Epidemiology and treatment of osteoporosis in women: an Indian perspective

Abstract

The number of women with osteoporosis, ie, with reduced bone mass and the disruption of bone architecture, is increasing in India. While data on prevalence of osteoporosis among women in India come from studies conducted in small groups spread across the country, estimates suggest that of the 230 million Indians expected to be over the age of 50 years in 2015, 20%, ie, ~46 million, are women with osteoporosis. Thus, osteoporosis is a major public health problem in Indian women. Low calcium intakes with extensive prevalence of vitamin D deficiency, increasing longevity, sex inequality, early menopause, genetic predisposition, lack of diagnostic facilities, and poor knowledge of bone health have contributed toward the high prevalence of osteoporosis. Bone health may be optimized by creating an environment to achieve peak bone mass during adolescence, maintenance of healthy bone throughout the life cycle, and prevention of bone loss postmenopausal. In Indian women, calcium, vitamin D, and bisphosphonates are the commonest first-line therapies used. The use of other drugs such as hormone replacement therapy, estrogen agonists, calcitonin, parathyroid hormone, and denosumab is decided as per the affordability and availability of treatment options. Major gaps still remain in the diagnosis and management of osteoporosis, thus highlighting the need for more structured research in this area. This review focuses on the epidemiology of osteoporosis in Indian women and available treatments.

The underlying pathophysiology and therapeutic approaches for osteoporosis

“…reported in India, the prevalence of vertebral fractures (17%) in men and women aged more than 50 (18.8% and 17.1% respectively). Among women more than 50 years of age, the incidence of hip fractures reported were 159/100,000 and 34.3/100,000 for low trauma fractures at hip, spine, and wrist . In 2014, in India, the prevalence of osteoporosis was estimated to be 10–15% and 20% in men and women respectively .…”

Alteration of fecal microbial compositions and bacterial taxa in female osteoporotic patients

“…One key reason is the sudden decline of estrogen production for women after the menopause but a gradual process for men (12). Therefore, hormone replacement therapy effectively decreased the risk of bone fracture in post-menopausal women (13, 14). It indicated that the pathophysiology of osteoporosis may differ between women and men.…”

Evaluation of low bone mass and prediction of fracture risk using metacarpal radiogrammetry method: a comparative study with DXA and X‐ray phantom

“…Several studies conducted across India have shown that the prevalence of osteoporosis is around 230 million people who were aged above 50 years in 2015, and that nearly 23 million women are expected to have osteoporosis . Osteoporotic bone fissures can be found in one in three women and one in eight men.…”