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Doc Talk: Can your bones weather a fall?

Osteoporosis is a silent disease that often shows up only after a fracture, but steps can be taken to prevent it

Kee Kok Wai on 07 Oct 2019

The Straits Times


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It was a fall that led to Madam Ong making an unscheduled visit to Toa Payoh Polyclinic.


The 58-year-old stallholder had walked slowly into the consulting room. She looked like she was in pain.


"Doctor, I slipped and fell at work two days ago and I am still feeling the pain in my back, despite taking painkillers," she said.


I sent her for an X-ray and it showed that she had a vertebral fracture in her spine.


Madam Ong has a condition called overactive thyroid where the thyroid gland produces too much thyroid hormones, which puts her at a higher risk of getting osteoporosis.


I see her every six months for the condition. When I saw her last year, I asked her to consider doing a bone mineral density (BMD) test to check if she has osteoporosis. This test uses X-ray technology to measure bone calcium content.


At that time, Madam Ong declined the test as she was busy. She is her family's breadwinner and takes care of her three children and aged father who has dementia.


This time, she finally agreed to go for the BMD test. The result showed that she had osteoporosis.


Osteoporosis occurs when you lose bone mass. Your bones become brittle and weak and can fracture easily. It is a common condition in women after menopause.


Those above 65 years old are at an even higher risk, especially if they have previously suffered a fracture, have a low body mass index or a family history of osteoporosis, have used oral steroids for a long time, went through early menopause or have hormonal or inflammatory conditions.


Smoking, excessive consumption of alcohol and a sedentary lifestyle are other risk factors.


Worldwide, one in three women will have osteoporotic fractures as they enter their 50s.


In Singapore, the Osteoporosis Self-Assessment Tool for Asians (Osta) is used as a simple tool to stratify the risk for screening in women. Osta is calculated by deducting your body weight from your age.


For example, if you are 60 years old and your body weight is 50kg, then your Osta score will be 10.


All post-menopausal women with an Osta score of more than 20 are encouraged to do a bone mineral density test. Those with a lower Osta score, but with a clear risk factor identified by their healthcare professional, should also get their bone density screened.


To prevent osteoporosis, you should quit smoking, reduce alcohol intake, eat a balanced diet and maintain an active lifestyle.


Having a diet rich in calcium and vitamin D will help you build bones up to the age of 30 and slow down the calcium loss from your bones after 30. You can also get vitamin D from exposure to sunlight.


Speak to your healthcare provider on the need for calcium and vitamin D supplements.


Regular physical activities, including resistance and weight-bearing exercises, can help to build stronger and denser bones.


It is important to treat osteoporosis. Treatment improves your bone strength and prevents further bone loss. This will reduce the risk of fractures. For better results, combine your treatment with proper nutrition and regular exercise.


Most of the approved osteoporosis medications are known as anti-resorptive agents. This means that they stop the depletion of bone minerals from bones.


Medicines that can stimulate bone formation are also available. There are potential side effects, such as inflammation of the stomach, atypical fracture of the leg, allergic reactions and a rare condition called osteonecrosis of the jaw, which involves the loss of blood supply to the jawbone. Discuss the options with your doctor.


Other than taking medicine to treat her osteoporosis, Madam Ong also took my advice to change her lifestyle habits. She now eats more green leafy vegetables and dairy products. She also exercises more.


To reduce her chances of slipping and falling again, she bought herself a pair of good non-slip covered shoes.


Osteoporosis is a silent disease. It often shows up only after a fracture. Speak to your healthcare provider early to assess your risk and get more information on the need for bone mineral density screening.


• Dr Kee Kok Wai is a family physician and an associate consultant at Toa Payoh Polyclinic.


Source: The Straits Times © Singapore Press Holdings Limited. Reproduced with permission.



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