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Osteoporosis
 
 

Understanding Osteoporosis

Osteoporosis refers to porous bones. It is a condition where a person's bones become weak, brittle and becomes easily fractured (crack or break). When a person suffers from osteoporosis, even a minor bump or fall can cause a serious fracture. Fractures from osteoporosis can occur in any bones in a person's body, but the most common areas are the hip, spine, wrist, ribs, pelvis and upper arm.

1 in 3 persons with hip fractures suffer a considerable loss of function of their hips and eventually become dependent on others. 1 in 5 people, however, dies within a year from sustaining hip fracture.

Osteoporosis is fast becoming a common problem in Singapore especially with an ageing population. So start protecting your bones today!

Symptoms

Osteoporosis is a 'silent' disease. There are usually no signs and symptoms during the early stages. However, at an advanced stage, you may experience:

  • Back pain
  • Loss of height over time, with a stooped posture usually associated with a rounded 'hump' (Dowager's hump) seen on the upper back of older people.
  • Fractures of the spine, wrist, hip or other bones areas.

Causes

Osteoporosis occurs when there is a greater loss of bone mass than bone production in the body.

Bones are living tissues that change constantly. New bone cells are produced to replace and repair old bone cells that are worn out. During childhood and adolescence, more bone tissues are deposited than broken down. Hence it is important to achieve your maximum bone growth (commonly known to as Peak Bone Mass) before the age of 30.

While a person's bone mass does not significantly change between the age of 30 to 50 years old, it is still important for one to continue a diet that is high in calcium. When men and women reach 65 and 50 years old respectively, their bodies will experience a substantial bone loss. Therefore, it is crucial to maintain a high calcium diet to constantly keep our bones strong and healthy.

Diagnosis

Routine X-rays are not able to detect osteoporosis until it is at a rather advanced stage whereby a person suffers a substantial bone loss. The best way to detect osteoporosis is to carry out a Bone Mineral Density (BMD) Test to measure a person's bone density at various sites of the body (e.g. Hip, spine). It is a simple and non-invasive procedure that measures bone calcium content to help detect early loss of bone mass.

Men and women over 65 years are at a higher risk of osteoporosis than younger people. Nonetheless, it is possible to have low bone mass at a much earlier age. Since osteoporosis does not indicate obvious symptoms until a fracture occurs, it is important to visit the doctor if you experience any of the following risk factors:

  • A previous non-violent fracture
  • Early menopause before age 45 years, whether natural or through surgery
  • An immediate family member who has osteoporosis
  • Being underweight
  • Being frail due to long-term illness
  • Smoking
  • Alcohol abuse
  • Unable to move for a long period of time
  • A diet that does not have enough calcium or vitamin D
  • Certain illnesses e.g. rheumatoid arthritis
  • Certain medicine e.g. corticosteroids, thyroid medication

Assessing your risks

The Osteoporosis Self-Assessment Tool for Asians (OSTA) is a guide to help assess an Asian woman's risk of osteoporosis. This is simply done by measuring your weight (in kilograms) against your age. For example, if you are 60 years of age and weigh 50 kilograms, you are categorised under the moderate-risk group (indicated in orange).

Above table is extracted from Health Promotion Board website.

Understanding your OSTA score

Risk Category What does it mean? What must you do?
High Your risk of having osteoporosis is HIGH. About 61% of individuals in the high-risk group suffer from osteoporosis. Consult your doctor to have your bone mass checked. In addition to a diet with adequate calcium and regular weight-bearing exercises, you may require medicine/supplements to strengthen your bones.
Moderate Your risk of having osteoporosis is MODERATE. About 15% of individuals in the moderate-risk group have osteoporosis. Consult your doctor to determine if you have any other risk factors. In addition to a diet with adequate calcium and regular weight-bearing exercises, you may need to change your lifestyle (such as quitting smoking, consuming less alcohol, etc) to reduce your risk.
Low Your risk of having osteoporosis is LOW. Only about 3% of individuals in the low-risk group have osteoporosis. However, if you experience any of the risk factors, please visit a doctor. You will still need to maintain a diet with adequate calcium and carry out regular weight-bearing exercises to maintain bone mass.

Treatment

Osteoporosis can be treated. There are now effective medicines available that can help to increase your bone density and reduce your risk of fractures.

Calcium and Vitamin D
Almost everyone on medication for osteoporosis will be given calcium and vitamin D supplements. This is to ensure that the body has enough of these substances to allow the specific osteoporosis medicines to work as well as they can. However, calcium alone is not an effective treatment for osteoporosis.

Hormone Replacement Therapy (HRT)
The latest large-scale clinical study has concluded that there are risks with the long term use of combined HRT. Women whose sole indication for using HRT is to prevent osteoporosis should be aware that there are currently many non-HRT alternatives (like bisphosphonates and SERMS) which may be effective both in the prevention as well as the treatment of osteoporosis.

Prevention

Prevention of osteoporosis is possible mainly through a change in a person's diet and lifestyle such as:

Increase intake of Calcium

  • In order to build and keep bones strong and healthy, the food you eat must contain enough calcium and vitamin D.
  • Calcium is found in dairy products such as milk and cheese which is usually lacking in the Asian diet.
  • However, calcium alone may not be enough to prevent bone loss and osteoporosis after menopause.

Regular Exercise

  • Regular weight-bearing exercises are important. They are the best way to keep your bones strong and healthy.
  • Exercises that increase muscle strength, improve flexibility and balance, increase endurance and coordination, will help prevent falls.
  • Everyone should try to exercise regularly at least 3 times a week for 30-40 minutes each time. Some recommended exercises are brisk walking, low impact aerobics and tai chi.
  • Always remember to perform proper warming up and cooling down exercises before and after each exercise session.

Quit Smoking & Reduce Consumption of Alcohol

  • Do not smoke. Smoking causes many other diseases besides increasing your risk of osteoporosis.
  • It is fine to drink a relatively small amount of alcohol. Consuming too much alcohol can a person to have a higher risk of getting osteoporosis.

Resources

Find out more information from:

Health Promotion Board
Osteoporosis Society of Singapore
Osteoporosis FAQ

FAQs

1. What is osteoporosis?

Osteoporosis refers to brittle or porous bones. This happens when your bones loses too much calcium and becomes weak. This disease may be detected usually after a fracture occurs or when the person shows reduction in height, hump in the back, or suffers low back pain.

2. Am I at risk of developing osteoporosis?

All men and women are at risk for osteoporosis. Some of the risk factors include:

  • Postmenopausal
  • Family history
  • Being petite
  • Eating disorders
  • Consuming excessive amount of caffeine
  • Smoking
  • Excessive use of alcohol
  • Vitamin D deficiency
  • Inactivity
  • Thyroid disease
  • Chronic steroid use

3. How do I know if I have osteoporosis?

A bone scan is usually carried out to indicate bone loss in the body. The procedure is painless and is called Dual-Energy X-ray Absorptiometry (DEXA) and takes about 10 - 20 minutes. This procedure measures the density or solidness of the bones, known as the bone mineral density (BMD). All women over 65 years are recommended to undergo a bone scan.

4. How can I prevent/treat osteoporosis?

There are medications available for bone strengthening and to reduce the incidence of fractures. However, prevention is still the better way to deal with osteoporosis. The measures include:

  • Maintaining a healthy diet and lifestyle. The food you eat must contain adequate calcium and Vitamin D, these will build and keep bones strong.
  • Exercising regularly to keep your bones strong and healthy. Regular weight bearing exercises are important throughout life.

Consult your doctor before you begin an exercise programme.

This article is reproduced with the permission from Agency for Integrated Care (AIC) and Singapore Sliver Pages.

For more information, please visit http://www.aic.sg/silverpages.

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