Osteoporosis

What is Osteoporosis?

Osteoporosis is a condition where the bones become weak and fragile, increasing the risk of fractures even with minor falls or injuries.

Bones are made of calcium and protein and have a honeycomb-like internal structure.
Healthy bones can withstand daily stress and minor falls.
In osteoporosis, the bone become thin and brittle.

What Happens in Osteoporosis?

A healthy person should not fracture a bone from a fall form a standing height.
In osteoporosis as the bones are weak this can happen and , it’s called a low-trauma or fragility fracture.
In osteoporosis, common fracture sites include:
- Spine (vertebrae)
- Hip
- Wrist (forearm)

These fractures can occur from:

Minor falls
Lifting objects
Even everyday actions without falling (e.g. coughing, bending)

Who is at Risk?

Postmenopausal women
Elderly men
Family history of hip fractures
People with a history of previous low-impact fractures
Vitamin D or calcium deficiency

How is Osteoporosis Diagnosed?

Osteoporosis often has no symptoms until a fracture occurs.

Main test: DEXA Scan (Dual-Energy X-ray Absorptiometry)

Measures bone density at spine and hip
T-score ≤ –2.5 = osteoporosis

Goal of Treatment
The most important goal is preventing fractures.

“Stop at one” – if you’ve had one fracture, take steps to prevent another.

Treatment Options

Bisphosphonates – First-line treatment
- Oral tablets (e.g., Alendronate) – once a week
  - Take on an empty stomach, first thing in the morning
  - Stay upright and avoid food/drink for at least 30 minutes
- Intravenous (e.g., Zoledronic acid) – once a year
  - May cause flu-like symptoms after first dose
  - Avoid in kidney disease
Denosumab (Prolia)
- Injection once every 6 months
- Option for patients who cannot take bisphosphonates
- Requires calcium level monitoring
PTH Analogues (e.g., Teriparatide)
- Daily injection for up to 18 months
- Reserved for very severe osteoporosis

Supplements

Calcium: 1000–1200 mg/day (diet + supplements)
Vitamin D: 800–1000 IU/day

Calcium-Rich Foods:

Small fish eaten with bones

E.g., sprats (haal masso), dried fish

The bones are a powerful source of natural calcium.

Dairy products

Curd (kiri), milk, cheese

Traditional buffalo curd is particularly rich in calcium.

Leafy greens

Gotukola, manioc leaves, drumstick (murunga) leaves

These also provide iron, fibre, and antioxidants.

Legumes & soy-based foods

Green gram, cowpea, soy milk, tofu

Great for vegetarians and affordable protein sources.

Nuts and seeds

Sesame seeds (thala), groundnuts (peanuts)

Can be added to rice, sambols, or eaten as snacks.

Vitamin D Sources:

Sunlight

15–30 minutes of morning sunlight (before 10 AM) on arms and face is usually enough for most Sri Lankans.
Darker skin needs slightly longer exposure.

Fatty fish

E.g., tuna, mackerel, salmon (when available)

Lifestyle & Prevention

Exercise:

Walk at least 40 minutes daily (can be split indoors/outdoors).
If very elderly/frail: 10 minutes, 3 times a day.
Strengthening & balance training:
- Get up and move every 10–15 minutes.
- Physiotherapist-guided programs are helpful.

How to Prevent Falls at Home:

Bathroom Safety
- Install grab bars near the toilet and shower
- Use non-slip mats inside and outside the bathroom
- Always mop dry after use
- Consider a commode chair if squatting is unsafe
Improve Lighting
- Use bright, warm lights in bedrooms, corridors, and stairs
- Install night lights or motion-sensor lamps
- Keep a torch near the bed for emergencie
Organize Cables & Rugs
- Tie fan cables to the wall or secure under furniture
- Avoid loose rugs or fix them with anti-slip tape
- Keep walkways clear of clutter
Modify Entrances & Stairs
- Add handrails to stairs and verandas
- Paint edges of steps with a bright colour
- Ensure steps are not slippery (use rough tiles or strips)
Footwear Matters
- Wear well-fitting, non-slip footwear even at home
- Avoid flip-flops, smooth soles, or walking barefoot

Strengthen Your Body

Even with home modifications, it’s essential to keep your body strong:

Do leg-strengthening and balance exercises daily (e.g. heel raises, wall squats)
Join a senior yoga or stretching class (check with your doctor)
Maintain a healthy diet with calcium and vitamin D

Monitoring & Follow-Up

DEXA scan every 1–2 years.
Regular review of:
- Calcium & vitamin D levels
- Kidney function (if on certain drugs)
Medication review with your doctor

When to Seek Medical Advice

New or sudden back pain
Loss of height or change in posture
Hip or wrist pain after a fall
Side effects from medication

Rheumatology