One in three women over the age of 50 is likely to find herself gritting what’s left of her teeth, in a bid to stoically bear with bones screaming in pain. 50 is far away, you think, as you head out post sunset for some sumptuous food with an undetermined nutritional quotient and cocktails that will leave you high on life but a little low on bone mass. 50 or not, osteoporosis may be closer than you think; Dr Pawan Nath, Consultant Orthopaedic Surgeon at Seven Hills Hospital reports, “a rising incidence of osteoporosis in women as young as 26.”

With most studies using a Caucasian database as the benchmark of peak bone mass and the DEXA (dual-energy X-ray absorptiometry) scan being a little too expensive for a lot of  Indian women, there’s not much evidence to support this observation. According to the International Osteoporosis Foundation, the average person gains bone mass until the age of 20-25; the bone mass level then remains stable until 45-50. Osteoporosis in younger people is rare, but can occur due to secondary factors such as malabsorption diseases, steroid use, anorexia and so on. In addition, today’s sedentary lifestyles (insufficient exercise, inadequate exposure to sunlight, improper nutrition, etc) are affecting the building of bone mass in young people, which could be detrimental to their future bone health.

Mumbai-based orthopaedic surgeon, Dr Bhupal Deokar, suggests that it’s more likely that younger women are suffering from osteomalacia, bone softening due to insufficient mineralization and osteopenia, lower than normal bone mass density (BMD). But that does not detract from the fact that the calcium and vitamin D deficiencies associated with these could blow up into osteoporosis if not attended to.

According to data provided by Dr Ambrish Mithal, of Medanta Hospital, New Delhi, who is board member and lead author of a soon-to-be-published International Osteoporosis Foundation (IOF) Asia-Audit, 2013, sources estimate that 50 million people in India are either osteoporotic or have low bone mass. There is no evidence that the age of onset of osteoporosis in dropping.

Nonetheless, with approximately 80% of the urban Indian population estimated to have vitamin D deficiencies, osteoporosis remains a major concern. A multi-centre study carried out by the Indian Council for Medical Research (ICMR) has confirmed data from smaller, single centre studies, revealing that Indians have lower BMD than their North American counterparts. The lower BMD in Indians is attributed to nutritional deficiencies as well as genetic and skeletal size differences.

Now, while we can’t control our genetic predispositions, we can control what we eat and how we live. Dr Sushil Sharma, Chairman of the Arthritis Foundation of India, advises adopting a banking approach to bone development by investing as much nutrition (calcium and vitamin D, in particular) and weight-bearing exercise (running, playing field sports, etc) in our bones before the age of 30. “After this you can only withdraw”, he warns.

The sun remains the single largest source of Vitamin D, and catching some sun between the hours of 11.00 and 3.00 is highly recommended. Yes, you read right! The noon time sun is good for you. Another thing you may want to note is that sunscreens hamper Vitamin D absorption. And while the milk debate may rage on till kingdom come, the truth is that for the Indian population, milk remains the most available and affordable source of calcium. Physician recommended doses of elemental calcium and Vitamin D have proved effective; however, going beyond the prescribed doses of Vitamin D can cause toxicity. Drugs such as bisphosphonates and teriparatides are not exactly side-effect free.

Our bones build strength and density up to the age of 30, maybe 35, based on our metabolism. Post this, the natural ageing process means you’ll lose bone mass faster than you can build it.
And once menopause kicks in and estrogen goes missing in action, it will become really difficult to replenish bone. Our life expectancy is rising and with career opportunities opening up across the board, that gender-tinted glass ceiling may well be museum-worthy one day, but the fact remains that if you’re 25 and you’d rather not have a dowager’s hump a quarter of a century down the line, the time to bone up on Vitamin D and minerals is NOW.


Henry Sapiecha

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