Osteoporosis

Osteoporosis has become a familiar term in recent years. Have you ever wondered if you are at risk? Does drinking milk help? Do you know how to prevent osteoporosis? Read on to find out more about your bones and what you should do when, or even before, this silent disease creeps into your life.

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Osteoporosis — The Silent Disease

Osteoporosis is a bone condition characterised by low bone mass or decreased bone strength. It results when there is an imbalance between new bone formation and old bone resorption (the process of losing substance). This means new bone formation is unable to catch up with bone loss. As more bone is lost, it eventually weakens, and becomes more prone to fractures, especially in the hip, spine and wrist.

There might not be any obvious symptoms in the early stages of this "silent epidemic", but towards the later stages, you might feel pain in the bones or muscles, especially in areas around the lower back. Apart from pain, people with osteoporosis may suffer from spinal compression fractures resulting in loss of height with a stooped back (called dowager's hump).

While any bone in your body can be affected by this bone-thinning disease, fractures in the hip and spine have raised special concerns 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 50 and above, and one and a half times in men of the same age group. Studies have shown that one in every five people with osteoporotic hip fractures died within a year. Therefore, it is important to know more about your bones to protect your bone health.

Osteoporosis Risk Factors

Do you know that throughout life, your skeleton loses old bone and forms new bone? During your childhood and teenage years, new bone is formed faster than old bone is lost. Your bones get denser and reach their peaks at around 20 years of age. After the peak bone mass, you may start to lose more bone than you form and the process speeds up as you age. When your bone loss is faster than it is replaced, your bones become less dense and weak.

Women are more prone to osteoporosis as they can lose up to 20 percent of their bone mass in the five to seven years after menopause. The hormone oestrogen protects bones. However, after menopause (or after the surgical removal of ovaries), the fall in the production of oestrogen leads to bone loss and thus increases the risk of fractures.

Men are also affected by osteoporosis though it is relatively less common. Oestrogen and the male hormone testosterone are important for bone health in men. Excessive alcohol intake, smoking or extreme thinness can decrease the level of such hormones in the body, resulting in bone loss.

Building strong bones during childhood and adolescence can help to prevent or delay the disease later in life.

Calcium for Osteoporosis

To build strong bones, an adequate intake of calcium is required. Refer to the Recommended Dietary Allowances (RDA) for the amount of calcium you are recommended to take. If the level of calcium in your blood and tissues is too low, calcium from the bones will be mobilised to these areas, causing bone loss.

Every day, calcium is lost in bodily excretions such as urine, faeces and sweat, or shed in skin, hair and nails. It can, however, be replaced by eating calcium-rich foods. Click here to see the types of calcium-rich food you can take. 

Calcium is better absorbed when taken in small amounts throughout the day. So try to spread your calcium intake over breakfast, lunch and dinner.

Also, make sure that you consume enough vitamin D in your diet as it is essential for calcium absorption. Refer to the RDA for the amount of vitamin D you are recommended to take. Adequate exposure to the sun helps in the production of vitamin D, too.

If your dietary intake of calcium and vitamin D is low and you are unable to increase it to the recommended levels, your doctor may suggest that you take supplements. Always discuss medication or supplements with your doctor before taking them.

Weight-Bearing Exercises

As bones suffer from the lack of physical activity, regular exercise can help to build stronger and denser bones. Weight-bearing exercises and resistance exercises are activities that make you move against gravity, and they have been recognised as important for building and maintaining bone density.

Weight-bearing exercises such as tai chi, brisk walking, skipping, dancing, hiking, jogging and aerobics can help to put force through the bones and strengthen them.

Resistance exercises like weight-lifting, push-ups, and standing and rising on your toes can also help to increase muscle strength and thus, decrease the risk of falls.

For older adults, it is important that the exercise you choose is suitable for your age and health condition. Consult your doctor before embarking on an exercise regimen.

Osteoporosis Risk Assessment

OSTA

You can find out your risk of getting osteoporosis by using the Osteoporosis Self-assessment Tool for Asians (OSTA).


 

Bone Mineral Density (BMD) Test

The best way to diagnose osteoporosis is to carry out a Bone Mineral Density (BMD) test. The test can be done on different bones of your body, usually the hip and spine, and it measures the amount of bone mineral you have in a certain area of the bone. The results of the BMD test help your healthcare provider to assess your risk of having a fracture, and make recommendations for the prevention or treatment of osteoporosis.

Most of our local hospitals conduct BMD screening. It is a painless and non-invasive (no needles or instruments will be placed through the skin or body) test, and usually takes less than 15 minutes.

Treatments For Osteoporosis 

Once diagnosed with osteoporosis, your healthcare provider may prescribe either anti-resorptive or anabolic medications.

Anti-resorptive medications can slow down the rate of bone resorption, thus preventing bone loss. Such drugs include:
Bisphosphonates
Calcitonin
Oestrogen/hormone replacement therapy (HRT)
Selective oestrogen receptor modulators (SERMs)

Anabolic medications can help to stimulate new bone formation and lower the risk of breaking bones. Currently, such medications take the form of parathyroid hormone injections.

Remember, for your medications to work, you must take them as prescribed, exercise regularly and continue to consume the recommended amounts of calcium and vitamin D.

Osteoporosis Prevention — Is It Possible?

Osteoporosis is largely preventable. You can reduce your risk for osteoporosis by having a balanced diet and an active lifestyle.

What You Can Do

Get the daily recommended amounts of calcium and vitamin D. The current dietary recommendation for calcium intake in Singapore is 800mg/day. According to the recent National Nutrition Survey in 2004, the average daily calcium intake of a Singaporean is 627mg.
Start exercising today. Regular exercise helps to build stronger and denser bones, and weight-bearing exercises are important for building and maintaining bone density.
Avoid smoking and excessive alcohol. The chemicals in cigarettes are bad for your bone cells and especially in women, smoking can prevent oestrogen from protecting the bones. Excessive drinking can also reduce bone formation.
Reduce your intake of caffeine. Caffeine in coffee, tea and some soft drinks may decrease calcium absorption. Try to maintain low daily intake of drinks with caffeine, and offset the calcium lost by increasing your calcium intake.
Say "no" to salty snacks. Eating too much sodium can cause bone loss. Try to reduce the amount of salty snacks and processed foods in your diet, and refrain from adding that extra dash of salt in your cooking.

Important Points to Remember About Osteoporosis

Osteoporosis is a deterioration of the bones, most commonly found in post-menopausal women.
To determine if you are at risk of osteoporosis, go for the BMD test or try OSTA (for Asian women).
Building strong bones through adequate consumption of calcium and vitamin D can help reduce the risk of osteoporosis.
Osteoporosis is largely preventable through a well-balanced diet and exercise.

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