Osteoporosis – the silent disease impacting Singaporeans

Osteoporosis, or porous bones, is a condition where your bones become weak and brittle.

Brittle bones are then prone to fractures, even with very minimal trauma. Most fractures from osteoporosis commonly occur in the hip, spine and wrist. Fractures in the spine and hip are of particular concern, as they almost always result in serious consequences such as hospitalisation or even death.

Over the last 30 years in Singapore, cases of hip fractures have increased five times in women aged over 50 and one and a half times in men of the same age group.

Osteoporosis is a ‘silent’ disease, as there are usually no signs or symptoms in the early stages.

However, in the later stages you may experience back pain, loss of height, stooped posture and fractures of the spine, wrists or hips.

Osteoporosis occurs when there is an imbalance between new bone formation and old bone resorption. Adult bone mass peaks at about the age of 30. After that, bone mass gradually decreases.

In pregnant and lactating mothers, there is a temporary increase in bone loss if the increased calcium demands of pregnancy or breastfeeding are not met by increased dietary intake of calcium. There is also a significant decrease in bone mass in women in the five to seven years after menopause, as the body produces less oestrogen which protects the body from bone loss.

Risk factors for osteoporosis include:

• Age – the risk increases as one gets older
• Gender – women are at higher risk of developing osteroporosis, particularly those who are menopausal or have had their ovaries removed. Women who experience menopause before the age of 45 are significantly more at risk.
• Having a family history of osteoporosis or related fractures
• Being thin and small built or underweight
• Previous fractures following low level trauma, especially after age 50
• Not consuming enough calcium in your diet
• Sedentary lifestyle
• Excessive alcohol intake – consumption of excessive amounts of alcohol reduces bone formation and also affects the body’s ability to absorb calcium
• Smoking
• Prolonged use of medications such as corticosteroids

Osteoporosis can be diagnosed through a bone mass density test, commonly done using a DEXA scan. It measures the bone mineral density or bone strength at the hip and spine.

The results of the bone mass density test will then help your doctor assess your risk and make recommendations for prevention or treatment of osteoporosis.

Diet

• Ensuring adequate calcium and vitamin D intake either through your food or supplements is important. An adult aged 50 and above should consume between 1000mg to 1200 mg of calcium daily.
• Vitamin D is needed by the body to absorb calcium, and it can be obtained through the skin exposure to sunlight, diet or through supplements. An adult aged 50 and above needs between 400 to 1000IU of vitamin D daily.

Weight bearing and resistance exercises

• Weight bearing exercises are activities where your bones support your body weight, and they help to build and maintain bone density. Some of these exercises include brisk walking, hiking, dancing, jogging, aerobics and taichi.
• Resistance exercises like weight lifting and push-ups will also help to increase muscle strength and decrease the risk of falls.

Avoid smoking and excessive alcohol intake

• Although you cannot ‘cure’ osteoporosis, you can prevent further bone loss, improve bone strength and reduce the risk of fractures with medication, exercise and ensuring good nutrition with adequate calcium and vitamin D.