What You Need To Know About Osteoporosis

It is often said the osteoporosis is common among women or the elderly as it is a condition that is often believed to be an inevitable part of ageing. The truth is, osteoporosis can strike at any age and both women and men can suffer from it. In fact, approximately 20% of osteoporosis patients in Malaysia are men.

So, what exactly is this disease? Osteoporosis literally means porous bone. It is a skeletal disease, which causes a progressive decrease in bone mass, density and strength. This causes the bone to become brittle, which means it can get fractured easily. In severe cases, simple activities like bending over to pick up a book or lifting a vacuum cleaner can cause a fracture!

Bones are actually living tissues with cells. Our bones grow during childhood and adolescence and reach a peak around the age of 30 (peak bone mass).  After that, the process of bone resorption (removal of old bone material) slowly begins to exceed bone formation and bones gradually begin to lose their density.

Osteoporosis develops when bone resorption occurs too quickly or if replacement occurs too slowly. This phenomenon causes bones to be porous, weak and vulnerable to fracture. Osteoporosis-related fractures have been recognised as a major health problem, particularly in the elderly.

Fractures commonly occur at the spine, wrist and hip. Wrist and spine fractures can reduce independence and quality of life. Hip fractures are associated with high morbidity and a mortality rate of up to 20% in the first year. The majority of those who survive are disabled, risk secondary complications and only 25% will resume normal activities.

Types of Osteoporosis 

There are two major types of osteoporosis, namely primary osteoporosis and the secondary osteoporosis. Primary osteoporosis occurs spontaneously and it is the most common form of the disease, comprising almost 95% of osteoporosis cases in women and 80% in men. Secondary osteoporosis is caused by a drug or another disorder.

Primary osteoporosis that is related to the onset of menopause is termed as Type 1 or postmenopausal osteoporosis. The decrease of oestrogen causes bone breakdown, which reduces bone strength and increases the risk of fractures. Ageing is the next factor which contributes to primary osteoporosis, and it is classified as Type 2 or senile osteoporosis. It often occurs amongst those who are 75 and above.

Secondary osteoporosis on the other hand, may be caused by a chronic case of kidney failure and hormonal disorders, such as Cushing’s disease, anorexia nervosa, diabetes mellitus. Drugs like corticosteroids, barbiturates and anticonvulsants may also contribute to osteoporosis.

Another type of osteoporosis is idiopathic osteoporosis, which is a rare. This type usually occurs in children and young adults who have no health problems or nutrient deficiency.

 

Factors that Contribute to Osteoporosis

Apart from being recognised as a major health problem amongst the elderly, it is estimated that over one million people are at risk of contracting osteoporosis in Malaysia.

Other than ageing and hormonal deficiency, there are many other factors that contribute to this disease. They are generally divided into modifiable and non-modifiable factors:

Non modifiable factors
  • Ethnic group (Asian and Caucasian)
  • Female gender
  • Advancing age
  • Menopause
  • Women with small body frames with a Body Mass Index of less than 19kg/m2
  • Family history

Modifiable factors

  • Sedentary lifestyle
  • Low calcium intake
  • Steroid intake
  • Cigarette smoking
  • Excessive alcohol and caffeine intake

 Chronic alcohol ingestion has been linked to higher incidences of fractures of the hips, spine and wrist as it interferes with the balance of calcium in the body. Alcohol also affects the production of hormones and which helps protect bones from breaking.

The Symptoms 

Osteoporosis has been called a ‘paediatric disease with geriatric consequences’, because it progresses for years without any signs or symptoms. As such, it is important to start building healthy bones from a young age to prevent osteoporosis from occurring later in life.

In most cases, osteoporosis does not show any symptoms because bone density loss happens progressively. However in rare cases, the symptoms might be obvious, such as sudden pains or aching bones and deformities when bones collapse or fracture.

Women who have postmenopausal osteoporosis are more prone to having wrist fractures. Spinal fractures can cause hunchback deformity, disfigurement, loss of height and chronic back pain, whereas hip fractures can result in permanent disability or even death.

Treating Osteoporosis 

Although osteoporosis is an irreversible process, a proper regime of medication and lifestyle changes may help restore bones in terms of density and strength. An early diagnosis of osteoporosis and treatments can help reduce the risk of getting a fracture or fracture related complications.

The Dual Energy X-ray Absorptiometry (DEXA) test measures bone density on various parts of the body, especially the spine and hip. Other tests like ultrasound and CT scanning can also accurately measure bone density.

If bone density testing indicates low density or osteoporosis, a pharmacological agent may be needed to help slow down the rate of bone loss and/or reduce the risk of future fractures. These agents include Hormone Replacement Therapy (HRT), Selective Oestrogen Receptor Modulators (SERM), Bisphosphonates and Parathyroid Hormone.

Prevention Is Better Than Cure 

To avoid osteoporosis, early detection and prevention is crucial. Increasing your bone density by consuming adequate amounts of calcium and vitamin D and eating a balanced diet with regular weight-bearing exercises will help reduce the risk.

If you are under 30, start building up strong bones. If you are above 30, focus on keeping your bone loss to a minimum. Here are a number of ways you can use to help prevent osteoporosis:

  • A Healthy Diet

Start building up stronger bones during childhood and adolescence by consuming a balanced diet, rich in calcium. Calcium is an essential component to build stronger, denser bones and it slows done the rate of bone loss later in life.

  • A Healthy Lifestyle

Reduce the consumption of caffeine as it interferes with the balance of calcium in the body.

  • Alcohol Consumption

Stop drinking alcohol as it induces deficiency of calcium, Vitamin D and magnesium.

  • Smoking

Smoking is often associated with various diseases and osteoporosis is one of them. It lowers bone mass, increases fracture rates and causes early menopause.

  • Exercising

Doing regular weight-bearing exercises such as walking, hiking and dancing for 30 minutes a day helps improve balance and flexibility and strengthen bones. If you have low bone density protect your spine by avoiding exercises and activities that require a lot of flexing, bending or twisting at the spine.

  • Self-management

Remember, safety first. Avoid circumstances that may lead to injury, such as slippery and wet floors. Sleep on firm mattress and use correct posture, such as bending at the knees, when lifting heavy objects. 

Many Asians have trouble digesting dairy products, which is an important source of calcium. If you are lactose intolerant, consume dairy products in moderation. You can also try eating dairy in small amounts over the course of the day.

An alternative is to eat calcium-rich food that is not dairy-based such as almonds and soybeans or take calcium supplements to ensure that your body receives an adequate amount.

Apart from calcium, your body also requires an adequate supply of Vitamin D and other minerals to maintain bone density. Vitamin D assists in the absorption of calcium. Get your Vitamin D from food sources such as egg yolks, saltwater fish or expose yourself to the morning sunlight for 15 minutes instead. 

 

Sidebar 1: Elements Of A Calcium-Rich Diet

The Asian diet is relatively low in calcium. In order to maintain stronger bones, start eating a variety of calcium-rich food like:

  • almonds
  • bok choy
  • broccoli
  • calcium-fortified orange juice
  • calcium-fortified soy milk
  • calcium-fortified rice
  • canned sardines with bones
  • milk, yogurt, cheese, ice cream
  • oysters
  • sesame seeds
  • soybeans
  • tofu

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