
• Getting too little exercise followed by a strenuous
workout also can cause back pain.
Low back pain

3. The lumbar spine, or low back, is a remarkably well-engineered
structure of interconnecting bones, joints, nerves, ligaments, and
muscles all working together to provide support, strength, and
flexibility.
• This complex structure also leaves the low back susceptible to
injury and pain
• Most acute low back pain results from injury to the
• Muscles
• Ligaments
• Joints or discs
Low back pain

4. Mechanical Lower back pain is often triggered by spinal
movement and involves spinal structures, such as the joints,
discs, vertebrae, ligaments, muscles or soft tissues. Eg-
Kyphosis, Disc bulge, Herniated disc, Ligament / Muscle strains,
Sciatica, ETC
Organic lower back pain is attributed to disease,
Eg- Osteoporosis; loss of bone mass causing vertebral fracture,
Rheumatoid arthritis, osteoarthritis, spondylitis ETC
Idiopathic refers to an unknown cause.
Low back pain causes

5. OSTEOPOROSIS
&
LOW BACK PAIN

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Osteoporosis
• “Osteo” means bone, and “porosis” means something that has
holes in it, like a sponge.
• Our skeleton keeps us healthy through a constant process of repair,
renewal, and mineral release. This process is called remodeling.
• The bone remodeling cycle consists of two distinct stages:
• bone resorption (breakdown and removal) and
• bone formation (generation of new bone)
• Bone Breakdown > Bone Formation = Osteoporosis

7. Osteoporosis
A disease characterized by:
– Low bone mass
– Micro architectural deterioration of the bone tissue
Leading to:
– Enhanced bone weakness
– Increase in fracture risk
Normal bone Osteoporotic bone
Bone Strength = Bone Mass + Bone Quality
microarchitecture microarchitecture

8. Normal bone

9. Osteoporotic bone

10. Osteoporosis
Weaker Bones
More risk of fractures

11. Spinal Compression Fractures and
Back/Osteoporosis Pain
The most common cause of osteoporosis pain is a spinal compression
fracture. It can cause:
What?
• Sudden, severe back pain that gets worse when you are standing or walking
with some relief when you lie down
• Trouble twisting or bending your body, and pain when you do
• Loss of height
• A curved spine is called kyphosis.
When ?
Lifting a bag of groceries, twisting to get out of a car, or tripping slightly
on a rug or sometimes even sneezing!

12. LOW BACK PAIN & OSTEOPOROSIS
People who develop a spinal fracture are at substantial risk
for additional fracture within the next 1-2 years
Ref:
Damodaran P, Subramaniam R, Omar SZ, Nadkarni P, Paramsothy M., Singapore Med J. 2000 Sep; 41(9): 431-5, “Profile of a menopause clinic in an urban population in Malaysia
http://www.outlookindia.com 2004
Osteoporosis Society of India (2003) Action Plan Osteoporosis: Consensus statement of an expert group. New Delhi
International Journal of Physical Education, Sports and Health 2019; 6(3): 233-237
DOI: 10.4103/0970-5333.186467 : http://www.indianjpain.org/text.asp?2016/30/2/111/186467
Asian Spine J 2017 Aug; 11(4): 610–617.
Over 55% of patients with hip fracture have evidence
of a prior vertebral fracture

13. LOW BACK PAIN & OSTEOPOROSIS
Low back pain (LBP) is experienced in 60%–80% of adults
at some point in their lifetime.
Spine fractures due to osteoporosis are common –
with one occurring every 22 seconds worldwide
Ref:
Damodaran P, Subramaniam R, Omar SZ, Nadkarni P, Paramsothy M., Singapore Med J. 2000 Sep; 41(9): 431-5, “Profile of a menopause clinic in an urban population in Malaysia
http://www.outlookindia.com 2004
Osteoporosis Society of India (2003) Action Plan Osteoporosis: Consensus statement of an expert group. New Delhi
International Journal of Physical Education, Sports and Health 2019; 6(3): 233-237
DOI: 10.4103/0970-5333.186467 : http://www.indianjpain.org/text.asp?2016/30/2/111/186467
Asian Spine J 2017 Aug; 11(4): 610–617.

14. IN WOMEN,
OSTEOPOROSIS >
HEART ATTACK STROKE BREAST
CANCER

15. 1 out of 8 males and
1 out of 3 females in
India suffers from
osteoporosis, making
India one of the
largest affected
countries in the world.
INDIA &
OSTEOPOROSIS

16. • Risk factors you cannot change:
• Female Gender
• Age
• Body size - Small, thin-boned women are at greater risk.
• Ethnicity - Indian women are at highest risk.
• Family history - People whose parents have a history of
fractures also seem to have reduced bone mass and may be at
risk for fractures.
Osteoporosis – Risk Factors

17. Risk factors you can change:
• A lifetime diet low in calcium and vitamin D.
• Medications - such as glucocorticoids or some anticonvulsants.
• An inactive lifestyle or extended bed rest.
• Cigarette smoking.
• Excessive use of alcohol.
• Sex hormones: abnormal absence of menstrual periods (amenorrhea),
low estrogen level (menopause), and low testosterone level in men.
Anorexia.
Osteoporosis – Risk Factors

18. Osteoporosis - Diagnosis
• Diagnosis is done by combination of
• Physical symptoms
• X ray
• BMD Test (DEXA Scan)

19. Osteoporosis – Can it be treated?
Yes
Treatment should always accompany lifestyle
changes with adequate supplementation with
Calcium and Vitamin D3

20. • Vitamin D synthesis is less in dark-skinned
persons (Indians)
• Exposure to sunlight is limited, especially in House
lady, Office going population.
• Vitamin D, Ca levels, and bone density are low in
Indians
• Vitamin D adequacy will reduce osteoporotic
fractures & risk of other diseases
Osteoporosis & Calcium/Vit D3
supplementation
Calcium Vitamin D
• Most abundant mineral in bone
• Intestinal absorption of Ca is not efficient,
especially with cereal-based diet.
• Intake of dairy Ca is usually inadequate.

21. Before
Anti-resorptives
Prevents further breakdown
of bones
Anabolic agents
Bone forming drug
Restores bone microarchitecture
Osteoporosis – Treatment Options
After

22. Osteoporosis – Treatment Benefits
• Increase in Bone strength
• Reduced risk of fracture
• Pain relief
Treatment is usually for longer duration and
should be continued as per your dr’s advise

23. General Guidelines for Managing
Low Back Pain & Osteoporosis
1. Active Life style:
Stay active within the limits of your pain and avoid activities that worsen the pain.
2. Practice good posture
Avoid excessive, prolonged, or forceful bending or twisting of your back.
3. Follow a home exercise program
Exercises to stretch and strengthen the back and stomach muscles should be done regularly.
4. Lose weight if you are overweight
5. If you smoke, quit
6. Manage stress
Stress can increase muscle tension. Take time out to relax, exercise, and practice relaxation techniques.

24. General Guidelines for Managing
Low Back Pain & Osteoporosis
7. Modify your environment
Certain changes to your workspace, attire, and home can reduce the stress on your back:
• Avoid wearing high-heeled shoes.
• If you sit for long periods of time, use a stool to bring your knees above your hips.
• Avoid having objects, such as a wallet, in your back pocket while sitting.
• Use a lumbar support pillow when sitting or driving.
• Sleep on a firm mattress.
• Avoid sleeping on your stomach.
• Sleep on your side or on your back with a wedge or pillow under the lower part of your
legs.

25. • There is not always an obvious cause of lower back pain, and it often
gets better on its own.
• Resting, trying hot or cold therapy, taking OTC pain relievers, and
gently stretching may help speed up recovery.
• However, a person should see a doctor for lower back pain that is
severe, does not seem to be getting better, or occurs alongside other
concerning symptoms, such as tingling or numbness down the
legs.
• People with lower back pain should seek immediate medical
attention if they also have any of the following symptoms:
1. Difficulty Walking Or Moving The Legs
2. Loss Of Bowel Or Bladder Function
3. Loss Of Sensation In The Legs
4. Very Severe Pain
When to see a doctor?

26. THANK YOU

27. OSTEOPOROSIS
OTHER MANIFESTATIONS

28. • Shoulder Pain
• Osteoporosis may lead to fracture of the upper arm bone at
the shoulder joint
• This injury is especially common among people 50 or older
who suffer from osteoporosis.
Joint Pain
Many patients tend to have pain in various joints due to micro-fractures caused by
Osteoporosis

29. Pain - Lifestyle and home remedies
• Rest
• Give the injury time to heal and help prevent further
damage
• Ice
• Ice reduces both pain and inflammation.
• You also can use an ice pack wrapped in a thin towel to
protect your skin.
• Not to be used for longer than 20 minutes at a time
• Heat
• Temporary pain relief by applying a heat pack or hot-water
bottle to the painful area

30. Pain - Lifestyle and home remedies
Compression
• Use a compression bandage that's lightweight, breathable and
self-adhesive
• This helps prevent fluid buildup in damaged tissues and
maintains knee alignment and stability
• It should be tight enough to support your knee without
interfering with circulation
• Elevation
• To help reduce swelling, try propping your injured leg on pillows
or sitting in a recliner.

31. • Pain relievers and anti-inflammatory drugs
• Avoid frequent usage without consulting your
doctor
Pain - Lifestyle and home remedies

32. Take home message
With Age increasing there increase risk for Osteoporosis and pain, so its
important to,
 Maintain a healthy weight.
 Get strong, stay flexible.
 Be smart about exercise.
 Consider switching to swimming, water aerobics or other low-impact
activities — at least for a few days a week.
Visit you doctor for further explanations