Osteoporosis is a degenerative condition in which bones of the human body gradually start losing bone mass or becoming porous (hence the name). Osteoporosis is more prevalent in women than men. One in three women after the age of 50 years will develop the condition compared to one in five men. Again, white Caucasian and Asian women are more at risk than African and Central American women. While there are many causes for Osteoporosis that are common to men and women, there are some reasons for the gender disparity, or why women are more at risk.
1. Bone thickness and genes: Women, in general, have thinner bones than men, which is purely an evolutionary trait. The trend continues generation after generation, given that most women choose a similar lifestyle and bone-workload, across generations. However, girls who take to sports in their childhood or early teens are able to buck this trend. Such girls can develop stronger and thicker bones than other women in their family, the benefit of which is passed on to the daughter too, in most cases.
2. BMI in younger years: Bone density increases gradually from childhood till it reaches its peak in the late 20s, or mid-30s in case of an athlete or sportswoman. Having a healthy bone mass in childhood and early teens is a good thing as the risk of developing Osteoporosis in later years reduces. So if you are a thin or skinny girl, and your elders are telling you to exercise and put on some healthy weight, its good advice. As muscle mass and overall weight increase, the bones also become denser which is good. In the same way, having a low BMI in childhood increases the risk of Osteoporosis in later years. While thin and skinny boys are more likely to do something to address the issue, thin and skinny girls are more likely to just live with the condition.
So also, eating disorders like bulimia and anorexia increase the risk, as the body does not get vital nutrients from the food. Here again, eating disorders are more common in girls and women than boys and men.
3. Peri and post-menopausal women: The female hormone estrogen as well as the male hormones testosterone and progesterone that are all present in the woman’s body start dropping in production, during and after menopause. This leads to reduced bone mass with time. In some women, this deterioration happens very quickly, over the first 5-7 years after menopause. Such women can easily develop a fracture in the bones. In other women, the drop is gradual which increases the risk of developing Osteoporosis over time.
4. Active/Sedentary lifestyle: Women who have desk jobs in younger years, and women who lead sedentary lifestyles with less activity levels at any age, are at risk. Also, the convenience available from modern-day kitchen appliances reduces exertion of bones and muscles compared to earlier generations, which has increased the risk. In the same way, women who are very active and exert themselves physically, are at lesser risk, irrespective of their menopausal status.
5. Diet: While calcium and mineral supplements are quite common today, the human body is most efficient in absorbing calcium from food. So women, or men, with a poor diet that is low in Calcium or Vitamin D can increase their risk of developing Osteoporosis. The increase in consumption of processed, refined and fast-foods in recent decades, in favor of healthy, home-cooked meals that contain fresh fruits and vegetables, is one of the reasons for the deficiency in nutrients. With more and more women entering the workforce, increased consumption of convenience-foods along with caffeine has become prevalent, while healthy diet has taken a back-seat, leading to higher prevalence of Osteoporosis. Carbonated beverages are another culprit. Women are as likely as men to pick up a bottle of fizz which increases the risk.
6. Lifestyle habits: Both smoking and excess alcohol-consumption increase the risk of Osteoporosis, in both men and women. However, due to the reasons explained above, women are more at risk than men, even if they consume the same quantity of alcohol, or smoke, as much as their male counterparts. Cultural shifts, professional or peer pressures, the easy availability of tobacco products and alcohol, and a desire to match men in lifestyle choices, are all pushing more and more women into lifestyle habits that increase their risk for Osteoporosis. Taken in isolation, lifestyle habits do not increase the risk for Osteoporosis in women any more than it does for men, but when combined with the other factors listed above, the risk is compounded, unlike men where such factors are absent.
7. Image and Societal factors: The trend of middle-aged men pumping weights in a gym is relatively new in India, or most parts of the world, unlike certain Western societies. That being the case, finding middle-aged Indian women pumping iron in a gym is extremely rare. Middle-aged women are more likely to be conscious of themselves and their workout regimen in a gym that is dominated by men, boys and younger women, which is one of the reasons most of them avoid gymnasiums. In the process, whatever little chance there is of restoring bone mass and arresting the spread of Osteoporosis is lost in middle-aged women, unlike middle-aged men who are less self-conscious in a gym. This only sustains the gradual degeneration of bone mass in women.
Given the above risk factors, it should be quite easy to notice the presence of this condition, and address it immediately, right? Wrong! Osteoporosis is called a silent killer because it does not always present prominent symptoms. It is easy to ignore those bouts of back or lower-back pain as general fatigue (“a hard day”) or age-related decline in health. Women who are overweight are even more likely to rationalize this way. As a result, Osteoporosis is detected when it is quite late, usually after a fracture or due to nagging bouts of severe back/hip pain.
If you are a woman who is 40 years or above of age, it is good to get an annual Orthopedic health checkup. Consult an orthopedic doctor or surgeon at a reputed hospital. He/she will explore all facets of your life, such as family history of bone conditions and cancer, your lifestyle choices, menstrual health, overall health and any medications being taken for other conditions, etc. Subsequently, he/she will order for a bone densitometry test.
Based on the results, the doctor may recommend lifestyle changes and put you on a preventive course of treatment in case of early-stage Osteoporosis. And in case of middle-stage Osteoporosis, he/she will choose the right course of treatment and rehabilitation, so that the bone degeneration can be slowed down as much as possible. Late-stage Osteoporosis may require a joint-replacement surgery and hormone-augmentation therapies.
End of the day, when it comes to Osteoporosis, or any bone and joint condition, prevention is better than cure. Women who are aware, cautious and take good care of their bone-health from a young age, can look forward to good bone-health and hence, a better quality of life, in their older years.
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Reviewed by Dr. Aravindan Selvaraj, Co-Founder, Executive Director and Chief Orthopaedic Surgeon, Kauvery Hospital
Kauvery Hospital is globally known for its multidisciplinary services at all its Centers of Excellence, and for its comprehensive, Avant-Grade technology, especially in diagnostics and remedial care in heart diseases, transplantation, vascular and neurosciences medicine. Located in the heart of Trichy (Tennur, Royal Road and Alexandria Road (Cantonment), Chennai, Hosur, Salem, Tirunelveli and Bengaluru, the hospital also renders adult and pediatric trauma care.
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