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Institute of Advanced Orthopedics, MOSC Hospital and Medical College, Kolenchery, Ernakulam, Kerala

Osteoporosis- weak bones


Osteoporosis is called the silent disease because people are unaware of the problem until a fracture is detected. Therefore, early diagnosis is important and prevention is strongly recom- mended for all women 50 years old and greater. The risk factors are below.

♦ People over age 50
♦ Small frames or low weight
♦ Family history of osteoporosis
♦ Caucasian or Asian women
♦ Early menopause or surgical removal of ovaries
♦ Certain medical conditions such as liver, kidney, and heart trouble ♦ Inactive lifestyle or conditions that require prolonged bed rest
♦ Eating problems such as anorexia or low calcium diet
♦ Use of certain medications such as thyroid hormones or steroids ♦ Excessive alcohol use, cigarette smoking, or lack of exercise.


Diet and life-style changes may help to decrease your chances of getting osteoporosis.

• Get adequate calcium and vitamin D

Calcium 1500 mg per day is generally recommended for postmenopausal women,\\men

over age 65, and those taking steroids. Women taking hormone replacement \\and men under age 65 need 1000 mg of calcium per day. Maintain a healthy calcium-rich diet with foods such as dairy products, salmon, and broccoli.

– Vitamin D is essential for absorption of calcium. Vitamin D is found in fortified milk and egg products. Also, our skin actually makes vitamin D when it is exposed to the sun. Vitamin D 400 IU (international units) is recommended for premenopausal women and men under age 65. Postmenopausal women, men over age 65, and people taking steroids should take 800 IU per day.

• Exercise

Exercise at least 3 times a week to slow down bone loss. Weight bearing activities such as walking, aerobics, jogging, and tennis make the skeleton stronger.

• Don’t smoke

Smoking increases bone loss, perhaps by decreasing the amount of estrogen a woman’s body makes and by reducing the absorption of calcium in your intestine.

• Avoid excessive alcohol and caffeine

Because alcohol and caffeine may reduce the amount of calcium in your body, limit each type of beverage to no more than two per day.


• Consider hormone replacement therapy (HRT)

-HRT is the single most important way to reduce a woman’s risk for osteoporosis during and after menopause. But it should be done with the guidance of an expert gynaecologist or endocrinologist.

If you can’t or don’t want to take estrogen, other prescription drugs can help slow bone loss and may even increase the minerals in your bones (bone density) over time. But these drugs may not offer protection against heart disease and Alzheimer’s disease. They include:

• Bisphosphonates

– Much like estrogen, this group of drugs can inhibit bone breakdown, preserve bone mass and even increase bone density in your spine and hip. Bisphosphonates may be especially beneficial for men, young people and those with osteoporosis due to steroid use. Side effects can include nausea, abdominal pain and irritation of the esophagus.

• Selective Estrogen Receptor Modulators (SERMs)

SERMs mimic estrogen’s beneficial effects on bone density in postmenopausal women, without some of the risks associated with estrogen, such as increased risk of uterine and, possibly, breast cancer.

• Calcitonin

Calcitonin is a hormone produced in your thyroid gland. It may slow bone loss and prevent spine fractures, but it may not prevent hip fractures. It is administered as a nasal spray or as an injection. Calcitonin is usually used to treat people with osteoporosis who are at high risk of fracture and can’t take estrogen or bisphosphonates.

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