Understanding Osteoporosis: More Than Just Calcium Deficiency

Osteoporosis is not just about calcium deficiency.

In the OPD, a common question is, “Sir, should I start taking calcium?”

However, managing osteoporosis is not just about calcium. It requires diagnosis, risk assessment, lifestyle changes, and appropriate medication all together.

Let’s understand this point-wise.

1. Osteoporosis progresses silently. Initially, there are no symptoms. The first sign is often a vertebral fracture, wrist fracture, or hip fracture.

2. Who is at higher risk? - Postmenopausal women - Age over 60 years - Low body weight or frailty - Long-term steroid use - Diabetes, thyroid disorders, chronic kidney disease (CKD) - Smoking and alcohol use - Family history

3. Diagnosis is not by guesswork but by tests. Standard test: DEXA Scan (Bone Mineral Density) T-score interpretation: - Between -1 and -2.5 indicates Osteopenia - Less than or equal to -2.5 indicates Osteoporosis

4. Calcium supplements are not for everyone. Not everyone should start calcium tablets without evaluation. First, assess: - Dietary calcium intake - Vitamin D status - Fracture risk Otherwise, unnecessary supplements may be started.

5. Daily physiological requirements: - Calcium: approximately 1000–1200 mg/day - Vitamin D: approximately 800–1000 IU/day These needs are met through diet, sunlight, and supplements combined.

6. Diet is important (not just tablets). Calcium-rich foods include milk, curd, paneer, ragi, nachni, sesame seeds, and leafy vegetables. Protein intake is also important for bone health.

7. Sunlight is an effective but often overlooked treatment. For Vitamin D, 20–30 minutes of morning sunlight exposure (face and arms) is recommended; tablets alone are not enough.

8. Exercise helps maintain bone strength. Bones retain strength when they bear load. Best exercises include brisk walking, stair climbing, resistance training, and balance exercises.

9. If osteoporosis is confirmed: Calcium alone is insufficient. Guideline-based medicines include: - Bisphosphonates - Yearly or six-monthly injections - Anabolic therapy in some cases This decision is based on DEXA results and fracture risk.

10. Common mistakes: - Taking calcium tablets for years without proper evaluation - Never having a DEXA scan - No exercise - No sunlight exposure This means treatment is ongoing but disease control is not achieved.

Osteoporosis is not just a calcium deficiency disease; it is a disease of reduced bone strength.

Therefore, management includes screening, nutrition, exercise, and appropriate medication.

Have you ever had a Bone Density Test (DEXA scan)? - Yes, I have - Doctor advised but I haven’t done it yet - Never done it

Dr. Ravindra L Kulkarni MD, DNB, FSCAI (Cardiology) Just For Hearts