Bones of Strength: Osteoporosis

1Twenty80: How does osteoporosis impact fracture risk in older adults, and what are the most common sites for osteoporotic fractures?

Dr. Murugeaswaran Silvaraju: 

One significant impact of osteoporosis is the high fracture risk, particularly in women where one in three may experience a fracture in their lifetime. There is a term  “beget fracture” in osteoporosis, which means that once a patient experiences a fracture, there’s a considerably elevated chance of another fracture within the next two years. This heightened risk stems from the weakened state of bones in osteoporosis, making them susceptible to further fractures due to increased stress and strain during recovery or inactivity.

An essential aspect of osteoporosis is its potential to worsen if patients remain sedentary, leading to disuse atrophy of both bones and muscles. For instance, in patients with ankle fractures who are immobilised for a significant period, the bone can become softer and weaker due to lack of use, a phenomenon known as disuse atrophy. This condition can also affect muscles, resulting in noticeable differences in muscle size between limbs.

The most common fracture sites in osteoporosis are the hip, spine, and wrist,  especially among older individuals. A hip fracture often requires surgery, spine(vertebral) fractures can result in loss of height, deformity, and intense back pain. Other common fractures associated with osteoporosis can occur at the shoulder (neck of the humerus), elbow, and ankle. These fractures often occur due to relatively trivial incidents such as falls or twists, emphasising the fragility of bones in individuals with osteoporosis.

1Twenty80: Does wearing modest clothing which may cover more skin and potentially limit exposure to sunlight, contribute to lower vitamin D levels and increase the risk of osteoporosis, especially in individuals who adhere to modest dressing practices regularly?

Dr. Murugeaswaran Silvaraju:  

The lack of sunlight exposure due to wearing clothing that covers the body, can indeed lead to vitamin D deficiency and consequently increase the risk of osteoporosis. This is because sunlight is a crucial source of vitamin D synthesis in the body. To mitigate this risk, individuals in such situations can consider spending time in areas where they can expose their upper limbs to sunlight, like a veranda or outdoor space, depending on their comfort and convenience. Alternatively, they may need to resort to vitamin D supplements to maintain adequate levels of this vital nutrient.

This issue isn’t limited to individuals wearing covered clothing; it extends to people in colder climates who often cover up due to weather conditions. In these regions, the risk of osteoporosis due to insufficient sunlight exposure is similarly elevated.

1Twenty80: Is it possible to improve bone health, even later in life?

Dr. Murugeaswaran Silvaraju: 

It’s ideal to start promoting bone health as early as childhood and adolescence because that’s when peak bone mass is achieved. During this period, bones adapt and become stronger in response to increased demand. However, this doesn’t mean that older individuals can’t benefit from bone-strengthening efforts.

Once individuals reach around mid-30s to 40 years old, the ability to reach peak bone mass diminishes. Nonetheless, engaging in regular exercise and movement can still indirectly benefit bone health by improving blood flow and maintaining bone strength. While it may not directly make bones stronger, it helps prevent them from becoming weaker.

So, is it ever too late to start? The answer is no. It’s never too late to begin prioritising bone health and implementing strategies to maintain or improve bone strength, even if the opportunity to achieve peak bone mass has passed.