Osteoporosis is a disease characterised by a reduction in bone density and bone mass. This would not only decrease bone strength but can lead to low impact trauma fractures (broken bones). Most common osteoporotic fractures occur in the hip, vertebra (spine bone) and wrist.

What are the symptoms of osteoporosis?

Osteoporosis is a 'silent' disease as it typically does not present with symptoms. This disease is often diagnosed only after a fracture or bone density scan.

An early sign of osteoporosis includes loss of height due to spine compression, which are tiny breaks in the weakened vertebra. This causes the vertebra to be shorter, resulting in loss of height and a change in posture. Compression fracture may also cause back pain.

What are the risk factors of osteoporosis?

Bone is regularly replaced throughout life, with new bone replacing old, maintaining our skeleton robust. However, increasing amounts of bone are lost and not replaced in persons with osteoporosis. This results in the bones gradually becoming brittle and more prone to fracture.

Certain risk factors may increase your likelihood of developing osteoporosis.

• Advanced age: More than 50 years old
• Gender: Females are more likely to develop osteoporosis, particularly if their menopause begins early (before 45 years old)
• Bone size: Individuals who are small and thinly built are at higher risk.
• Family history: Higher risk if you have a parent or sibling with osteoporosis.
• Ethnicity: Asian and White women have the highest risk of developing osteoporosis.
• Nutrition: A diet low in vitamin D, calcium and protein can increase the risk of developing osteoporosis.
• Long term use of certain medications:
  • Chemotherapeutic agents for cancer treatment
  • Steroids
  • Antiepileptic medicines for seizures and neurological disorders treatment
  • Thiazolinediones for Diabetes Mellitus Type II treatment
• Medical conditions: Hyperthyroidism, celiac disease, inflammatory bowel disease (IBD), inflammatory bone diseases such as myeloma and rheumatoid arthritis, anorexia nervosa, multiple myeloma, HIV infection, chronic liver disease.
• Unhealthy lifestyle:
  1. Prolonged inactivity and sedentary lifestyle increase the rate of bone loss
  2. Heavy intake of alcohol
  3. Smoking and usage of tobacco

How is osteoporosis diagnosed?

Osteoporosis is usually diagnosed during routine screening for the disease. Screening for osteoporosis is recommended for:

• Women aged 65 years and older.
• Women aged 50 to 64 years who have risk factors that increase the likelihood of developing osteoporosis.
• Men aged 70 years and older.

Your doctor would first conduct physical examination and x-rays. Laboratory tests may be required depending on the risk factors.

Bone density scan

A bone density scan, also known as dual-energy x-ray absorptiometry (DEXA), is done to confirm an osteoporosis diagnosis. It is a short, safe, and painless procedure that takes approximately 10 to 20 minutes, depending on the part of body being scanned. It helps to detect low bone density of those at risk of osteoporosis and monitor treatment effectiveness if you have been previously diagnosed and are on medication.

Your bone density reflects the porosity of your bones. Learn about bone density scan and how you can increase bone density naturally.

How is osteoporosis treated?

Osteoporosis treatment aims to slow or stop bone loss and prevent fractures. It is a long term or chronic condition, but proper treatment can help improve bone mass.

In the initial treatment of osteoporosis, your doctor would recommend:

• Proper intake of calcium and vitamin D
• Weight bearing exercises
• Modifying risk factors

Medication

Some medications used to treat osteoporosis include:

• Bisphosphonates: To preserve bone density and reduce the risk of fractures
• Selective oestrogen receptor modulators (SERMs): To preserve bone density and minimise the risk of fractures
• Parathyroid hormone (PTH): Regulates the amount of calcium in bone
• Denosumab (monoclonal antibody): Helps reduce bone loss
• Vitamin D and Calcium supplements
• Hormone replacement therapy (HRT): Taken by menopausal women, rarely used
• Calcitonin: For postmenopausal women, rarely used

How can osteoporosis be prevented?

1. Healthy, balanced diet
   • Diet rich in protein, calcium and vitamin D increases the formation of organic matrix of bone and reduces bone loss.
   • Good sources of calcium include low-fat dairy products, broccoli, dark green leafy vegetables and calcium-fortified foods such as tofu and bread.
   • Good sources of vitamin D include egg yolks, red meat, fatty fish, liver, fish oil and vitamin D fortified foods such as milk and cereals.
   • Eat plenty of fruits and vegetables.
   • Consume an appropriate amount of calories based on your weight, height and age. Consult your doctor or nutritionist if you are unsure how much you need to maintain a healthy weight.
   • Reduce alcohol intake. For women, no more than one drink per day, whereas for men, no more than two drinks per day.
2. Quit smoking and avoid second-hand smoke
   • One of the best things you can do for yourself is to avoid smoking at all costs.
   • If you do smoke, the best time to stop smoking is now. With your doctor's help, you can figure out the best strategy to quit smoking.
3. Exercise
   • Strength and resistance training is essential in developing bone strength.
   • Regular exercises also help build muscle mass and improve a person's balance and coordination. This, in return, lowers the risk of falling.
   • However, if you are older, not usually active and have been diagnosed with osteoporosis, it is crucial to not put a sudden strain on your bones and muscles. Avoid high impact exercises.
   • Talk to your doctor about specific activities that are right for you.

How to live with osteoporosis?

People with osteoporosis have a high risk of fractures and falls. Therefore, fall prevention strategies can help keep you safe.

Here is what you can do:

• Keep your home clutter-free, especially floors and walking areas.
• Prevent slips with carpet runners.
• Wear shoes with thin nonslip soles.
• Do not walk around in slippers or socks.
• Ensure carpets and rugs are skid-proof.
• Use a nonslip rubber mat for your shower and tub.
• Install bars that you can grab in the bathroom.
• Improve lighting in your home.
• Be mindful of pets so that you do not trip over them.
• Use a walker or a cane for stability.

Book an appointment at Pantai Hospitals

Take action to improve your bone health now. You do not have to wait until you have a fractured bone to begin. You can begin at any age.

Early detection of osteoporosis makes it easier to treat the condition with effective and appropriate treatment. A dedicated and expert team of Orthopaedic specialists at Pantai Hospital is available for consultation to provide the best care and assistance.

Get in touch with us to book an appointment today if you have concerns or questions regarding carpal tunnel syndrome. We assure you the best possible care tailored to your specific needs.