Which is more prevalent among the female population - Osteopenia or Osteoporosis? A cross sectional study

 

Padmanabhan. K¹, Jibi Paul², Sudhakar. S³, Senthil Selvam. P⁴, Sathya Priya. V⁵, Veena Kirthika. S^6*

^1,2,6Assistant Professor, Research Supervisor, Vice Principal, Faculty of Physiotherapy, Dr.MGR Educational and Research Institute, Deemed to be University, Maduravoyal, Chennai-600095.

³Principal/ Professor, Meenakshi College of Physiotherapy, Chennai.

⁴Principal/ Professor, School of Physiotherapy, Vels Institute of Science, Technology and Advanced Studies, Chennai.

⁵Professor, Department of Biochemistry, A.C.S Medical College and Hospital, Chennai.

 

ABSTRACT:

AIM: The aim is to study the prevalence of osteopenia and osteoporosis using quantitative calcaneal ultrasound among female population. METHODOLOGY: It was a cross-sectional study with a sample size of 270 female subjects between 30-70 years for 3 months duration. Subjects who underwent hysterectomy, under hormone replacement therapy, under calcium and vitamin D supplements and diabetes mellitus were excluded. Recruited subjects were screened for osteopenia and osteoporosis using quantitative calcaneal ultrasound. Demographical information including age, height, weight, body mass index, menstrual status, blood pressure and socio-economic status were recorded. RESULT: Out of 270 subjects 57.4% were osteopenic, 15.9% were osteoporotic and 26.7% were normal. There was a close association between the demographical status and the prevalence of osteopenia and osteoporosis. CONCLUSION: Osteopenia seems to be more prevalent than osteoporosis. Early diagnosis of osteopenia among females is necessary to delay the onset of osteoporosis.

 

 

 

INTRODUCTION:

Osteoporosis is a disease characterized by low bone mass and disruption of bone architecture leading to impaired skeletal strength and increase susceptibility to fracture ⁽¹⁾.It is a decrease in bone mass due to activation of osteoclast which enhances bone resorption ⁽²⁾. Osteopenia refers to bone mineral density lower than normal peak bone mineral density but not low enough to be classified as osteoporosis ⁽³⁾.

 

 

 

 

Osteopenia increase the risk of osteoporosis. Causes of osteoporosis are dark skin pigmentation, recent modernization of India resulting in working indoor, reduced physical activity, limited exposure to sun, low consumption of Ca, vitamin D deficiency, oestrogen deficiency, early menopause, genetic factors, bed rest for longer time due to some illness can lead to weakness of the bones and eventually to osteoporosis. High prevalence of vitamin D deficiency in India is a major contributor to low bone mass ^(4,5). Thin and lean persons are more prone to this disease ⁽⁶⁾. Osteoporosis is a major global public health problem associated with significant morbidity, mortality and socioeconomic burden. The greatest bone loss occurs in women during perimenopause and is associated with estrogen deficiency, a condition leading to menopause ⁽⁷⁾. Statistics show that there are about 300 million people with osteoporosis in India.

 

 

Bone aging is a natural phenomenon and in women around 30 years of age, imbalance between bone loss and bone formation occurs. If the bone loss becomes severe, women may develop osteoporosis⁽⁸⁾. Although studies on bone mineral density and menopause status have been conducted in various countries, limited data are available regarding bone mineral density and its determinants in our population⁽⁹⁾. This study was undertaken to estimate the prevalence of osteopenia and osteoporosis in women. Various quantitative techniques are available for the measurement of BMD. Dual energy X-ray absorptiometry is the advanced bone densitometer for measuring BMD. In India, only multi-speciality hospitals have this facility and DEXA scan is very expensive. Quantitative heel ultrasound is yet another technique for assessing BMD and the risk of fracture. Quantitative ultrasound of calcaneus when compared to DEXA scan has also been shown to be better predictor than clinical risk factor for women with lowest T-score. This method of screening will help in early detection and treatment of osteoporosis⁽¹⁰⁾. Ultrasound assessment can be performed non-invasively and the patient is not exposed to ionizing radiation. Ultrasound technology is less expensive than X-ray technology and devices can be designed to be portable⁽¹¹⁾. Measurement of BMD with T-score -1.0 or greater is normal, between -1.0 and -2.5 is osteopenia, -2.5 or below is osteoporosis⁽¹²⁾.This cross sectional study is intended to study the prevalence of osteopenia and osteoporosis among Indian women.

 

METHODOLOGY:

The university research and ethics committee (ACS/2018/59) approved the study protocol. Total 270 female subjects in the age group between 30 to 70 years participated in this cross sectional study and were assessed for the bone mineral density and t score using quantitative calcaneal ultrasound.  The study was performed between February 2018 and April 2018 at the A.C.S Medical College and Hospital and done in accordance with ethical guidelines for biomedical research on human subjects, Indian Council for Medical Research (ICMR), 2006 and also in accordance with the guidelines of Helsinki declaration, revised 2013.

 

PROCEDURE:

A cross sectional study involving 270 female participants was done. Subjects were excluded if they had Vitamin D deficiency, Underwent hysterectomy, under Calcium and vitamin D supplements, Diabetes mellitus. All the subjects signed the informed consent form before participating in this study.  The subjects demographic information such as age, gender, height, weight, body mass index, blood pressure, menstrual status and socioeconomic status were collected and recorded. Based on their BMI, subjects were classified into underweight (BMI<18.5), Normal (BMI is 18.5-25) and overweight (BMI is 25-30).Socioeconomic status was classified using B.G Prasad classification scale 2016 into Upper class when the Per capita income per month is Rs. 6277 and above, Upper middle class with Rs. 6276-3139, Middle class with Rs.3138-1833, Lower middle class with Rs.1882-943 and Lower class with < Rs.942. The subjects BMD were then measured by using a quantitative calcaneal ultrasound. T.score measurement was based on WHO criteria.

 

 

FIG.1: BMD MEASUREMENT USING QUANTITATIVE CALCANEAL ULTRASOUND

 

DATA ANALYSIS:

Data analysis was entered in Microsoft excel 2013 and statistical analysis using the SPSS software 16.0 windows.

 

Table-1 Total prevalence of osteopenia and osteoporosis:

T. SCORE	NO. OF SUBJECTS	%
Normal	72	26.7
Osteopenia	155	57.4
Osteoporosis	43	15.9

 

 

GRAPH-1

TABLE-2 BMD DISTRIBUTION ACCORDING TO AGE:

AGE GROUP	NO. OF SUBJECTS	NORMAL	OSTEOPENIA	OSTEOPOROSIS
30-45	142	54(20%)	73(27%)	15(5.6%)
46-70	128	18(6.7%)	82(30.4%)	28(10.4)

 

 

GRAPH-2 (BMD DISTRIBUTION ACCORDING TO AGE

 

TABLE-3 BMD DISTRIBUTION ACCORDING TO BMI:

BMI	NO.OF SUBJECTS	NORMAL	OSTEOPENIA	OSTEOPOROSIS
Underweight	100	1(4%)	65(24.17%)	34(12.6%)
Overweight	58	56(20.7%)	2(7%)	0.00
Normal	112	15(5.6%)	88(32.6%)	9(3.3%)

 

 

GRAPH-3 (BMD DISTRIBUTION ACCORDING TO BMI)

 

TABLE-4 BMD DISTRIBUTION ACCORDING TO MENSTRUAL STATUS:

MENSTRUAL STATUS	NO. OF SUBJECTS	NORMAL	OSTEOPENIA	OSTEOPOROSIS
Pre-menopause	112	40(14.8%)	60(22.2%)	12(4.4%)
Peri-menopause	30	14(5.2%)	13(4.8%)	3(1.1%)
Post-menopause	128	18(6.7%)	82(30.4%)	28(10.4%)

 

 

GRAPH-4 (PRE MENOPAUSAL WOMEN)

 

GRAPH-4 (II): PERI MENOPAUSAL WOMEN

 

 

GRAPH-4 (III): POST MENOPAUSAL WOMEN

 

TABLE-5 BMD DISTRIBUTION ACCORDING TO BP

BP STATUS	NO. OF SUBJECTS	NORMAL	OSTEOPENIA	OSTEOPOROSIS
Normal	203	57(21.1%)	110(40.7%)	36(13.3%)
Hypertension	67	15(5.6%)	44(16.3%)	8(3.0%)

 

GRAPH-5 (BMD DISTRIBUTION ACCORDING TO BP)

 

 

TABLE-6 BMD DISTRIBUTION ACCORDING TO SOCIO-ECONOMIC STATUS:

SOCIAL CLASS	NO. OF SUBJECTS	NORMAL	OSTEOPENIA	OSTEOPOROSIS
Upper class	153	42(15.6%)	86(31.9%)	25(9.3%)
upper middle	117	30(11.1%)	69(25.6%)	18(6.7%)

 

 

GRAPH-6 BMD DISTRIBUTION ACCORDING TO SOCIO-ECONOMIC STATUS

 

RESULT:

The result of present study indicates that out of 270 women participants, 72 subjects (26.6%) were normal, 155 subjects (57.4%) were osteopenic and 43 subjects (15.9%) were osteoporotic. According to the age group 35-45 years, 54 subjects (20%) were normal, 73 subjects (27%) were osteopenic and 15 subjects (5.6%) were osteoporotic. In the age group 46-70 years, 18 subjects (6.7%) were normal, 82 subjects (30.4%) were osteopenic and 28 subjects (10.4%) were osteoporotic. According body mass index, out of 100 subjects 1 (4%) was normal, 65 subjects (24.27%) were osteopenic and 34 subjects (12.6%) were osteoporotic. According to menstrual status, out of 112 premenopausal women 40 subjects (14.8%) were normal, 60 subjects (22.2%) were osteopenic and 12 subjects (4.4%) were osteoporotic. Out of 30 perimenopausal women 14 subjects (5.2%) were normal, 13 subjects (4.8%) were osteopenic and 3 subjects (1.1%) were osteoporotic. Out of 128 postmenopausal women 18 subjects (6.7%) were normal, 82 subjects (30.4%) were osteopenic and 28 subjects (10.4%) were osteoporotic. According to BP status, out of 203 with normal BP, 57 subjects (21.1%) were normal, 110 subjects (40.7%) were osteopenic and 36 subjects (13.3%) were osteoporotic. Out of 67 subjects with hypertension, 15 subjects (5.6%) were normal, 44 subjects (16.3%) were osteopenic and 8 subjects (3.0%) were osteoporotic. When the socio-economic was taken into account, out of 153 subjects under upper class, 42 subjects (15.6%) were normal, 86 subjects (31.9%) were osteopenic and 25 subjects (9.3%) were osteoporotic. Out of 117 subjects who were under upper middle class, 30 subjects (11.1%) were normal, 69 subjects (25.6%) were osteopenic and 18 subjects (6.7%) were osteoporotic.

 

According to the result obtained there is a close association between increasing age and osteopenia (30-45 years - 27%) and (46-70 years – 30.4%). When the BMI parameters were considered, there shows a close association between women within normal BMI and osteopenia (88 out of 112 subjects – 32.6%) and also underweight women (65 out of 100 subjects– 24.17%).

 

When the menstrual status was considered, there was a close association between postmenopausal women and osteopenia (82 out of 270 subjects – 30.4%). On considering BP, there was a close association between women with normal BP and osteopenia (110 out of 270 subjects – 40.7%). Finally when the socio-economic status of the participants were considered there was a close association between those women in upper class and osteopenia (86 out of 270 subjects – 31.9%).

 

DISCUSSION:

In our study the prevalence of osteopenia was 57.4% and osteoporosis 15.9%. Osteoporosis is an age related disease of bone that leads to an increased risk of fracture. In osteoporosis, the bone mineral density is decreased, bone microarchitecture is disrupted and the amount and variety of protein in bone is altered ^[13].

 

Identifying individuals with low bone mass remains a clinical challenge in our country. Quantitative calcaneal ultrasound remains the commonest modality of measuring bone mineral density of cancellous bone in the heel. Quantitative ultrasound method can be useful particularly in situation where the DEXA is cost effective and not available especially for screening individuals with low bone mass, who otherwise will remain undiagnosed. Quantitative ultrasound measurement may act as a good screening tool for identification of patients with low bone mineral density. QUS is rapid, portable and non-ionizing device ^[14].In this study the BMD was decreased as the age advanced among women. Osteopenia and Osteoporosis has been greatly under diagnosed and under treated in India ^[15].A study carried out by Benu Gopal Das in 2016, revealed that osteopenia was presenting 62.2% and 10.9% was osteoporotic.^.

 

Osteopenia and Osteoporosis is an important public health problem that should be prevented by diagnosis and appropriate treatment. Women diagnosed with osteopenia and osteoporosis are advised to perform weight bearing exercises and muscle strengthening exercises to increase physical activity and increase daily intake Calcium and vitamin D that should be at least 1200mg and 1500- 2000 IU per day^[16].

 

CONCLUSION:

The study concludes that there was prevalence of osteopenia and osteoporosis among the study samples in the age between 30 – 70 years women. There is a close association between age, BMI, menstrual status, BP, socio-economic status and prevalence of osteopenia and osteoporosis, but osteopenia seems to be more prevalent than osteoporosis among South Indian women. Over 300 million people suffer from osteoporosis in India. More women die of osteoporotic fracture. India shows the highest prevalence of osteoporosis and osteopenia. One in two women above the age of 35 to 45 years suffers from osteoporosis. Osteoporosis shows no symptoms and is often diagnosed only after a fracture by which time the patients may have suffered considerable bone loss. It is necessary to create awareness among the women and educate them about the disease burden. Assessing the prevalence of osteopenia and osteoporosis among women is helpful to health professionals to carry out health awareness campaigns and enhance health related knowledge to the community.

 

CONFLICT OF INTEREST:

None of the authors have conflicting interests declared.

 

FUNDING:

Nil.

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Received on 31.10.2018         Modified on 27.12.2018

Accepted on 12.01.2019      © RJPT All right reserved