While one’s body shape, height and weight remain the centre of concern for people of all ages, one of the most important parts of the body lies buried from our sight and thereby brutally ignored — our bones! This trend continues until the slightest of injury in older age reveals daunting flaws in the framework that supports us throughout our lives.

Of all the diseases that weaken the bones, osteoporosis is the most common. Occurring due to an imbalance in the bone metabolism such as reduced bone formation, accelerated bone resorption or both, it results in decreased bone density and increased susceptibility to fractures. With diminished bone mass, the bone becomes thin, brittle and porous; hence, the name osteoporosis.

Although essentially an old age disease, there are a multitude of risk factors for osteoporosis such as Asian or white ethnicity, family history of osteoporosis, previous fractures, low levels of calcium/vitamin D or hormones oestrogen/testosterone in the body. Other risk factors include low body weight, smoking, heavy alcohol intake, sedentary lifestyle, eating disorders, endocrine abnormalities, chronic inflammatory diseases, chemotherapy and use of certain drugs.

Osteoporosis is a disease that grows silently over the years, until it reaches a stage where it may present as aching bones, fractures (with or without trauma), lower back or neck pain, loss of height and stooped posture. It is important to understand that once bone damage occurs it is almost impossible to revert to normal again, and hence prevention becomes the mainstay of the therapy.

Bone density is the mass per unit volume of a bone. It is directly related to the bone strength. Bone mass builds gradually during childhood, reaches its peak at about age 25, maintains itself for a decade and naturally begins to decline thereafter. Calcium and phosphorus are the main minerals that constitute the bones, while Vitamin D plays a vital role in the absorption of calcium.

Ensuring that your body receive adequate minerals is the first step towards achieving healthy bones. Foods rich in calcium such as leafy green vegetables, cheese, ice cream, low-fat milk, yoghurt, salmon and tofu should be included in the diet, along with Vitamin D sources such as fatty fish, fish liver oils and eggs. Unlike the popular belief, research shows that calcium is best absorbed from plant sources rather than dairy products.

Exercise comes next in line for the prevention of spongy bones. It plays its part by increasing balance and strength and in turn reducing the frequency of falling. Some of the recommended exercises include walking, jogging, dancing, weights, yoga and use of rowing machines. However, the preferable level and type of activity vary with age and comorbidity (existence of two or more medical conditions) and therefore one should begin exercises after consulting a physician. In general, intense exercises and those with high impact or with a risk of falling must be avoided.

A daily intake of 1.2 to 1.5 gm of calcium and 800-1,000 international units of Vitamin D3 is needed to increase bone mass. This should include the total consumption either through diet or supplements. While taking calcium supplements, it is recommended that more than 600 mg should not be taken at a time, also it should not be taken in combination with other medications/supplements or within a couple of hours of fibre-rich foods.

The diagnosis of osteoporosis is ideally done by a DXA or dual-energy X-ray absorptiometry scan. All women who are 65 and older or those younger than 65 with risk factors for osteoporosis should have a DXA scan done to evaluate their bone status and the presence of osteoporosis or osteopenia (bone mass less than normal but greater than that required to label osteoporosis).

For people with borderline results in DXA scan, a Fracture Risk Assessment Tool (FRAX) has been developed by WHO to assess the probability of fracture in forthcoming years. It is available online and takes into account all individual risk factors to assess the risk of fracture and need for prophylactic treatment.

Although less likely, the risk for developing osteoporosis is present in all individuals at almost any given age. While medications can help improve bone strength, the only way to build and maintain healthy bones is by following a bone-friendly lifestyle including a healthy diet, exercise, avoiding smoking/alcohol, timely screening, preventing falls and treating diseases that may quicken the onset of osteoporosis.