Courtesy of THIS Quarterly magazine
 
 
Bone Matters
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Osteoporosis, a medical condition characterised by low bone mass or decreased bone strength, is a major public health problem in Singapore. Osteoporosis occurs when new bone formation is unable to catch up with bone loss. As more bone is lost, it weakens and becomes more prone to fractures, particularly in the hip, spine and wrist areas. Bone loss may also be caused by hormonal changes and deficiency in calcium or vitamin D.

Statistics have shown that one in three women over 50 years old suffers from osteoporosis. This number is likely to increase with Singapore’s rapidly ageing population.

In the early stages of this silent disease, there may not be obvious symptoms. People with osteoporosis may also suffer from spinal compression fractures, which cause loss of height with a stooped back called dowager’s hump.

Most people do not realise that their bone tissues are diminishing until the first sign of a broken bone, which indicates the onset of osteoporosis. While this disease can affect any bone in the body, fractures in the hip and spine have raised special concerns as they almost always result in serious consequences.

The most accurate way to diagnose osteoporosis is to carry out a bone mineral density (BMD) test. It is a painless and non-invasive test that is typically done with a dual-energy X-ray absorptiometry (DXA) scan, and usually takes less than 15 minutes. BMD screening is available at public and private medical centres in Singapore.

The BMD 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 test results will help the doctor make recommendations for the prevention or treatment of osteoporosis, as well as assess your risk of getting a fracture.

Causes of bone loss

Age

After we reach our peak bone mass (the amount of bony tissue present at the end of the skeletal maturation) in the early 30s, bone loss of 1 to 2% happens each year. Oestrogen are steroid hormones that promote the development and regulation of the female reproductive system and secondary female characteristics of the body. Oestrogen also helps maintain bone density, and thus postmenopausal women are susceptible to bone loss and osteoporosis.

Inactivity

A sedentary lifestyle could lead to more bone loss. When astronauts go into space, they lose bone quickly in the weightless (anti-gravity) environment. Patients who are immobilised or bedridden do not use the muscles and bones in their hips and spine, causing rapid bone loss.

 

Pre-existing medical conditions

Long-term medical conditions such as rheumatoid arthritis, hyperthyroidism and chronic kidney disease cause increased bone loss. Osteoporosis may also be caused by medications such as oral corticosteroids, medicine used to treat seizures or epilepsy, and hormone-blocking treatment for prostate or breast cancer. Any condition that causes calcium or vitamin D to be poorly absorbed can also lead to weak bones.

The butterfly effect

It has been clinically proven that medications for osteoporosis not only improve bone density, but also lower the risk of fractures in the spine and hips. In Singapore, there are 1,300 new cases of hip fractures every year. Due to the ageing population, this figure is projected to rise to 9,000 in 2050.

Hip fracture incidence rates in Singapore men and women above the age of 50 have increased by one and a half times and five times respectively since the 1960s. Studies have shown that one in every five people with osteoporotic hip fracture died within a year.

Apart from the financial burden of osteoporotic fractures, the social dependence is also high. Although 90% of Singaporean patients are fit enough for surgery after a fracture, 20% of them die in the first year. Of the survivors, many become wheelchair-bound, nonambulant or bedridden.

Slow down bone loss

Bone loss can be decelerated with healthy lifestyle measures. These include:

  • Eat a balanced diet that includes adequate intake of calcium and vitamin D
  • Exercise regularly. Weightbearing activities such as tai chi, jogging, tennis, hiking, aerobics, skipping and dancing help put force through the bone and strengthen it. Resistance exercises such as weightlifting and press-ups can also help to increase muscle strength and decrease the risk of falls
  • Avoid overconsumption of alcohol
  • Avoid falls, especially for the elderly
  • Patients with osteoporosis require medicine to reduce boss loss and prevent fractures.

A sedentary lifestyle could lead to more bone loss. When astronauts go into space, they lose bone quickly in the weightless (anti-gravity) environment. Patients who are immobilised or bedridden do not use the muscles and bones in their hips and spine, causing rapid bone loss.

 
 
 
A/PROF LEONG KENG HONG

MBBS (Singapore) 1983
Master of Medicine (Singapore) 1989
Doctor of Medicine 2005
Member of the Royal College of Physicians (UK) 1989
Fellow of the Academy of Medicine, (Singapore) 1992
Fellow of the Royal College of Physicians (Edinburgh) 1997

Leong Keng Hong Arthritis and Medical Clinic
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Gleneagles Medical Centre

Singapore 258499
Tel : (65) 6472 4337
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