Prevalence of osteoporosis in Eastern Odisha – A cross-sectional study of bone mineral density
Madhuchhanda Pattnaik1, Tanmoy Mohanty2, Sunil Kumar Jena3
1 Department of Physiology, SCB Medical College, Cuttack, Odisha, India
2 Department of Orthopaedics, SCB Medical College, Cuttack, Odisha, India
3 Department of Physiology, VIMSAR, Burla, Odisha, India
|Date of Submission||25-Jun-2021|
|Date of Acceptance||08-Dec-2021|
|Date of Web Publication||15-Jun-2022|
Dr. Tanmoy Mohanty
Burdwan Compound, College Square P.O., Cuttack – 753 003, Odisha
Source of Support: None, Conflict of Interest: None
Introduction: Osteoporosis is a common metabolic disease of the bone characterized by decreased bone mass and micro-architectural deterioration in bone tissues that results in increased susceptibility to fractures. Osteoporosis is a significant public health problem in many parts of the world, also in India. The primary purpose of the article is to find out the prevalence of osteoporosis in Eastern Odisha through the cross-sectional study of bone mineral density (BMD). Materials and Methods: Two thousand and one hundred individuals within the age range of 20–82 years were included in the study. It was conducted between February 2016 and August 2017. The instrument to measure BMD was the Achilles Express Bone Ultradensitometer. Their average BMD was calculated according to T score by using the World Health Organization guidelines for the classification into normal, osteopenic, and osteoporotic. The findings were statistically analyzed. The results were compared with the results of other authors. Statistical analysis was performed using the SPSS software version 16 (IBM Corporation, Armonk, New York USA). Results: Prevalence of osteoporosis was found to be 22.4% and osteopenia 37.9%. There was a significant difference in the prevalence of osteoporosis between premenopausal and postmenopausal women. Conclusion: In India, no centralized data are available to show the prevalence of osteoporosis. This study was an effort to find out the prevalence of osteoporosis in Eastern part of Odisha, India. Ultrasonic heel densitometry is a safe and noninvasive method for the assessment of BMD to diagnose and assess the osteoporotic individuals so that adequate steps can be taken in them to prevent fracture and other complications of osteoporosis.
Keywords: Achilles express bone ultradensitometer, osteopenic, osteoporosis
|How to cite this article:
Pattnaik M, Mohanty T, Jena SK. Prevalence of osteoporosis in Eastern Odisha – A cross-sectional study of bone mineral density. J Orthop Traumatol Rehabil 2022;14:1-4
|How to cite this URL:
Pattnaik M, Mohanty T, Jena SK. Prevalence of osteoporosis in Eastern Odisha – A cross-sectional study of bone mineral density. J Orthop Traumatol Rehabil [serial online] 2022 [cited 2022 Jul 3];14:1-4. Available from: https://www.jotr.in/text.asp?2022/14/1/1/347369
The World Health Organization (WHO) defines osteoporosis as being based on a certain reduced level of bone mineral density (BMD). In this diagnosis, peak bone mass is measured and compared to the peak bone mass in a young adult of the same race and sex (T-score)., The difference obtained between the subject’s value and the normal is expressed in terms of standard deviations (SD) below the mean.
According to the WHO, the criteria for osteopenia are defined as “BMD between − 1 and − 2.5 SD below the young adult reference mean.” Osteoporosis is similarly defined as “BMD that is − 2.5 or more below the young adult reference mean.” Established or severe osteoporosis is defined as “A T-score below − 2.5 in the presence of one or more fragility fractures.”
Any fracture resulting from osteoporosis gives rise to pain, suffering, and disability. In old age, when a bone becomes fragile and fractures, it adds up to other age-related complications which may be fatal. According to the WHO technical group report series, “Life expectancy at present is 67 years in India and is expected to increase to 71 years by 2025 and to 77 years by 2050.” According to the guidelines for the diagnosis and management of osteoporosis, it is stated: “At present, 10% of the Indian population is older than 50 years; however, these figures will rise to 34% by 2050.” Thus rise in graying population as a result of increased longevity will cause increased proportions of people living beyond 50 years. This is likely to cause more cases of osteoporosis in the Indian population. In 2013, estimates suggested that ~50 million people in India had T-scores of <−1. The primary purpose of the article is to find out the prevalence of osteoporosis in Eastern Odisha through the cross-sectional study of BMD and to compare it with other available studies.
Basic principles of densitometry
It is the ash weight, the residual after complete dehydration represents mineral content and is proportionate to bone strength., In ultrasound bone densitometry, ultrasound waves when passed through cancellous bone, the waves are attenuated by it. The degree of attenuation is directly proportional to the ash weight density of the bone. The two most common measurements, i.e., broadband ultrasound attenuation and speed of sound (SOS) are combined to give a composite index known as stiffness index expressed as T score which has a coefficient of variation (r = 0.85) concerning BMD of the heel by dual-energy x-ray absorptiometry (DEXA). Gradually with advanced techniques, the accuracy of measurements improved. It largely depends upon the soft tissues surrounding the bone. The soft tissue surrounding the peripheral skeleton is less; hence, the peripheral measurements are more accurate. The more accurate the device, the lower the diagnostic variability as defined by SD. Measurements done for peripheral include radiographic densitometry and ultrasound bone densitometry.
Quantitative ultrasound (QUS) bone densitometry is a noninvasive, nonhazardous method, in which ultrasound waves when passed through calcaneus get modified. The SOS is calculated in the inbuilt computer of the machine, which gives the stiffness index of the bone. The SD (T-score) reflects the BMD.
|Materials and Methods|
The study was conducted between February 2016 and August 2017. Free camps were being organized to assess the BMD of individuals, using ultrasound bone densitometer in various clinics of Cuttack, Odisha, India and its neighboring suburban areas. 2100 adults within the age range of 20–82 years were included in the study. A detailed history of complaints, associated diseases, and previous treatment pertaining to osteoporosis was recorded. Informed written consent was obtained from all the participants involved in this study. Patients with a history of recent or old fracture of the calcaneus, history of steroid therapy, endocrine disorders, drug intake that could affect bone turnover were excluded from the study. After careful verification of data of 2100 participants, it was found out that only 2058 entries were recorded correctly with all relevant parameters that were necessary for the inclusion.
The instrument to measure BMD was the achilles express bone ultradensitometer. The foot was cleaned and electrolyte gel was applied to both sides of the calcaneous before the person rested the right heel in the space provided on the platform of the instrument. Care was taken to see that the heel did not move while the ultrasound was passed and the machine gave a signal at the end of the test. After the required calculations were done inside the machine, a printed chart came out. This instrument used transducers at a fixed position to minimize errors due to contact pressure, change of pressure, and variable heel width.
The findings of the present study are presented in different tables from [Table 1], [Table 2], [Table 3], [Table 4], [Table 5], [Table 6].
[Table 1] and [Figure 1] depicts the demographic profiles of the study population. There are more male participants (1138) as compared to female participants (920). In the case of males, the maximum participants were from the age group (30–39) and (60–69). In the female study group, the maximum participants were from the age group (50–59) and (40–49).
[Table 2] and [Figure 2] compares the BMD status in both males and females participants. Male participants were more normal (40.4%) as compared to females. In male subjects, the cases of osteopenia were more prevalent (41.4%) than female participants (33.4%). Osteoporosis cases were more in females (27.8%) as compared to males (18.1%). In general, in the study group (39.6%) were normal, (37.6%) were osteopenic, and (22.4%) were osteoporotic.
[Table 3] and [Figure 3] shows the BMD pattern in female study cases. In the age group (20 − 39) T score was normal in maximum subjects (57.1%) as compared to the (40 − 59) age demographics, where the percentage of osteopenia and osteoporosis gradually rises. The age group (60 − 79) years shows the highest percentage of osteoporotic cases 86 out of 198 cases.
[Table 4] and [Figure 4] shows the comparison of BMD status in three different age groups (20–39), (40–59), and (60–79), consisting of male participants. Participants having normal BMD are highest (49.5%) in the age group (20–39). In the age group (40–59), the percentage of osteopenia is the highest, and in the age group (60–79), the percentage of osteoporosis is the highest.
[Table 5] shows the T-score of premenopausal women (17–35) compared with the T-score of postmenopausal women. The P value was highly significant as shown by [Table 5].
The BMD status of the study population showed that 37.9% were osteopenic and 22.45% were osteoporotic. When we compared the BMD status in both sexes, the prevalence of osteoporosis was more in females (27.8%) than that of males (18.1%).
When the prevalence of osteoporosis was studied in different age groups, it was marked that as the age advances there was a rise in the cases of osteopenia and osteoporosis. It was more marked in the female study group (43.4%) as compared to males (26.08%) in the age group 60–79 years.
Why at all we need to assess bone mass? It is important clinically to diagnose the cases of osteopenia and osteoporosis. It can be used for fracture risk prediction and reduce the morbidity of old age. The genesis of osteoporosis is complex. It is not known whether osteoporosis in Indians is a consequence of lower peak bone mass or an increase in age-related loss of bone. Peak bone mass is attained between the age group of 25–35 years and approximately 6% of bone is lost per the decade after having peak bone mass in Indians. Certain factors affect peak bone mass. These are both genetic and nongenetic (nutrition, smoking, exercise, and hypogonadism). Sub-clinical calcium and Vitamin D deficiency are present in a significant proportion of the general population in India, often before peak bone mass is reached, resulting in reduced peak bone mass and a state of continuing deficiency further promotes bone loss. After menopause, there is an acceleration of bone loss averaging 2% per year for the next 5–10 years followed by a slower rate of bone loss. Lifetime losses may reach 30%–40% of peak bone mass in females and 20%–30% in males.
When the result of the present study was compared with similar studies done by other workers who had used ultrasound bone densitometry study, it was seen that in the study of Patel et al., the percentage of normal individuals was the highest (48.4%) and osteoporosis was low (9.63%) as compared to our results which were (39.65%) and (22.44%) respectively. When compared with the study of Sharma and Rao, here the incidence of osteoporosis was higher about 39.95% as compared to 22.44% in our study population. Rao et al.’s study on 288 patients was almost similar to our findings, where they found that 20.83% were osteoporotic and 35.76% were osteopenic.
The findings of the present study correlate well with the findings of Ramalingaiah et al. done on 1188 subjects. The percentage of osteoporosis and osteopenia was almost similar, osteoporosis (21.46%) and osteopenia (39.73%), although Ramalingaiah et al. l had done the study based on DEXA scans.
When we compared our results with that of Bhaskar Borgohain, who also used the DEXA scan for the estimation of BMD, the demographic profiles were very similar, where they selected participants from the age group (20–84), but their percentage of osteoporosis and osteopenia was slightly higher. This may be because he included symptomatic patients admitted to the hospital.
Literature review revealed an interesting study conducted by El-Desouki et al. to establish the correlation between DEXA and QUS. They found the correlation between all modalities to be significant but varied from high to low. It was high between the lumbar spine and femoral neck, moderate between lumbar spine and forearm, and low between the lumbar spine and QUS of the heel. We can presume that heel densitometry can be a good predictor of BMD value for the lumbar spine.
In India, no centralized data are available to show the prevalence of osteoporosis. This study was an effort to find out the prevalence of osteoporosis in the eastern part of Odisha. Ultrasonic heel densitometry is a safe and noninvasive procedure for BMD assessment, even though DEXA is still the gold standard for it.
By estimating BMD, we can estimate the fracture risk of a person by using available tools such as WHO’s FRAX risk factors assessment., Thus, fracture which is a major cause of morbidity and mortality in elderly men and postmenopausal women can be prevented by lifestyle modifications such as doing regular exercise, adequate diet, and treating the cause.
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Conflicts of interest
There are no conflicts of interest.
Handa R. Epidemiology, pathophysiology and diagnosis of osteoporosis. Mannual of Rheumatology. 5th Edn. New Delhi; CBS Publishers and distributers Pvt. Ltd; 2018. p. 529-36.
Kanis JA, Alexeeva L, Bonjour JP, Burkhardt P, Christiansen C, Cooper C. et. al. Assessment of fracture risk and its application to screening for postmenopausal osteoporosis. Synopsis of a WHO Report. Osteoporosis Int.1994;4:368-81.
Kanis JA, Delmas P, Burckhardt P, Cooper C, Torgerson D. Guidelines for diagnosis and management of osteoporosis. The European Foundation for osteoporosis and bone disease. Osteoporos Int 1997;7:390-406.
Government of India: Ministry of Home Affairs Office of the Registrar General and Census Commissioner, India; 2011. Available from: [Last accessed on 2015 May 03].
Mithal A, Kaur P. Osteoporosis in Asia: A call to action. Curr Osteoporos Rep 2012;10:245-7.
Sterkel BB, Miller PD. Bone mass measurement-techniques in clinical practice. In: The Osteoporotic Syndrome. 4th ed. Singapur: Harcourt Publishers; 2000. p. 46-7.
Gupta A. Osteoporosis in India – The nutritional hypothesis. Natl Med J India 1996;9:268-74.
Ahuja M. Normal variation in the density of selected human bones in North India. A necropsy study. J Bone Joint Surg Br 1969;51:719-35.
Patel A, Nair N. Osteoporosis monitoring and awareness project – A case for timely action. Ind Med Gaz 2000;cxxxiv:173-7.
Sharma DR, Rao S. Osteoporosis epidemiology review and panacea osteoporosis evaluation study. J Indian Med Assoc 2000;98:655, 658-9.
Rao H, Rao N, Sharma LR. A clinical study of bone mineral density using heel ultradensitometer in southern Maharashtra. Indian J Orthop 2003;37:119-27.
Qureshi A, Ullas M, Ramalingaiah A. Burden of Osteoporosis in the Urban Indian Population. EC Orthopaedics. 2017;7:74-81.
Bhaskar B, Phukan P, Sharma K. Prevalence of osteoporosis among vulnerable adults residing in the north eastern region of India: A preliminary report from a tertiary care referred hospital. J Orthop Traumatol Rehabil 2017;9;74-81.
El-Desouki MI, Sherafzal MS, Othman SA. Comparison of bone mineral density with dual energy X-ray absorptiometry, quantitative ultrasound and single energy X-ray absorptiometry. Saudi Med J 2005;26:1346-50.
Unnanuntana A, Gladnick BP, Donnelly E, Lane JM. The assessment of fracture risk. J Bone Joint Surg Am 2010;92:743-53.
Willson T, Nelson SD, Newbold J, Nelson RE, LaFleur J. The clinical epidemiology of male osteoporosis: A review of the recent literature. Clin Epidemiol 2015;7:65-76.
[Figure 1], [Figure 2], [Figure 3], [Figure 4]
[Table 1], [Table 2], [Table 3], [Table 4], [Table 5], [Table 6]