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Mrs M is a 70-year old lady, with no history of any chronic disease. Following a mildbout of cough, she felt a sharp pain in the lower back region. She thought it was a ‘usual’ muscular pain and tried to tackle it by taking a painkiller and using a hot water bottle overnight, When the pain persisted, she decided to visit her doctor, As per the doctor’s advice, she went for an X-Ray of the lower back, On reviewing the X-Ray, the doctor discovered that she had suffered a vertebral fracture. The doctor asked Mrs M to run some blood tests and a bone mineral density scan, On a follow-up visit with the tests, the doctor announced that she was suffering from osteoporosis.

Osteoporosis is often referred to as a ‘silent disease’ because bone loss occurs without any apparent symptoms. The first sign of osteoporosis is usually a fracture which is the result of a weakened bone. Osteoporosis is a condition in which the bones become fragile and brittle; the density and quality of the bones is reduced; and this in turn, predisposes one to fractures. As the bones become thinner and moreporous, this risk increases – a minor bump, an accident or even normal daily activity can cause a serious fracture, like in the case of Mrs M. Typically, there are no symptoms in osteoporosis until the first fracture takes place.

Apart from the huge personal and human detriment, osteoporosis is undoubtedly a major public healthproblem which has an enormousimpact, both social and economic. It is estimated that – around the world – one out of every three women and one out of every five men, over the age of fifty, sustain an osteoporotic fracture – sooner or later.

While any bone can be affected by osteoporosis, the bones of the wrist, hip and backbone (spine) are the most vulnerable to fractures. In the short term, spine fractures (Vertebral compression fractures) can cause immense and intense pain, possible loss of movement, and the inability to carry out daily chores. A fracture caused by weak bones as a result of osteoporosis places one at higher risk of subsequent fractures. In about half the cases, this risk increases after the first fracture; and the risk of new fractures rises exponentially with each new fracture --- in what is known as the ‘cascade effect’.

Women, who have suffered a fracture in their spine, are 4 times more likely to have anouther fracture within the next year, compared to women who have never had an osteoporotic fracture.

It has been found that Indians are prone to fractures at a yonger age and Indian men are also commonly affected by osteoporosis.

Although osteoporosis can be easily diag-nosed and treated, studies have shown that it remains seriously under-diagnosed and under treated. To a large extent, it is a preventable disease since it is never too late to adopt a bone friendly lifestyle – all that is required is exercise, enough sunlight, and a n adequate inclusion of calcium and protein in the diet. This approach keeps the bones healthy and helps prevent osteoporosis.

• Mithal A Editorial Health of Indians. Natl Med J India 2003: 16: 294-2976 • Gupta A Osteoporosis in India – the nutritional hypothesis. Natl Med J India 1996: 9: 268-74