Osteoporosis, often referred to as the “silent disease,” weakens bones to the point where they are easily fractured. While this condition affects millions globally, Indian women are disproportionately at risk. As we mark World Osteoporosis Day on October 20th, it is crucial to understand why Indian women are more susceptible to this debilitating disease and what steps can be taken to reduce this risk.
What is Osteoporosis?
Osteoporosis is a condition characterized by the loss of bone mass and deterioration of bone tissue. This leads to fragile bones that are prone to fractures, even from minor falls or, in severe cases, from sneezing or bending over. Women, particularly postmenopausal women, are at greater risk due to the drop in estrogen levels, a hormone that protects bones.
The Situation in India
India is home to more than 230 million postmenopausal women, a group highly vulnerable to osteoporosis. Studies show that Indian women develop osteoporosis at an earlier age compared to their Western counterparts, with a majority affected after the age of 40. The reasons behind this heightened susceptibility are multifaceted, ranging from dietary deficiencies to lifestyle choices, genetic predisposition, and cultural factors.
Key Factors Contributing to Osteoporosis in Indian Women
1. Nutritional Deficiencies
A major contributor to osteoporosis in Indian women is widespread malnutrition, especially deficiencies in calcium and vitamin D. Calcium is essential for building and maintaining strong bones, but Indian diets, especially vegetarian ones, are often low in calcium-rich foods like dairy products. Moreover, lactose intolerance is common in India, leading many women to avoid milk-based products.
Vitamin D deficiency is another major concern. Despite abundant sunlight, over 70% of Indians are vitamin D deficient. This can be attributed to limited sun exposure due to cultural practices such as wearing clothing that covers most of the body, and the use of sunscreens or spending time indoors. Vitamin D is essential for calcium absorption, and its deficiency further exacerbates the risk of developing weak bones.
2. Early Menopause and Low Estrogen Levels
Indian women, on average, experience menopause at an earlier age (around 47-49 years) compared to women in Western countries. Early menopause leads to a premature drop in estrogen levels, which accelerates bone loss. In addition, conditions such as polycystic ovary syndrome (PCOS) and hysterectomy performed at a younger age further contribute to decreased estrogen levels, making bones more susceptible to osteoporosis.
3. Genetic Factors
Genetic predisposition also plays a significant role. Studies indicate that women from certain ethnic backgrounds, including South Asians, have lower peak bone mass, which makes them more vulnerable to bone loss as they age. Indian women, especially those with a family history of osteoporosis, are at higher risk.
4. Sedentary Lifestyle and Lack of Exercise
Physical inactivity is a major risk factor for osteoporosis. With urbanization and changing lifestyles, many Indian women are becoming increasingly sedentary. Lack of weight-bearing exercises like walking, running, or resistance training contributes to reduced bone density. Coupled with poor dietary habits, this sedentary lifestyle accelerates bone deterioration.
5. Cultural and Societal Factors
Cultural norms and practices also play a role in making Indian women more prone to osteoporosis. Traditional roles often prioritize family over personal health, leading many women to neglect their own nutritional needs. Additionally, the pressure to remain slim often results in restrictive diets that are low in essential nutrients, further increasing the risk of osteoporosis.
6. Inadequate Awareness and Screening
Awareness about osteoporosis and the importance of bone health remains low in India. Routine screening for bone density is uncommon, particularly in rural areas. Most women only realize they have osteoporosis after suffering a fracture, at which point the disease is already advanced.
Preventing Osteoporosis: What Can Be Done?
While Indian women are at higher risk of developing osteoporosis, there are several preventive measures that can be taken:
1. Increase Calcium and Vitamin D Intake
Ensure adequate consumption of calcium-rich foods like dairy products, leafy greens, nuts, and fortified cereals. Vitamin D supplements or sensible sun exposure can also help in maintaining healthy bone mass.
2. Regular Exercise
Incorporate weight-bearing and resistance exercises into daily routines. Activities like brisk walking, running, and yoga can strengthen bones and improve overall health.
3. Early Screening and Bone Health Monitoring
Women, particularly those above 50, should undergo bone density tests to assess their risk for osteoporosis. Early detection allows for timely interventions such as medications or lifestyle changes.
4. Hormone Replacement Therapy (HRT)
For women undergoing early menopause, HRT can help maintain estrogen levels, thereby reducing the risk of osteoporosis. However, this should be done under medical supervision due to potential side effects.
5. Lifestyle Modifications
Avoid smoking, excessive alcohol consumption, and restrictive dieting. A balanced diet and a healthy lifestyle can significantly lower the risk of osteoporosis.
Conclusion
Osteoporosis is a growing concern for Indian women, but with greater awareness, early screening, and lifestyle changes, it is possible to prevent and manage this condition. This World Osteoporosis Day, let’s encourage women to prioritize their bone health. Simple steps like improving nutrition, staying active, and undergoing regular health checks can make a significant difference in reducing the burden of osteoporosis among Indian women.
By addressing the unique challenges faced by Indian women, we can help ensure healthier, stronger bones for future generations.
By Dr. David Chandy
Director - Endocrinology & Diabetology, Sir H. N. Reliance Foundation Hospital