LETTER RE: Osteoporosis for the practicing neurologist

We read the article on osteoporosis by Rothman et al.¹ with interest and found it worth additional discussion for its practical implications. A neurologist may face osteoporosis as myelopathy, radiculopathy, osteomalacic myopathy, hypokalcemic tetany, seizure, aches, pains, encephalopathy, and irritability. In India there are no epidemiologic data on exact prevalence. The men:women ratio may be distorted because men are more likely to be brought for hospital care.² Nonmodifiable risk factors include female sex, old age, small and thin build, Caucasian/Asian ethnicity, and family history of fractures. Important modifiable risk factors include calcium and vitamin D deficiency, sedentary lifestyle, smoking, and excessive alcohol and caffeine intake.² Medical conditions like hypogonadism, thyrotoxicosis, Cushing syndrome, anorexia nervosa, malabsorption syndromes, chronic liver and renal disease, drugs like glucocorticoids and anticonvulsants, and chronic inflammatory conditions like rheumatoid arthritis may lead to secondary osteoporosis. Therefore, physicians and respective specialists may play a great role in preventing this silent killer.²

In general, Indians have poor bone health, and osteoporosis is common in India. Peak bone mass achieved during puberty is a strong predictor of development of osteoporosis in later years. High prevalence of vitamin D deficiency in India is a major contributor to low bone mass. As a public health measure, it is important to encourage children to drink milk and play in the sun. This will ensure adequate calcium intake, vitamin D synthesis, and exercise. These 3 are the crucial elements in determining peak bone mass. There is thus an urgent need for greater public awareness in this regard. For the middle-aged and elderly, early detection and treatment of osteoporosis with available agents can reduce the risk of fractures and associated morbidity and mortality.

Balanced diet is a must to have healthy bones and avoid complications related to osteoporosis. Adequate nutrition is important throughout pregnancy. Thus the nutritional needs of both mother and child must be considered. Breastfeeding should be encouraged to give children a good skeletal start. Birthweight is linked to adult bone mineral content and there is evidence that low birthweight relates to higher rates of osteoporotic fracture in adult life. Inadequate nutrition in early childhood may have persisting adverse effects on bone. Adults who consumed milk less than once a week in childhood and adolescence have higher rates of osteoporotic fractures later in life.

Disclosures: The authors report no disclosures.

References

1. Rothman MS, West SG, McDermott MT. Osteoporosis for the practicing neurologist. Neurol Clin Pract 2014;4:34-43.

2. Malhotra N, Mithal A. Osteoporosis in Indians. Indian J Med Res 2008;127:263-268.