Osteoporosis treatment aims to lower the risk of the next fracture. In osteoporosis the inside of the bone loses mass and its internal framework becomes thin, so the bone can break from a force it would normally withstand: a fall from standing height, a sudden twist, even a cough or lifting a light bag. Dr. Aman Khanna, an orthopaedic surgeon in Surat, assesses osteoporosis and treats the fractures it causes at his OPD in Mahavir Health Campus, Athwa Gate.
What osteoporosis does to bone
Bone is living tissue that is broken down and rebuilt all through life, and after about the age of 30 the balance tilts slowly towards loss. In women the loss speeds up after menopause, when oestrogen levels fall. Men lose bone more gradually, but they are affected too, particularly with age, long-term steroid tablets or heavy alcohol use.
The wrist, the spine and the hip are the usual places for a break. Spinal bones can collapse a little without a clear injury, showing up as back pain, loss of height or a stooped posture. A hip or spine fragility fracture establishes the diagnosis whatever the scan shows. A break at other sites after a minor fall is a strong warning sign and should lead to assessment.
Who should ask about a bone density scan
- Any break after a minor fall, particularly after the age of 50
- Women after menopause, and women whose periods stopped early
- Older women and men, earlier if any of the risk factors below apply
- People who have taken steroid tablets for months at a time
- A parent who broke a hip, low body weight, smoking or regular heavy drinking
- Long-standing vitamin D deficiency, an overactive thyroid or parathyroid, rheumatoid arthritis, or chronic kidney or liver disease
- Height that has dropped, or new rounding of the upper back
How osteoporosis is diagnosed
The standard test is a DEXA scan, which measures bone density at the lower spine and the hip using a very small dose of radiation. The result is given as a T-score. A T-score of -2.5 or lower is osteoporosis, and a score between -1 and -2.5 is low bone density, also called osteopenia. This applies to women after menopause and men aged 50 and over; for younger adults a different measure, the Z-score, is used. A fragility fracture of the hip or spine can establish the diagnosis even when the scan figure is better than that.
An X-ray of the spine is used when back pain raises the question of a collapsed vertebra. Blood tests, usually calcium, vitamin D, kidney function and thyroid, look for a treatable reason behind the bone loss. The OPD does not arrange the scan, but Dr. Khanna advises where to have a DEXA scan.
How osteoporosis is treated
- Calcium and vitamin D. Food is the first source of calcium. Supplements are added when the diet falls short or the vitamin D level is low. Vitamin D is dosed from a blood level, and calcium supplements only top up what food does not provide.
- Medicines that slow bone loss. The bisphosphonate group is the most widely used, given as tablets taken at set intervals or as an infusion once a year. Some injections given every six months must not be stopped suddenly, because bone can be lost rapidly and spine fractures can follow, so the doctor plans what comes next before they end.
- Medicines that build bone. These are injections kept for people at high risk of fracture, chosen after assessment.
- Treating the cause. Correcting a thyroid or vitamin D problem, and reviewing long-term steroid use with the doctor who prescribed it.
- Exercise and fall prevention, described below.
Dr. Khanna prescribes the treatment himself, after assessment. Treatment is long-term. The scan is repeated after an interval to see how bone density is responding, and the medicine is reviewed from time to time. Some of these medicines need a dental check or a kidney test first.
Low bone density: is treatment needed?
Whether low bone density needs medicine depends on your age, past fractures, steroid use and family history as well as the scan. Together these decide the fracture risk. Someone with borderline low bone density and no other risk factors may need only calcium, vitamin D, exercise and a later repeat scan. Someone with the same score and a previous fracture may be advised to start medicine.
Exercise, food and avoiding falls
Weight-bearing activity such as brisk walking and climbing stairs, along with strength and balance exercises, supports bone and reduces the chance of falling. Enough protein, no smoking and low alcohol help as well. Exercise and diet help the medicines; they do not replace them.
Since most fractures follow a fall, check the home: good light on stairs, no loose rugs, a non-slip mat in the bathroom, and a review of any tablet that causes dizziness.
Where surgery fits
Osteoporosis itself is treated with medicines and lifestyle measures; surgery comes in when a bone has broken. A hip fracture in an older person is usually treated with surgery, and some wrist and spine fractures need an operation too, while many are managed in a cast or brace. Bone quality affects how a fracture is fixed, and starting osteoporosis treatment after a fracture is advised to reduce the risk of another one. See hip fracture surgery and fracture and trauma care.
When to see a doctor
Book an assessment after any fracture from a minor fall, with new back pain after a small strain, when height is dropping, or if you have been on steroid tablets for a long time. Bring earlier X-rays, scan reports and your medicine list.
To book an OPD visit, use WhatsApp or the clinic and hours page.