Osteoporosis 101: Symptoms, Causes, Treatment & Prevention 

What is Osteoporosis?

Osteoporosis is a condition where the bones become weak and brittle. A person with osteoporosis may break their bones when they experience a mild slip or fall. Others might even have fractures when they do simple activities such as bending down or coughing.

To explain how osteoporosis occurs, you have to remember that our bones are tissues. They naturally break down and get replaced on a continued basis. What happens in osteoporosis is the bones break down faster than they get replaced.

Osteoporosis can affect anyone, but it is more prevalent in Caucasians and Asian women, especially after menopause. Some underlying conditions can also predispose a person to experience osteoporosis.

Osteoporosis in Singapore

Authorities in Singapore call osteoporosis a silent pandemic. It is “silent” because most cases present little to no symptoms until later; it is a “pandemic” because more and more people are getting affected by it.

When patients do experience symptoms, they observe pain in their bones, particularly in their lower back. However, the most concerning issues are cases of fractures that might result in hospitalization and even death.

In the last 3 decades, there were 5 times more cases of hip fractures in women aged 50 and above, and about 1.5 times more cases in men of the same age. Reports also mentioned that about 1 in 5 people who experienced osteoporotic hip fractures died within a year.

For this reason, it is crucial to be informed about osteoporosis in all aspects — causes, treatment, and, of course, prevention.

Causes of Osteoporosis

As mentioned earlier, our bone is in a continuous state of renewal: old bone tissues get replaced with new ones.

When we are young, our bones get replaced faster than they break down. This is why our bone mass increases. After the early 20s, the process of replacing lost bone tissues slows down, but most people only reach their peak bone mass when they are 30.

The higher your peak bone mass is, the more bone tissues you have in the bank. Experts believe the lower your peak bone mass is, the more likely you are to develop osteoporosis.

This is why it’s important for children to “build up” their bones, primarily with calcium in their diet.

Risk Factors of Osteoporosis

Factors that increase your risk of osteoporosis include:

• Inadequate intake of dietary calcium
• Low levels of Vitamin D; D vitamins influence calcium absorption
• Cigarette smoking
• Excessive intake of alcohol and caffeine
• Sedentary lifestyle
• Long-term use of some medications, like corticosteroids
• Menopause, due to the loss of oestrogen which is crucial for bone health
• Having relatives with osteoporosis

Certain health conditions can also increase a person’s risk of developing weak and brittle bones. Examples of these conditions include:

• Thyroid diseases, as the levels of thyroid hormone influence the level of calcium in the body
• Rheumatoid arthritis
• Long-term kidney and liver disease
• Conditions that affect the body’s ability to absorb nutrients, such as Crohn’s disease and Celiac disease

Symptoms of Osteoporosis

In many cases, osteoporosis has no symptoms until the later stages. However, reports urge people to watch out for the following signs:

• Losing height, which means you are becoming shorter by a few inches
• Change in posture, indicating that you are stooping or bending
• Shortness of breath, which often happens with compressed vertebral discs, resulting in decreased lung capacity
• Pain in the lower back
• Experiencing fractures due to falls and slips

When to Seek Medical Help

If you experience any of the signs and symptoms listed above, do not hesitate to talk to your doctor about osteoporosis. Pay close attention to potential symptoms and risk factors and let your doctor know about them.

Diagnosis for Osteoporosis

To date, the most reliable way to diagnose osteoporosis is through DEXA or dual x-ray absorption scan, a tool that measures your bone density. The doctor typically uses the scan on your hip or spine; in some cases, they also use this on the forearm.

DEXA results appear as T-scores; according to reports, a T-score of 2.5 or lower is the definition of osteoporosis.  

Treatment for Osteoporosis

The treatment for osteoporosis includes lifestyle modifications and medications. However, if the doctor determines that your risk of sustaining osteoporosis-related fractures is low, you might not need medications right away.

Medication for Osteoporosis

In most cases, people need medications if:

• Their T-score is 2.5 or lower.
• They have been diagnosed with hip or spine fracture from a fall while standing; doctors typically do not count instances when you sustained the fracture from a fall from a high place.
• They have an increased risk of osteoporosis-related fractures in the next 10 years and a T-score between 1 and 2.5, which usually indicates osteopenia (low bone mass).

Your doctor may recommend any or a combination of the following:

Bisphosphonates

These medications preserve bone mass by slowing the rate at which our bones break down. The doctors may give you bisphosphonates orally (tablets) or through injections. Please note that this class of medications needs about 6 to 12 months to work, and you may have to take them for years.

If you are taking them orally, reports say that you must do the following:

• Take bisphosphonates on an empty stomach.
• Stand upright for approximately half an hour after administration.
• After taking the medication, wait about 30 minutes to 2 hours before eating or drinking anything.

The doctor might also recommend Vitamin D and calcium supplements while you are on bisphosphonates. However, you usually have to take them at different times of the day.

Selective Oestrogen Receptor Modulators (SERMs)

SERMs work like the hormone estrogen, which preserves bone density and prevents bone fractures, especially on the spine. People usually take SERMs in tablet forms.

Please note that these medications may result in the following side-effects:

• Hot flushes
• Leg cramps
• Increased risk of blood clots

Hormone Replacement Therapy or HRT

Hormone replacement therapy sometimes helps menopausal women cope with their symptoms. Although it is not explicitly an osteoporosis medication, reports say that it can promote bone strength and reduce the risk of fractures.

The concern with HRT is that it slightly increases the risk of developing the following health conditions:

• Breast cancer
• Ovarian cancer
• Endometrial cancer
• Stroke
• Venous thromboembolism

For this reason, you and your doctor must first weigh the risks and benefits of HRT before using it as a medication for osteoporosis.

Parathyroid Hormone

People with osteoporosis might also receive parathyroid hormone, which works by promoting bone cell growth, thereby increasing bone density.

However, many doctors only give parathyroid hormone to individuals with very low bone density, and after observing that other medications did not work.

Osteoporosis Management

If you are diagnosed with osteoporosis, doctors will likely suggest the following lifestyle modifications:

Find Ways to Prevent Falls

As mentioned earlier, even the slightest of falls can lead to fractures. For this reason, be as proactive as possible in preventing falls. Generally, you can avoid fall accidents by:

• Removing hazards that can cause you to trip, slip, or fall, such as slippery rugs and long cables.
• Place rubber mats on areas that could get wet and slippery, such as the floor by the sink and bathroom.
• Wear non-slip and well-fitted shoes even inside the house, especially if the floor is naturally slippery.
• Consider wearing a hip protector. Hip protectors are designed to spread the impact of a fall to the surrounding muscles and fats in the hip area; hence they reduce the risk of hip fractures. However, please note that you need to wear them correctly for them to work. Ask your doctor about wearing a hip protector.
• Attend regular sight and hearing tests. Having sharp sight and hearing are essential in preventing accidents that may result in falls and fractures.

Perform Regular Exercises

At this point, you might be thinking: wouldn’t it be better for people with osteoporosis to skip working out because they might break their bones?

As much as we want to prevent fractures, regular exercise — regardless of whether you have osteoporosis or not — is crucial for overall health. Doctors emphasise that working out reduces the risk of heart conditions and even cancer.

However, due to the increased risk of fractures, it is essential to consult a doctor before starting any exercise programme. In most cases, your doctor will recommend low-impact workouts such as walking, gardening and dancing.

Eat Foods That Are Good for Your Bones

Like physical activity, a healthy and balanced diet is also essential for individuals with osteoporosis.

Strive to consume 5 servings of fruits and vegetables every day to get the nutrients you need. Make sure to consume protein from healthy sources like lean meat and nuts. Choose healthy and unsaturated fats instead of saturated and trans fat.

Other important points regarding osteoporosis diet include:

• Avoiding salty snacks and processed meat. Too much sodium can trigger bone loss.
• Reducing caffeine intake. Excessive consumption of caffeine and carbonated drinks might interfere with calcium absorption.
• Limiting alcohol consumption as excessive amounts can interfere in bone formation.
• Add adequate calcium and vitamin D to your diet.

Experts say that adults need approximately 700 to 1000 mg of calcium daily (in Singapore, it’s about 800 mg). With osteoporosis, you might need more, so talk to your doctor about the possibility of taking calcium supplements. To give you a rough estimate, 200 ml of milk, 150 g of plain yoghurt and ½ tin of sardines typically contain 240 mg of calcium. 

As for Vitamin D, adults usually need 600 IU of it daily; however, getting 1,000 to 2,000 IU per day is also generally safe. Examples of foods rich in Vitamin D include fortified milk, egg yolk and oily fish. Healthy exposure to morning sunlight (15 minutes, thrice a week) can also help to improve your vitamin D levels.

How To Prevent Osteoporosis

Preventing osteoporosis should be a priority, especially if you are at risk of developing it in the future. To protect yourself from osteoporosis, consider doing the following:

• Talk to your doctor about supplements: This is crucial, particularly if you feel that you are not getting enough calcium and vitamin D.
• Follow a regular exercise regimen: Physical activity is important for bone strength and balance. To promote bone health, weight-bearing and resistance training exercises are helpful. Weight-bearing workouts are the kind where you need to “carry” your body. Examples include running, hiking, and aerobics. Resistance training requires you to “resist” an opposing force. For this, you can use tools such as elastic bands (resistance bands).
• Avoid cigarette smoking: Certain substances in cigarettes are not good for the bone cells.
• Be mindful of your diet: Remember to have a healthy, balanced diet and avoid excessive intake of alcohol, salty foods and caffeine.
• Have regular check-ups: Attending regular check-ups help to diagnose osteoporosis early on and gives you more time to intervene appropriately.

Are You Worried About Osteoporosis?

If you need help with osteoporosis, the best course of action is to consult a doctor. Not only will they give an accurate diagnosis, but they can also provide details about your risks and preventive measures you need to take. For greater convenience, you can also book an appointment with our house call doctors for an in-person consultation in the comfort of your home.

Download our app today or call our Care Advisors at +65 6100 0055 for a free care consult.