New drugs offer hope to postmenopausal women suffering from osteoporosis

Pune: Meera, a 52-year-old woman, began experiencing debilitating back pain and joint discomfort shortly after menopause. Though she initially attributed the symptoms to aging and the stress of daily life, she soon realized that her condition was far more serious.
After a thorough examination and a basic X-ray, Meera was diagnosed with spinal fracture in the endplate of the first lumbar vertebra (L1), which is located in the lower back owing to osteoporosis — a silent condition that affect many women during menopause, exacerbated by hormonal changes, especially after a hysterectomy.
Women in the menopausal phase and those who have undergone hysterectomies are particularly vulnerable to spinal health issues due to hormonal fluctuations in addition to elderly men (people over 60 years of age).
According to Indian Menopause Society, around 50 million women in India are affected by osteoporosis, with the risk significantly increasing post-menopause. The menopausal syndrome often manifests as joint pain, muscle aches, and significant back discomfort.
Experts emphasize the importance of proactive measures for women approaching menopause or dealing with the aftermath of hysterectomy.
Regular DXA scans, recommended around the age of 50, can help assess bone health, while essential blood tests — such as those measuring vitamin D, calcium, and parathyroid hormone levels — are crucial for identifying deficiencies that could lead to osteoporosis.
"Women like Meera face a higher risk of osteoporosis during menopause, leading to weakened bones that can crack under pressure, even with minor falls. Osteoporosis is a silent killer," said Sancheti Hospital's chief spine surgeon Dr Shailesh Hadgaonkar.
Dr Hadgaonkar sees around 40-50 patients who are diagnosed with osteoporotic spines every month, and the spine department at Sancheti Hospital attends to approximately 1,200 patients every year. In addition to women with menopause and hysterectomies, these are also patients who are old and have other co-morbid conditions.
Fractures from osteoporosis can severely impact quality of life, with studies showing that women over 50 are at a heightened risk in addition to elderly men.
"Postmenopausal osteoporosis is a growing concern in India, with an estimated 46 million women over the age of 50 affected by the condition. A significant trend is the increasing use of diagnostic tools like DEXA scans to detect early bone loss, and the adoption of FRAX tool to assess fracture risk in postmenopausal women," said spine surgeon Dr Bhavuk Garg, professor, department of orthopaedics, All India Institute of Medical Science (AIIMS), New Delhi.
At AIIMS, New Delhi, research is advancing in various directions to address the unique challenges faced by the Indian population. "Notably, a clinical trial is underway at AIIMS for an oral drug that shows promising results as an affordable and effective alternative to teriparatide, which is currently the gold standard for severe osteoporosis," Dr Garg said.
Historically, treatment options for osteoporosis include anti-resorptive medications aimed at slowing bone loss. However, new therapeutic advancements are providing hope for better management. One such drug is teriparatide, a hormonal treatment that promotes new bone formation. "This drug is like giving calcium and vitamin D directly into the bones," Dr. Hadgaonkar said.
Another significant breakthrough is Romosozumab, an USFDA-approved medication recently introduced in India. Administered once a month, this injectable treatment offers a more convenient alternative to the daily injections required by teriparatide.
"Romosozumab is a game-changer, as it not only helps form new bone but also reduces the risk of fractures," he added.
For women who prefer less frequent treatment, Denosumab is another viable option, requiring injections only twice a year. This drug works by preventing bone resorption, making it suitable for many patients reluctant to commit to regular injections.
Dr Hadgaonkar emphasizes the importance of proactive measures for women approaching menopause or dealing with the aftermath of hysterectomy. Regular DXA scans, recommended around the age of 50, can help assess bone health, while essential blood tests — such as those measuring vitamin D, calcium, and parathyroid hormone levels — are crucial for identifying deficiencies that could lead to osteoporosis.
The theme for World Spine Day on October 16, 2024, is "Support Your Spine". This campaign aims to raise public awareness about spinal health and disability, encouraging individuals of all ages to adopt practices that promote spinal well-being.