When to start treatment to prevent fractures?

Revolutionizing Mobility for Musculoskeletal Disabilities:
Breaking Barriers and Transforming Perceptions.

‘Osteoporosis: Tackling the epidemic on a war footing’

What is ‘Osteoporosis’?

Osteo is bone
Porosis is full of pores

Osteoporosis is a condition when bone becomes weak and brittle. Such bone may break down even with minimal force like falls. Hence the name fragility fracture. It is a silent disease; it doesn’t give any symptoms until a fracture happens. This is why people need to take it seriously. When one visits a doctor with a fracture, it is too late.

Honourable Shri Justice Arun Kumar Mishra,
Chairperson, National Human Rights Commission of India; Dr Dhananjay Gupta, Organizing Chairman, IAOC 2023, Director, Orthopaedics & Joint Surgeries, Fortis Flt. Lt. Rajan Dhall Hospital, Delhi; and Dr Ajay Shukla Director and MS Dr RML Hospital.

How big is the problem concerning Osteoporosis?

According to the World Health Organization (WHO) and International Osteoporosis Foundation (IOF):

It is 2nd only to cardiovascular diseases as a global healthcare problem
India is one of the largest countries affected by it
1 out of 8 males and 1 out of 3 females are affected by it
50 million people in India with this problem or low bone mass

Why is the problem of Osteoporosis big in India?
Indian population consumes a much lower amount of calcium, about 300 to 500mg per day, while it should be somewhere around 1000mg.

Why is the problem of Osteoporosis big in India?
Indian population consumes a much lower amount of calcium, about 300 to 500mg per day, while it should be somewhere around 1000mg.

Dr. Manjari Chandra, Nutritional Medicine, Functional Nutrition & Nutrigenomics, Max Hospital

Who is at high risk of Osteoporosis?

Genetic predisposition of the population. India, as a population, is prone to this disease.
With older age and decreasing death rates, the average population has an increased lifespan that was not earlier—a more dependent old age population. E.g. Hip fractures are common in older adults.
Due to lower estrogen, post-menopausal women have a calcium loss effect on bone.
The average intake of calcium is deficient. When there is low calcium in the blood, it starts borrowing from bones, leading to bone depletion. Thus making bones weak – Osteoporosis.
Inactive lifestyle
Ethnicity: Where the risk of fracture is higher.
Chronic illness patients are undertaking medication that may reduce calcium absorption.

Prevention of Osteoporosis:

Did you know? 99% of total calcium in body is stored in bones

Calcium-fortified diet to reach peak bone density in early years (upto 20years)
Vitamin D – Exposure to the sun also enables our body to manufacture vitamin D.

Tip 1: Daily, there should be 20 minutes of exposure to the sun with 40% of the body uncovered (hands, legs, face and neck) during daytime when the shadow is shorter than height and also maximum UV B to UV A ratio.

Tip 2: 2 cups of milk daily will give 600mg of calcium.

Tip 3: Almonds, Pine nuts, Walnuts, Ragi, Buckwheat, Amaranth, Sitaphal, and Spinach are vegetable sources of calcium. The glycemic index is low in millets, which helps in calcium absorption.

Tip 4: A better form of dairy is when you have broken down or converted lactose to lactic acid. Curd made at home (slightly sour), Indian cottage cheese or good quality fermented hard cheese (that does not melt quickly).

Tip 5: Vitamin D from seafood (shrimps, oysters, clamps)

*Supplements cannot substitute diet.

Felicitation of Warriors: Rising against all
odds for an independent and dignified life: Mrs. Gulshan Mehra

Prevention measures in the early stages of Osteoporosis:

Right Posture
Right Alignment
Weight Management
1. Dietary measures
2. Exercise

Improve Health of Joints:

Reduce Inflammation
Relief by Nutritional components
Supplements aid

Did you know? Sarcopenia is a loss of muscle mass—intake of a good amount of protein and weight training exercises.

Brisk Walking, Climbing stairs, Surya Namaskar postures, and Yoga help improve muscle mass.

When to start treatment to prevent fractures?

Diagnose patient for Osteoporosis – Bone Density Test and other investigations.
When patients are likely to become Osteoporosis.
1. In Women after the age of 60-65 years. Start treatment at perimenopausal time.
2. In men, after 70 years.
3. People are taking long-term steroids.
Surgery for Fragility Fracture of Lower limb for quick mobility
Support Upper limb fracture by using aids – plaster, sling, etc.

Did you know? Fragility Fracture is Osteoporosis. Wrist fracture is a Fragility Fracture. Don’t wait for 2nd fracture. Seek Treatment Quickly!

The FRAX® tool has been developed to evaluate patients' fracture risk. It is based on individual patient models that integrate the risks associated with clinical risk factors and bone mineral density (BMD) at the femoral neck. Visit: https://frax.shef.ac.uk/FRAX/

Dietary advisories:
More than just reducing the intake of food or inflammatory food, a nutritionist can help dig deeper into understanding the problem at a hormone level and suggest a time of food intake frequency of food intake, reduce inflammation for healing and reduce dependency on painkillers.

A compromised gut does not help break down, digest, and assimilate nutrients from food intake into the body.

Tip 1: Maintain a substantial gap between the last and first meals.
Tip 2: Intake calcium from diet and supplements between 20 and 40. Take Calcium supplements with meals for maximum absorption and avoid kidney stones—a daily dose of 1000mg of calcium in adults.

Did you know? A nutrition-dense diet without a robust gut will not be beneficial.

On Calcium and Vitamin D:
Ideally, replenish calcium with diet.

Calcium Carbonate is the most commonly used calcium supplement, and the preferred choice is to be taken with meals. If taken in between meals, it increases the risk of kidney stones.
Calcium intake can lead to heart disease if the calcium supplement intake exceeds 1gm.
Increased Vitamin D supplements also cause kidney stones.
Vitamin D Cholecalciferol granules are best recommended over liquid or nano form.

How do you prevent a fall in the elderly? Must Do’s!!

Bedside switch for light
The carpet should be sturdy. Avoid small, thin rugs at home.
Slippers should be changed every 3-4 months for better grip.
Footwear in which the entire foot can go in quickly.
Non-slip tiles or mats in the bathroom
Sensor-based lights in hallways and areas of the home
Change spectacles with a new number every six months to 1 year
Avoid long clothes or shawls
Avoid loose wires
Side-rail in bathroom
Put on your trousers/pyjamas while sitting
Do not lock the bathroom door from inside

Worse can be delayed:
People with frail bones have restrictions and don’t feel confident to go alone, yet they fear operative treatment:

Fixed notions
Do not have adequate information
Past Traumatic experiences
Other people’s ill experiences
No control over the unexpected outcome

Osteoporosis is a multifactorial problem. Generally, people delay taking the treatment and come back with severe conditions. Doctors face many challenges despite the best treatments available; one primary reason is a lack of confidence, lack of knowledge, anxiety, and psychological-emotional-social factors.

What should we do?

To spread Awareness about Musculoskeletal Disabilities, like Arthritis and Osteoporosis.
To believe that We Can Prevent Osteoporosis.
Our main aim should be prevention rather than treatment.

Let us all help prevent Osteoporosis!

Source: INDIA ARTHRITIS AND OSTEOPOROSIS CONCLAVE 2023, on 3 December 2023, Delhi

Disclaimer: The information provided herein is based on what was heard and understood as communicated by the speakers during the event. While every effort has been made to accurately represent the content, nuances, and context of the discussions, it is essential to note that interpretations may vary, and potential inaccuracies could arise from limitations in auditory perception or language comprehension. This summary is not intended to serve as an official transcript and should be used for informational purposes only. Any decisions or actions taken based on this information are at the sole discretion of the reader, and we recommend verifying details with official sources if precision is crucial.

When to start treatment to prevent fractures?

Diagnose patient for Osteoporosis – Bone Density Test and other investigations.
When patients are likely to become Osteoporosis.
1. In Women after the age of 60-65 years. Start treatment at perimenopausal time.
2. In men, after 70 years.
3. People are taking long-term steroids.
Surgery for Fragility Fracture of Lower limb for quick mobility
Support Upper limb fracture by using aids – plaster, sling, etc.

Did you know? Fragility Fracture is Osteoporosis. Wrist fracture is a Fragility Fracture. Don’t wait for 2nd fracture. Seek Treatment Quickly!

The FRAX® tool has been developed to evaluate patients' fracture risk. It is based on individual patient models that integrate the risks associated with clinical risk factors and bone mineral density (BMD) at the femoral neck. Visit: https://frax.shef.ac.uk/FRAX/