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Do You
Have Brittle
BonesJuly
2012

OSTEOPOROSIS COMES FROM THE GREEK, MEANING “porous bones”. It is a disease in the bones that leads to an increased risk of fracture. Bones become brittle and break easily, even after very little trauma, for example falling at home. This is different from the traumatic fractures that occur after road accidents. The bones that most commonly break are around the wrist, the spine and the hip.

When suffering from osteoporosis the bone mineral density is reduced, the bone microarchitecture deteriorates, and the amount and variety of proteins in the bone is altered. There might not be any symptoms in the early stages of this condition until a fracture occurs. People with osteoporosis may suffer from spinal compression fractures resulting in a loss of height with a stooped back, also known as dowager’s hump.

Osteoporosis is defined by the World Health Organisation as a bone mineral density that is 2.5 standard deviations or more below the mean peak bone mass of average of young, healthy adults. Established osteoporosis includes the presence of a fragility fracture. To decide whether a bone mineral density test is needed or not, you can do the OSTA test at the Osteoporosis Society (Singapore).

While you can be affected by this bone-weakening disease in any bone in your body, fractures in the hip and spine are particularly serious, due to the fact that these often result in hospitalisation or sometimes even death. Over the last 30 years in Singapore, cases of hip fractures have increased five times in women aged 50 and above, and 1.5 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. Those at risk of fractures need medication to prevent these fractures from happening, for example bisphosphonates, strontium ranelate or denosumab. The medications can reduce the chance of getting a fracture by about 50 per cent. All medications can have side effects but patients should take medication if the benefits outweigh the risks. Those who have low bone mineral density, low body weight, on steroids or with a family history of osteoporosis may need medication after consulting with their rheumatologist.

The disease is split into three categories, classified as primary type one, primary type two, or secondary. The form of osteoporosis most common in women after menopause is referred to as primary type one or postmenopausal osteoporosis. Primary type two osteoporosis or senile osteoporosis occurs after age 75 and is seen in both females and males at a ratio of 2:1. Finally, secondary osteoporosis may arise at any age and affect men and women equally. This form of osteoporosis results from chronic predisposing medical problems or disease, or prolonged use of certain medications.

Prevention of osteoporosis is important. An adequate intake of calcium is recommended, to build strong bones. You lose calcium on a daily basis via bodily excretions such as urine, faeces and sweat. We also lose it when shedding skin, hair and nails. It is possible to replenish your loss by eating calcium-rich foods. Calcium rich foods include certain dried herbs, cheese, sesame seeds, tofu, almonds and green leafy vegetables. Calcium is better absorbed when taken in small amounts throughout the day, so try to spread your calcium intake over breakfast, lunch and dinner. It is also important to consume enough vitamin D in your diet as it is essential for calcium absorption. Exposure to the sun helps in the production of vitamin D. If you cannot eat enough naturally you can take supplements.

Apart from diet, other lifestyle changes include doing weight-bearing exercise to strengthen your bones. Tai Chi, brisk walking, skipping, dancing, hiking, jogging and aerobics can help to build up your 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 decrease the risk of falls.

About Our Arthritis Specialist

A/Prof Leong Keng Hong is a senior consultant Rheumatologist at Gleneagles Medical Centre and Adjunct Associate Professor, Yong Yoo Lin School of Medicine, National University of Singapore. He founded the Osteoporosis Society (Singapore) in 1996 and served as its President until 2004. He was also the Inaugural Chairman of the Chapter of Rheumatologists, College of Physicians, Academy of Medicine, Singapore from 2004-2007 and its current Chairman until 2013.

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