Osteoporosis: Cure at hand for silent killer

With rising life expectancy, the incidence of osteoporosis is on the rise in India, so is the risk of bone fractures associated with brittle bones. This extreme thinning of bones can now be arrested, thanks to a new line of treatment called denosumab, an osteoporosis medication for people who are at high risk of fractures.

We often hear of elderly people, sometimes even younger ones, suffering a fracture from a low impact injury or fall. This is because progressive bone depletion has made their bones too weak to tolerate even a slight injury. High risk of fractures is a major concern for people living with osteoporosis. Once a patient suffers an osteoporosis-related fracture his or her risk of a future fracture increases up to 10 times. Around 25 per cent of patients who sustain a hip fracture die within a year, and less than half of those who survive, regain their previous level of function.

“As we age, bone mass or density is lost. This phenomenon is termed as Osteoporosis which happens in both sexes but especially aggravates in women after menopause. In extreme cases, they become abnormally porous and fragile and extremely susceptible to fractures. While the normal course of treatment involves prescribing calcium and vitamin D supplements to patients, but it is not always sufficient. Newer and advanced treatment options like Denosumab is now available in India. One Denosumab injection every 6 months help to arrest bone loss in patients at high risk of fracture. It slows down the natural rate of bone depletion and allows people with osteoporosis to lead a normal life,” says Dr Navaladi Shankar, Orthopaedic - Spine Surgeon, Apollo Hospital, Greams Road, Chennai.

Denosumab is a new class of drug, made available in India recently which is given as a six-monthly injection to help strengthen bones and reduce the risk of fractures in osteoporosis patients. Denosumab is a monoclonal antibody that slows the natural rate at which bones break down. It works by blocking a protein and suppressing the cells that break down bone.

Essentially bone density is at its peak till 35 years and thereafter it starts decreasing. Bones naturally start becoming thinner with age as the rate of depletion of the bone outstrips the rate at which new bone is made. The bones lose calcium, other minerals, and mass, making them weak. Rampant vitamin D deficiency and inadequate calcium intake in younger people are aggravating the incidence of osteoporosis. With improper diets, fault lifestyles and absence of sun exposure, a large part of our population including relatively younger adults are falling prey to osteoporosis.

“Osteoporosis prevalence is rise even among youngsters, especially among women. The lack of vitamin D leads to weaker bones, mostly due to low exposure to sunlight among the urban population. The change in lifestyle these days has also added to the low production of vitamin D through the skin. There is a need to ensure adequate intake of food rich in calcium, vitamin D and sufficient sunlight exposure,” said Dr Nalli Uvaraj, chief spine surgeon at Rajiv Gandhi Government General Hospital.

While there is limited data available on osteoporosis prevalence in India, it was estimated by a study in 2013 that around 50 million people in India were either osteoporotic or had low bone mass. A UN Population Projection for India suggests that 3,06,000 hip fractures occurred in 2015.

In a study among Indian women aged 30–60 years from low-income groups, bone mineral density (BMD) at all skeletal sites were much lower than values reported from developed countries, with a high prevalence of osteopenia (52%) and osteoporosis (29%), thought to be due to inadequate nutrition.