Although ageing is inevitable, adopting some good habits can delay the onset of osteoporosis. Chia Hui Jun reports
The silver tsunami gathering on Singapore’s shores may explain why doctors are seeing more hip fractures in recent years. As people age, their bones lose mass, putting them at risk of debilitating or fatal fractures in their spines, pelvises and wrists.
Increasingly, sedentary lifestyles play a part in the rising number of fractures too, doctors said. The number of hip fractures here has risen from 1,300 in 1998, to more than 2,000 in 2008. The International Osteoporosis Foundation expects this number to hit 9,000 by 2050. The problem is serious, as about 30 per cent of patients die in the first year after a hip fracture from complications such as deep vein thrombosis and infections, said Dr Manju Chandran, the director of Singapore General Hospital’s (SGH) osteoporosis and bone metabolism unit.Then there is the cost of hospitalisation. A 2008 study published in the Singapore Medical Journal found that the average hospitalization cost for a hip fracture here was $10,515 and the average length of the hospital stay was 16 days.
Osteoporosis, or “porous bones”, sets in with age as one’s bone mineral density is reduced and the amount and variety of proteins in the bone is altered. It has no symptoms and a fracture may be the first sign. Osteoporosis is diagnosed through a bone scan to determine how much mass the bone has lost. It affects more women than men, as hormonal changes during menopause interferes with calcium absorption into the bone, said Dr Michael Soon, an orthopaedic surgeon at Mount Elizabeth Medical Centre. Women also get it earlier. Even an active lifestyle may not prevent osteoporosis.
Madam Lim Whatt Neo, 62, was diagnosed with osteopenia 11 years ago after she sought treatment for frequent back pain. A precursor to osteoporosis, osteopenia occurs when bone mineral density is lower than normal. “After five years of working at a farm, even bending my back slightly was painful and I thought I needed help,” she said. But some good habits can help to prevent osteoporosis, said Dr Manju.
One should avoid smoking and drinking too much alcohol. Daily coffee intake should not exceed eight cups, said Dr Soon. Consuming more green leafy vegetables and dairy and soya products, or getting 10 to 15 minutes of sun exposure three to four times a week will add calcium and vitamin D to one’s body, said doctors. Weight-bearing exercise like running, brisk walking and dancing also helps to stimulate bone health. Yoga and taiji have also been shown to prevent falls and increase bone mineral density, said Dr Manju.
Osteoporosis is usually treated with medication which manipulate one’s calcium balance at the cellular or hormonal level. This prevents further bone loss and adds more bone by controlling bone metabolism in the body, said Dr Soon.
Bisphosphonates can be taken orally daily or intravenously yearly. This class of drugs acts on the bone cells to stop bone metabolism. This artificial stopping of bone loss increases the patient’s bone density.
Recombinant, or man-made, parathyroid hormone treatment, injected daily, also controls bone metabolism in the body by triggering bone-forming cells to make more bone. Hormone replacement therapy was previously used but is now avoided because of an increased risk of breast and uterine cancer, deep vein thrombosis and a small risk of stroke and heart attack.
Alternative ways of administering the drugs and less frequent doses of medication are being studied, said Dr Manju. Madam Lim was referred to a physiotherapist for exercises as her fracture risk is low. She has added 30 minutes of stretching exercises, taught by her SGH physiotherapist, into her daily routine – a 20-minute morning jog. She takes calcium supplements too. “Now, I tell my grandchildren that I cannot carry them anymore as my doctor advised me against carrying heavy objects,” she said. She is optimistic despite her limitations. “I can still do most of what I want and I have no complaints. Life is back to normal. Having osteopenia is not the end of everything.”