Why young Indians in their 20s are developing brittle bones

medium nocaption118378247Recently, a 22-year-old woman walked into an orthopaedic surgeon’s room with complaints of fatigue and joint pain that refused to go away. She had a history of hypothyroidism and polycystic ovarian disease but, at her age, bone-related complications seemed unlikely. The doctor recommended a bone density scan and, to his surprise, found the onset of osteopenia — bone loss due to aging and other factors.For the first time in his 20 years of practice, Dr Mahesh MN, who works at Sathya Sai Orthopaedic Multi-Speciality Hospital in Bengaluru, is noticing a startling trend of osteopenia cases in young adults. Most of them report lethargy, bone pain and frequent fractures after small injuries. “What was common among women in their 40s can now be seen in 20-year-olds,” says Dr Mahesh. “Back in the 2000s when I started my practice, osteopenia was considered a common bone condition among the elderly, but now it is striking the young.”EARLY DAMAGEDoctors say inadequate nutrition and lack of physical activity in childhood lay the foundation for adult bone diseases. Dr Parag Sancheti, chairperson of Pune’s Sancheti Hospital, was appalled to find osteopenia in an 11-year-old boy. “He came for a femur fracture evaluation from a minor trauma when we made the discovery. He had no significant comorbidities but was found to have poor dietary calcium intake, low sunlight exposure and limited physical activity,” he says. ShowQuotesA SILENT DISEASEOsteopenia and osteoporosis are both varying degrees of bone loss as measured by bone mineral density (BMD), a marker for how strong a bone is. Osteopenia is the first stage of bone loss, and often referred to as a ‘silent’ disease since most people with the condition experience no symptoms at all. It typically affects people over 50. Genetics and lifestyle factors also play a part. The good news is that it is reversible.Dr Sancheti says early signs of osteopenia include frequent fractures from minor injuries, persistent bone pain, particularly in weight-bearing areas, noticeable decrease in height and early curvature of the spine or stooped posture. Most ignore these symptoms till the problem worsens to osteoporosis.MEN GET IT TOOA 2024 study published in the Journal of Medical Internet Research (JMIR) showed that with advancing age, women have a higher prevalence of osteopenia and osteoporosis. Testosterone gives men natural protection as it helps maintain bone health and density, but that doesn’t mean men don’t get it. A 2017 paper on ‘Rising prevalence of osteopenia in young and middle-aged men in South Mumbai’, published in the Madridge Journal of Behavioural and Social Sciences, found osteopenia to be an undetected condition in Indian males, with almost 50% prevalence in the elderly and 18% in the young. Vertebral and hip fractures led to functional impairment and greater mortality risk in men than in women.FINDING THE ROOT CAUSEDr Mahesh links rising incidence to poor sleep quality, too much junk food, alcohol and smoking, a sedentary lifestyle, and lack of vitamin D. “Major lifestyle changes in the past 20 years, with more people working through the night and poor dietary intake, has led to this trend. Most patients may not even know they have osteopenia. They must look for fatigue, weakness and pain in knees which are classic symptoms of weaker bones,” he says. medium nocaption118359535The first step of treatment for osteopenia involves diet and exercise choices. The risk of breaking a bone when you have osteopenia is fairly small, so doctors don’t usually prescribe medicine unless your BMD is close to osteoporosis level. But combating a sedentary lifestyle is crucial. Like muscles, bones get stronger when you use them. So, the best moves for bones are weight-bearing exercises that force your body to work against gravity. Dr Amit Kale, senior orthopaedic surgeon at DPU Super Specialty Hospital, Pimpri, recommends at least 10,000 steps daily. “That, and adequate sunlight exposure to boost vitamin D levels, a balanced diet rich in calcium, including dairy products, bananas, custard apple, finger millet etc. One can also take vitamin D and calcium supplements.”Treatment depends on the root cause — hormonal imbalance, lifestyle, diet, or lack of exercise. “For a 22-year-old who came to our hospital last year, we adopted a multi-pronged approach that will take about 5-6 months to completely treat osteopenia. Sometimes, people also require counselling as depression and stress contribute to the condition. Early intervention is crucial to treat osteopenia and avoid osteoporosis,” says Dr Mahesh.