Last updated on 7 October 2021
What is osteoporosis?
Osteoporosis is a condition that affects the bones. Bone is continuously being broken down and replaced, and osteoporosis occurs when bone breaks down faster than it can be replaced. This causes the bones to become weak and brittle, and thus easily fractured. Asian women are particularly susceptible.
Picture this: You’re at the wet market buying fish and vegetables, and you see an elderly lady in front of you slip and fall. Due to osteoporosis, which has weakened her bones, she breaks her hip bone and is unable to get up. Someone has to call an ambulance to send her to the hospital.
It may sound alarming to you, but this situation happens more than 6 times every day in Singapore, and it is becoming more common with our ageing population. 1 in 4 people who fracture their hips will also pass away within 12 months of the injury.
Osteoporosis in women
Osteoporosis is more common in women than men. Women have a higher risk of developing osteoporosis if they have:
- Reached menopause
- Had their hormone-producing ovaries removed early
Likewise, men with low testosterone levels also face higher risk of developing osteoporosis.
Risk factors for osteoporosis
A family history of osteoporosis can increase your risk for developing the disease, as well as being petite or thin because this typically means you have less bone mass.
Individuals on long-term medications such as long-term steroids, taken by patients with chronic medical problems such as asthma and rheumatoid arthritis, can also develop osteoporosis.
It is important to note that some traditional Chinese medicines can also contain significant amounts of steroids.
Lifestyle habits like excessive smoking and alcohol consumption may also increase the risk of osteoporosis.
How can I prevent and reduce the risk of osteoporosis?
Bone mass and density
Your bone mass is the greatest when you’re in your 20s. After 30, it will begin to decline. Breastfeeding mothers, in particular, experience significant bone loss when they are lactating.
It is therefore very important to strengthen your bones as much as you can when you are young.
Diet and lifestyle
Eating well and leading an active lifestyle can help build strong bones when you are young.
A healthy diet with sufficient calcium and vitamin D is important for strengthening bones. You can consume more calcium through diet choices by having more dairy, leafy greens, and soy products, while vitamin D can be produced by your skin through adequate sun exposure.
Regular exercise, strength training and weight-bearing exercises also stress the bones and stimulate them to strengthen.
Osteoporosis in postmenopausal women
Postmenopausal women are at increased risk of osteoporosis due to several reasons.
Hormones and osteoporosis
Women who reach menopause have reduced levels of oestrogen, which leads to reduced bone mass.
Bone mass and density also decrease with age. This is because the rate of new bone growth slows, to the point where bone loss occurs faster than it can be replaced.
How is osteoporosis diagnosed?
You can assess your risk of developing osteoporosis by visiting your family doctor.
Bone mineral density (BMD) test
If required, your doctor may send you for a bone mineral density test, which will help your doctor find out if your bone mass is normal, slightly deficient (osteopaenia) or very deficient (osteoporosis).
Your doctor will then be able to advise whether you need an anti-fracture treatment.
How is osteoporosis treated?
The main problem with osteoporosis is the risk of easily fracturing your bones. Treatment is therefore centered on reducing your chance of fractures.
Regular strength training and weight-bearing exercises
Regular strength training and weight-bearing exercise such as brisk walking and taichi (a type of Chinese martial art) can help reduce the rate of bone loss.
Such activities also improve muscle strength and coordination, and reduce the risk of falling.
Calcium and vitamins
A healthy diet with sufficient calcium and vitamins such as D and K2 may help reduce the risk of developing an osteoporotic fracture.
In severe cases, special medication to decrease the rate of bone loss or to build bone density may be prescribed. These drugs need to be taken for many years to reduce the risk of fractures.
Bisphosphonates are a class of medication known as antiresorptive drugs. These help to stop the body from reabsorbing bone tissue. It can be taken daily, weekly, monthly, or even yearly.
Delivered as an injection every 6 months, biologics are a relatively new form of treatment that help to improve bone density.
As decreased oestrogen is a risk factor for reduced bone density, osteoporosis is sometimes treated using oestrogen. Similarly, testosterone may be used to increase bone density in men who have low levels of the hormone.
Other hormone-related therapies include synthetic hormones and raloxifene, known as a selective oestrogen receptor modulator. These work in similar ways to reduce the risk for fractures.
However, each of these drugs also carry risks as they are associated with significant side effects, such as atypical fractures in your thigh bones. You should discuss all the risks and benefits with your doctor before you begin treatment.
I have osteoporosis and have fallen and broken a bone. What should I do?
You should see a doctor to have your fracture assessed. Some fractures of the spine and pelvis do not require much medical treatment apart from painkillers, while some fractures such as simple wrist fractures will be able to heal with the help of a cast.
While treatment in a cast may sometimes facilitate healing, restricted movement and limited weight-bearing may result in rapid loss of muscle and bone strength. In an elderly individual, this may result in loss of function, mobility, and independence.
Other more serious fractures, however, may require surgical treatment to restore function and to prevent future complications from developing.
Fortunately, with modern orthopaedic techniques, an experienced surgeon may be able to fix your fracture well enough to allow early use of the injured limb and thus help to preserve its function.
Enabling patients to walk reduces the chance of deconditioning, which could result in the patient becoming wheelchair or bed-bound. In some severe cases, where the bone is not fixable, a joint replacement may be required to restore function. This commonly occurs with fractures of the hip, shoulder, and elbow.
Physiotherapy can also help to restore function to injured limbs after the fractures have healed, helping to improve muscle strength, coordination and balance to reduce the chance of falling in the future.
Finally, your doctor will advise you if you need to take medication to reduce the risk of further osteoporotic fractures. Other medical problems that predispose you to falling, such as visual impairment, giddiness or low blood pressure, may need to be treated as well. Your doctor may also need to review the medication you are taking, as some drugs may affect balance and levels of consciousness.
Important points to remember
Prevention is better than cure.
Build your bones when you are young with regular exercise, strength training, and a healthy balanced diet with sufficient calcium and vitamin D.
Reduce your risk of falling.
Maintaining muscle strength, coordination and balance can help prevent you from falling and fracturing a bone.
Supplements and oral medication can help reduce the risk of fractures.
Calcium, vitamin D, vitamin K2, and specialised medication for osteoporosis can help reduce the risk of fractures after a fall.
Thigh pain when taking osteoporosis medication is a warning.
See your doctor quickly and avoid excessive walking if you develop thigh pain when taking medication for osteoporosis.
Early surgery is beneficial.
Early surgery can restore function, preserve independence, and improve quality of life.
Article reviewed by Dr Bernard Lee, orthopaedic surgeon at Gleneagles Hospital