|Year : 2019 | Volume
| Issue : 1 | Page : 29-33
Evaluation of osteoporosis among medical and paramedical staffs in a tertiary health-care hospital in India
Vetrivel Chezian Sengodan, Marimuthu Sivagnanam, Nandakumar Thiagarajan, Surendar Vellaiyan
Institute of Orthopaedics and Traumatology, Coimbatore Medical College and Hospital, Coimbatore, Tamil Nadu, India
|Date of Web Publication||4-Feb-2019|
Vetrivel Chezian Sengodan
Institute of Orthopaedics and Traumatology, Coimbatore Medical College and Hospital, Coimbatore, Tamil Nadu
Source of Support: None, Conflict of Interest: None
| Abstract|| |
Background: Osteoporosis is a silent, underdiagnosed disease, which is characterized by low bone mass leading to increased susceptibility to fractures. Screening for osteoporosis is not routinely done despite growing awareness of this condition and its complications. Routine screening practices can help early detection and treatment. Materials and Methods: The objective of this study was to measure the bone mineral density (BMD) of health-care professionals (doctors and nurses) using calcaneal ultrasound heel bone densitometer. This was a cross-sectional study conducted in a tertiary care hospital involving 863 individuals. BMD was measured using calcaneal quantitative ultrasonography and T-scores were calculated. Results: The overall prevalence of osteoporosis and osteopenia among men and women was similar in our study. Nearly 50% of staff nurses were found to be below normal as per T-scores. Among doctors, contrasting popular belief, the prevalence of osteoporosis was higher in males than in females. Conclusion: This study indicates that medical professionals are equally at risk of osteoporosis as the normal population and should be targeted for routine screening and preventive interventions to curtail osteoporosis and its complications.
Keywords: Bone mineral density, calcaneal quantitative ultrasonography, osteopenia, osteoporosis
|How to cite this article:|
Sengodan VC, Sivagnanam M, Thiagarajan N, Vellaiyan S. Evaluation of osteoporosis among medical and paramedical staffs in a tertiary health-care hospital in India. J Nat Sc Biol Med 2019;10:29-33
|How to cite this URL:|
Sengodan VC, Sivagnanam M, Thiagarajan N, Vellaiyan S. Evaluation of osteoporosis among medical and paramedical staffs in a tertiary health-care hospital in India. J Nat Sc Biol Med [serial online] 2019 [cited 2019 Jun 16];10:29-33. Available from: http://www.jnsbm.org/text.asp?2019/10/1/29/251497
| Introduction|| |
Osteoporosis is the most common generalized disease of the skeletal system, which is characterized by low bone mass, microarchitectural deterioration of the bone tissue, increase in bone fragility, and susceptibility to fracture. Osteoporosis is always a silent disease and a major global public health problem associated with significant morbidity, mortality, and socioeconomic burden. It is estimated that by 2050, half of the world's fractures will occur in Asia., The lifetime risk for osteoporotic fractures of hip, spine, and wrist is reported to be 40%, with one in three women over 45 years of age likely to suffer a fracture due to osteoporosis.
Low bone density is a major risk factor for osteoporosis and associated fractures. Therefore, early detection of bone fragility is of utmost importance. Several noninvasive techniques are developed to detect osteoporosis, and the gold standard recommended by the World Health Organization (WHO) is the dual-energy X-ray absorptiometry (DEXA). However, there are several limitations of DEXA, which prevent it from being used for mass screening of osteoporosis. A population-based screening program is currently necessary as osteoporosis is a rising health-care problem in the developing countries.
Quantitative ultrasonography (QUS) methods are used in recent years for the assessment of skeletal status. It has several advantages, including nonexposure of patient or operator to ionizing radiation, low cost, and portability. QUS has, hence, emerged as a promising tool for identifying individuals at risk of sustaining a fragility fracture. Different sites such as vertebra, hip, and forearm have been used by DEXA for estimation of bone mineral density (BMD). Calcaneum is the most common site for measurement of BMD using QUS, as it is easily accessible and predominantly consists of metabolically active trabecular bone and hence is more likely to reflect skeletal changes [Figure 1]. Large prospective studies have demonstrated that both broadband ultrasound attenuation and speed of sound (SOS) at the calcaneum can predict osteoporotic fractures. Bone has a mechanically anisotropic structure. In contrast to bone density measurements based on X-ray attenuation, ultrasound parameter reflects the structural anisotropic of bone., Therefore, QUS may have greater potential to be used in the assessment of bone strength.
|Figure 1: Quantitative ultrasonography device measuring bone mineral density on mediolateral surface of calcaneum|
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| Materials and Methods|| |
A cross-sectional study was conducted by the Institute of Orthopaedics and Traumatology, Coimbatore Medical College Hospital, Coimbatore, Tamil Nadu, India, by screening the health-care professionals using calcaneal QUS-based SOS approach. The study was reviewed and approved by the institutional ethics committee in September 2017.
The study group consisted of 863 health-care professionals including nursing students, paramedical workers, staff nurses, medical students, and doctors, in the age group of 17–60 years. Two hundred and fifteen nursing students, 72 staff nurses, 431 medical students, 108 doctors, and 37 paramedical staffs were screened. Of 863 individuals, 215 were male and 648 were female.
A trained technician using QUS measured the BMD of the right side calcaneum of the individuals. The system consisted of unfocussed transducers. There are two probes on the QUS device: the emission and receiver probes. The sound waves produced by any unique piezoelectric probes are emitted and traveled longitudinally or horizontally through the bone under study. The segment of bone under study was placed between these probes and the ultrasound waves emitted from the emission probes were sensed by the receiver probe. According to the International Society for Clinical Densitometry, calcaneal QUS is the only recognized measurement of QUS as the determinant of bone health status.
T-scores were obtained and categorized as per the WHO classification [Table 1]. Individuals with T-score value of <−2.5 were categorized as osteoporotic, T-score between −2.5 and −1 were considered osteopenic, and T-score value more than −1 were considered as normal. The results were analyzed statistically using the Chi-square test.
| Results|| |
Of 215 males, 57 (26.5%) males had osteopenia and 15 (6.9%) males had osteoporosis. Whereas, among 648 females, 184 (28.39%) had osteopenia and 52 (8.02%) had osteoporosis. Among males, 33.4% had low BMD levels as per the WHO criteria, whereas 36.4% of females had below normal BMD [Table 2].
Distribution of osteoporosis and osteopenia among medical students
Four hundred and thirty-one medical students in the age group between 17 and 35 years were screened. Of 93 male medical students, 37 (27.4%) had osteopenia and 5 (3.7%) had osteoporosis. Among 214 female medical students, 69 (23.31%) had osteopenia and 13 (4.39%) had osteoporosis. Our results suggested that 31.1% of male and 27.7% of female medical students had low BMD values. The medical students were also analyzed as per the age group. Between 17 and 35 years, 28.7% had low BMD and 4.17% were suffering from osteoporosis [Figure 2].
|Figure 2: Group-wise distribution of normal, osteopenic, and osteoporotic patients|
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Distribution of osteoporosis and osteopenia among staff nurses
In our study, only female staff nurses in the age group of 21–58 years were analyzed. Of 72 staff nurses, 50% were below normal as per T-scores. In the age group between 31 and 40 years, 40.9% had osteopenia, 9.09% had osteoporosis, and 50% had low BMD levels [Table 3]. Our results suggest that statistically higher number of female staff nurses had lower BMD (P value: 0.001 P < 0.01).
|Table 3: Age-wise distribution of osteoporosis and osteopenia among staff nurses and doctors|
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Distribution of osteoporosis and osteopenia among nursing students
Of 215 nursing students in the age group between 17 and 21 years, 38.1% had low T-scores as per the WHO criteria. Osteoporosis was observed among 18 (8.37%) individuals and osteopenia was seen in 64 (29.77%) individuals in our study [Figure 2].
Distribution of osteoporosis and osteopenia among doctors
Of 108 doctors in our study, 53 were male and 55 were female. Among male doctors, 37.7% had low BMD level. Among female doctors, 58.1% had low BMD level. Without gender discrimination among doctors, 48.1% had significantly low BMD level. (P value 0.033511 P <0.05).
Among doctors in the age group between 31 and 40 years, 34.21% had osteopenia and 42.1% had low BMD level. Doctors in the age group between 41 and 50 years, 52.3% had low BMD level and 38.09% had osteopenia as per the WHO criteria [Table 3].
Distribution of osteoporosis and osteopenia among paramedical staffs
Among paramedical workers, of 37 individuals, 37.8% had low BMD level. Among females, 50% had low BMD level. In the age group between 51 and 60 years, 71.4% had low BMD level [Figure 2].
| Discussion|| |
Osteoporosis is a major global public health problem associated with significant morbidity, mortality, and socioeconomic burden. Despite this, it often remains undiagnosed until a fracture occurs. QUS is an affordable and portable technique reported to predict the risk of osteoporotic fractures in elderly women. The use of an economical method for screening BMD is the need of the hour in our country for population-based screening. It is estimated that currently, 50 million Indians are living with osteoporosis or osteopenia. The considerably high prevalence of osteopenia and osteoporosis in this study among medical professionals could be viewed as a tip of an iceberg as BMD screening is not routinely done and there is no such recognizable signs and symptoms of low BMD unless the individuals turn up with fractures.
In our study, among medical students in the age group between 17 and 35 years, the incidence of osteopenia was more common among males than females. Hence, our results suggest that osteoporosis is not a disease exclusive to female gender. Hence, in concurrence with previous suggestions, active young male adults must also be screened and treated for osteoporosis.
In this study, among nursing students in the age group of 17–21 years, the prevalence of osteoporosis was 8.37%, which suggests that young girls in this age group are also prone to osteoporosis. The National Institute of Nutrition has reported that Indian women experience early onset of osteoporosis due to diet low in calories, proteins, and calcium. Hence, early mass screening is the need of the hour and recommended.
Among the age-wise distribution, the majority of premenopausal women in the age group between 31 and 40 years, 38.8% had osteopenia and 48.6% had low BMD level [Table 4]. A preliminary screening over 6 months in women over 25 years in Jammu suggested that a substantial female population had osteopenia and osteoporosis. After the age of 45 years, the incidence of osteoporosis was 20.25% and osteopenia was 36.79%. In our study, the prevalence of osteoporosis was 9.7% and osteopenia was 38.8% and these values are closer to the values reported previously. In contrast, the prevalence of 58.75% of low BMD level was reported among women in the age group of 40–60 years [Table 5].
Among staff nurses, in the age group between 51 and 58 years, significantly higher number (93.3%) had low BMD level as per the WHO criteria [Table 3]. The prevalence of 67.91% of low BMD is reported among females in the age group of 20–76 years; these reports are similar to our study in the age group of 30–40 years in staff nurses (50%).
Among doctors, the prevalence of osteoporosis was 11.32% in males, whereas in female doctors, it was 10.9%. Our results suggest that osteoporosis is more among males than females, which is against our popular belief that osteoporosis is a disease of female gender.
| Conclusion|| |
Osteoporosis is a globally emerging silent disease, which is often diagnosed only at a late stage. The need of the hour is to educate medical professionals regarding the availability and use of such screening tools, so that osteoporosis can be diagnosed early and optimal preventive measures can be initiated. This study may be useful to know the incidence of osteoporosis among medical and paramedical professionals among the Indian population. However, our study group was small with only 863 individuals. A large multicentric study is further warranted.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
| References|| |
Glüer CC. Quantitative ultrasound techniques for the assessment of osteoporosis: Expert agreement on current status. The international quantitative ultrasound consensus group. J Bone Miner Res 1997;12:1280-8.
Delmas PD, Fraser M. Strong bones in later life: Luxury or necessity? Bull World Health Organ 1999;77:416-22.
Johnell O, Kanis JA. An estimate of the worldwide prevalence, mortality and disability associated with hip fracture. Osteoporos Int 2004;15:897-902.
Cooper C, Campion G, Melton LJ 3rd
. Hip fractures in the elderly: A world-wide projection. Osteoporos Int 1992;2:285-9.
Handa R, Ali Kalla A, Maalouf G. Osteoporosis in developing countries. Best Pract Res Clin Rheumatol 2008;22:693-708.
Takano Y, Turner CH, Burr DB. Mineral anisotropy in mineralized tissues is similar among species and mineral growth occurs independently of collagen orientation in rats: Results from acoustic velocity measurements. J Bone Miner Res 1996;11:1292-301.
Glüer CC, Wu CY, Jergas M, Goldstein SA, Genant HK. Three quantitative ultrasound parameters reflect bone structure. Calcif Tissue Int 1994;55:46-52.
Hans D, Arlot ME, Schott AM, Roux JP, Kotzki PO, Meunier PJ, et al.
Do ultrasound measurements on the os calcis reflect more the bone microarchitecture than the bone mass? A two-dimensional histomorphometric study. Bone 1995;16:295-300.
Langton CM, Palmer SB, Porter RW. The measurement of broadband ultrasonic attenuation in cancellous bone. Eng Med 1984;13:89-91.
Aggarwal N, Raveendran A, Khandelwal N, Sen RK, Thakur JS, Dhaliwal LK, et al.
Prevalence and related risk factors of osteoporosis in peri – And postmenopausal Indian women. J Midlife Health 2011;2:81-5.
Chan MY, Nguyen ND, Center JR, Eisman JA, Nguyen TV. Quantitative ultrasound and fracture risk prediction in non-osteoporotic men and women as defined by WHO criteria. Osteoporos Int 2013;24:1015-22.
Mithal A, Bansal B, Kyer CS, Ebeling P. The Asia-Pacific regional audit-epidemiology, costs, and burden of osteoporosis in India 2013: A report of international osteoporosis foundation. Indian J Endocrinol Metab 2014;18:449-54.
Bliuc D, Nguyen ND, Milch VE, Nguyen TV, Eisman JA, Center JR, et al.
Mortality risk associated with low-trauma osteoporotic fracture and subsequent fracture in men and women. JAMA 2009;301:513-21.
Sharma S, Tandon VR, Mahajan A, Kour A, Kumar D. Preliminary screening of osteoporosis and osteopenia in urban women from Jammu using calcaneal QUS. Indian J Med Sci 2006;60:183-9.
] [Full text]
Vaasanthi PA, Radha S, Nambisan B. Prevalence and determinants of osteoporosis in women aged 40-60 years. Int J Reprod Contracept Obstet Gynecol 2016;5:4434-40.
Nikose S, Singh P, Khan S. Prevalence of osteoporosis in female population in rural central India [By calcaneal ultrasound]. J Womens Health Care 2015;4:262.
[Figure 1], [Figure 2]
[Table 1], [Table 2], [Table 3], [Table 4], [Table 5]