1. Osteoporosis Slide show

2. The Osteoporosis Landscape
In India, an estimated 43 million women suffer from osteoporosis

3. India: Some Hard Facts Over 61 Million Indians have osteoporosis.
80% are women.
On a global basis, Indians have the highest prevalence of osteopenia.
Compared to Caucasians, osteoporotic fractures in the Indian population occur years earlier in age.
Osteoporotic fractures are more common in Indian men than in the West.

4. India: Some more hard facts
Over 45 Lakhs Indian women above 60 have a fractured spine.
Over 2.5 Lakhs Indians suffer osteoporotic hip fractures every year.
Most of these fractures are never investigated for osteoporosis - and therefore never treated for the cause.
Gupta et al, Indian Journal of Medical Research 1967:55:1341-8

5. Incidence of Hip fractures
Asia will emerge as the largest sufferer of osteoporosis related fractures

6. Osteoporosis vs other diseases
Total incidence of osteoporosis related fractures far exceeds other diseases

7. What makes us more prone?
Indians have a poor calcium intake
We don’t drink enough milk as children
We have a higher incidence of varied degrees of lactose intolerance
Rice is a poor source of calcium
Vegetarian diets and cereals have low bio-availability of calcium (<30%)
Vit D deficiency is common
Protein intake is poor
Excess salt intake – may increase urinary loss of calcium
Healthy exercise is neglected
Significantly lower BMD: mean spinal BMD by DEXA is 2SD below the American-European population between 20 to 59 yrs population*
Lower BMI: osteoporosis is more common in thin women
Late menarche’ in girls - low estrogen exposure
Awareness is low
*Nangia et al, ESICON 1977

8. Why is osteoporosis serious?
It affects many more women than heart attacks, strokes and breast cancer together
Osteoporosis kills by its complications-An osteoporotic fracture reduces the sufferer’s life expectancy by a decade.
In addition, it seriously compromises quality of life
Fractures are very expensive to treat-the economic burden of osteoporotic fractures is immense.

9. Common Fracture/BMD measurement Sites

10. World Health Organization (WHO) guidelines for osteoporosis
Peak Bone Mass
Normal
Osteoporosis
Osteopenia -1
T-Score
-2.5 -2

11. Who to Treat? T-Score* Therapy Decision Below -2.5 High Risk Treat
Above -1.0
Therapy Decision
High Risk
Treat
Moderate Risk
Treat if other risk factors
Low Risk
Check again in 1-2 years
Treatment is critical for patients with fracture
Other potential candidates for treatment are patients with low BMD and/or other risk factors
The results from BMD testing provide a general guide for when to initiate therapy. As a rule of thumb, patients who present with a vertebral or hip fracture, those with a T-score lower than -2.0 and no risk factors, and patients with a T-score lower than -1.5 and other risk factors, as well as those in whom nonpharmacologic measures are ineffective, are candidates for drug treatment to reduce the risk for fracture.27 Many of these patients have already experienced fracture and may have “silent” fractures. While women with a T-score above -1.5 generally do not require drug therapy, they should be encouraged to follow the fundamental measures for bone health and be monitored every 1 to 2 years for changes in fracture risk.28
International Osteoporosis Foundation

12. Osteoporosis: a team work
Sp. Doctor
Dietitian
Govt.
NGO
Patient &
Family
Sp. Nurse
Orthopaedic
Surgeon
Physio.
Orthotist
Fm. Doctor