Osteoporosis and bone health
The word 'osteoporosis' means porous bone. Osteoporosis is a bone disease that cause loss of bone density, decreasing its strength and make fractures more likely to happen. Osteoporosis occurs when formation of new bone could not keep up with the rate of bone loss.
Osteoporosis- related fractures especially hip and spine fracture are recognized as a major health problem in elderly leading to increase morbidity, mortality, prolonged hospital stays and needing care in the nursing home.
Osteoporosis remains underdiagnosed and undertreated in Malaysia, with very little data documented on its prevalence. It is often known as a 'silent disease' because bone loss occurs without symptoms, until the bone becomes brittle enough to break (fracture) with minimal or no force. Occasionally patient will complain of back pain caused by vertebral fracture, loss of height and a stooped posture.
Several risk factors of osteoporosis are advanced age, sex (women more likely to develop osteoporosis), race (greatest risk for Caucasion and Asian descent), family history of fracture, menopausal status (bone loss accelerates after menopause), smoking, sedentary lifestyle, drinking excessive alcohol and caffeine and low body mass index. Risk of osteoporosis also increase if you have medical illness such as thyroid disease, taking several medications like steroid and seizure medication and not taking enough calcium-rich foods in your diet.
Osteoporosis can be assessed clinically by using OSTA and FRAX scoring to assess risk of osteoporosis and evaluate fracture risks. Your doctor may also order blood test such as blood count, kidney and liver function test, calcium, vitamin D level, testosterone level and thyroid function test as well as bone mineral density (BMD) scan. The gold standard for measuring BMD is dual-energy x-ray absorptiometry (DXA), the recommended method for diagnosis of osteoporosis and monitoring the effect of therapy. Osteoporosis is defined by BMD of more than –2.5 SD from the young adult mean (T-score) and osteopenia when the T-score is between –1.0 and –2.5.
Despite increasing number of older population and cases of fall involving older patients are climbing every year, there are still lack of awareness about osteoporosis in our community and importance of bone health.
What can you do to improve your bone health and prevent osteoporosis?
- Practice healthy lifestyle by maintaning healthy weight, aim BMI between 18-24
- Regular physical activity such as weight-bearing exercises like brisk walking, jogging and resistance training
- Stop smoking
- Cut down on alcohol consumption
- Cut down on excessive caffeinated beverages to 1-2 serving per day. Excessive caffeine can interfere with intestinal calcium absorption and increase urinary calcium excretion
- Fall prevention at home by installing grab bars, extra lighting and ensuring the floor is clutter-free
- Getting sunlight for natural Vitamin D
- Consuming foods that are rich in calcium or supplementing with calcium and vitamin D supplements. The recommended daily intake for calcium is 1000 mg (both dietary and supplements) and for vitamin D is 800 IU
- Regular health screening that includes hormonal check and bone profile assessment
Besides calcium and vitamin D supplementation, other medical treatment can be considered such as Biphosphonates like Alendronate and Risendronate that act as powerful inhibitors for bone loss and subcutaneous injection of Denosumab every 6 monthly. Post-menopausal women can also benefits from osteoporosis prevention with use of HRT, however it should not be use as primary indication for osteoporosis prevention
Osteoporosis is not part of a natural ageing process and it can be prevented and treated if its detected at earliest stage. If you are concern with osteoporosis and your bone health, talk to our doctor about the necessary investigations and treatment available for you. Learning about the symptoms and risk factors can help you take the right steps to keep your bones strong and maintain good bone health for life.