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Ram Gulam, India

Ram Gulam was a satisfied man. He was the respected panch (head of the village council) in the Indian village of Larpur, in the District of Azamgarh, a hamlet of 5000 people in the state of Uttar Pradesh. He was also a well-to-do farmer, owning land and a small cattle ranch.

Pictures of Ram Gulam show a tall, proud, good looking 58-year-old man, with big moustaches and a sense of self-confidence.


One sunny morning Ram Gulam shared a pot of tea with fellow villagers and discussed an important judgment he was going to make later in the day at the village council meeting. Ram Gulam promised to objectively review both sides of the case, involving a land dispute, and excused himself to prepare for the meeting.

While in the bath Ram Gulam slipped. "The fall was trivial," he recalls, "but the pain was excruciating." He could not stand and his family took him to the district hospital, at Azamgarh, 40 kms away from his village. After an X-ray, the doctor on duty diagnosed a fracture to the neck of the femur and told him that he would need surgery.

Not convinced that such a small fall could cause a fracture needing surgery, he was brought by his relatives to Delhi, some 400 kms away. There, Dr Sushil Sharma, an orthopedic surgeon closely associated with the Arthritis Foundation of India, explained that Ram Gulam had broken the head of his femur, commonly called a hip fracture, because of weak bones. The surgeon operated and Ram Gulam began a long and painful rehabilitation, during which his job as community affairs judge in the local council was provisionally taken over by another person.

Only after four months could he resume light exercise and meet friends, Ram Gulam recalls. "But I remained skeptical of my doctor's diagnosis that I had osteoporosis – I was convinced that weak bones was a disease for women, not men," he says. While on one of his evening walks, Ram Gulam made a quick movement to dodge a stray dog. He slipped, fell, and fractured his other hip. Again he saw the surgeon, and again he had a hip replacement surgery. But this time his rehabilitation was much more difficult. He was bedridden. Once again he lost his panchayat decision-making position at the village community court. No longer would he wear the pagri headgear of a judge. His esteem was gone and he had become isolated.

Today Ram Gulam is an ill and depressed man. He can walk with the help of walker, but at age of 65 he looks 90. He has started osteoporosis treatment, but after his two hip fractures the weak bones have already taken their toll.

After his second hip surgery he went for a BMD check. His T-score was -4.9, and his spine showed evidence of vertebral collapse. He has lost 4 cm in height in the past seven years, and he is in constant pain. As he gets around the hospital corridors with his walker, Ram Gulam is totally heart broken – he has now been told that his job as the village council head has been permanently given to another man.

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