Her face told me immediately that something was not right. My mother-in-law is usually cheerful and enthusiastic to greet us when we visit her home for the holidays, but this time her voice was feeble and her face was darkened by a smothered grimace. Then I noticed the limp and her hand bracing her back.
“Mother, what happened?” I asked.
“Oh, I fell two days ago. I slipped as I stepped down from the chair and fell on my bottom. I was reaching for the paper plates to use for the ancestral rites. Even though I fell on my bottom, my back has not stopped hurting,” she said.
It was the day before Lunar New Year. All of the private medical clinics were closed.
I decided to forego taking my mother-in-law to an emergency room since she could walk, urinate, defecate and denied having an abnormal sensation and tingling in her legs or feet.
Over the course of the next two days, however, no amount of extra-strength Tylenol, massage, and heat therapy would significantly mitigate the pain.
A spinal X-ray performed two days after Lunar New Year revealed the cause of my mother-in-law’s intractable discomfort: a compression fracture of one of the lower vertebrae due to osteoporosis.
Alice Hyun-Kyung Tan
Q: What is osteoporosis?
A: Osteoporosis is a disease in which the density and quality of the bone deteriorate, making it susceptible to fracture. It is estimated to affect 200 million women worldwide, but osteoporosis is not limited to females. Importantly, 1 in 5 men over the age of 50 will experience an osteoporotic fracture, and the overall mortality is 20 percent in the first 12 months after a hip fracture in men.
Q: What are the risk factors for osteoporosis?
A: Some risk factors are beyond a patient’s control, such as older age, parental history of fracture, female gender, personal history of fracture, menopause, long-term glucocorticoid use, rheumatoid arthritis, and primary/secondary hypogonadism in men. Other osteoporosis risk factors are modifiable: excessive alcohol intake, smoking, low body mass index, vitamin D deficiency, insufficient exercise, low dietary calcium intake, and eating disorders.
Q: Can osteoporosis be prevented?
A: Yes. A well-balanced diet with adequate amounts of calcium and vitamin D, participation in regular physical activity, and avoidance of smoking and heavy alcohol intake are vital steps to preventing osteoporosis.
These measures should be emphasized even in children and adolescents since attaining optimal bone mass in early adulthood decreases one’s risk of osteoporosis later in life.
Q: How is osteoporosis treated?
A: In addition to the lifestyle treatments of weight-bearing exercise and sufficient intake of calcium, vitamin D, and protein, there are a number of pharmaceutical agents in the form of pills and injections that can be used to treat osteoporosis.
Q: Where can I learn more about osteoporosis?
A: The NIH Osteoporosis and related Bone Diseases National Resource Center (http://www.niams.nih.gov/Health_Info/Bone/) and the International Osteoporosis Foundation (www.iofbonehealth.org) are good sources of reliable information regarding osteoporosis.
By Alice Hyun-Kyung Tan, M.D.
The author is a diplomat of the American Board of Internal Medicine and clinical assistant professor of Internal Medicine at Samsung Medical Center International Health Services. ― Ed.