13.NOV.2018 5 MIN READ | 5 MIN READ

For osteoporosis patients, a fracture can cause more than pain and inconvenience. Dr Bernard Lee, orthopaedic surgeon at Gleneagles Hospital, tells us more about the condition.

Picture this: You’re at the wet market buying fish and vegetables, and you see an elderly lady in front of you slip and fall. Due to osteoporosis, which weakens her bones, she breaks her hip bone and is unable to get up. Someone will have to call an ambulance to send her to the hospital.

It may sound alarming to you, but this situation happens more than 6 times every day in Singapore, and it is becoming more common with our ageing population. 1 in 4 people who fracture their hips will also pass away within 12 months of the injury.

Who gets osteoporosis?

Osteoporosis is more common in women than men. Women who have reached menopause or had their hormone-producing ovaries removed early are at a higher risk of developing osteoporosis due to the reduction in protective hormone levels. Likewise, men with low testosterone levels also face higher risks.

Individuals on long-term medications such as long-term steroids, taken by patients with chronic medical problems such as asthma and rheumatoid arthritis, can also develop osteoporosis. It is important to note that some traditional Chinese medicines can also contain significant amounts of steroids.

Lifestyle habits like excessive smoking and alcohol consumption may also increase the risk of osteoporosis.

I’m still young. Can I reduce my risk of getting osteoporosis?

Prevent and treat osteoporosis - Reduce risk
Your bone mass is the greatest when you’re in your 20s. After 30, it will begin to decline. It is therefore very important to strengthen your bones as much as you can when you are young. Particularly for breastfeeding mothers, bone loss is significant when you are lactating. All this makes it increasingly important to pay attention to bone health.

Eating well and leading an active lifestyle can help build strong bones when you are young. A healthy diet with sufficient calcium and vitamin D is important for strengthening bones. You can consume more calcium through diet choices by having more dairy, leafy greens, and soy products, while vitamin D can be produced by your skin through adequate sun exposure. Regular exercise, strength training and weight-bearing exercises also stress the bones and stimulate them to strengthen.

I’m postmenopausal. What should I do?

You can assess your risk of developing osteoporosis by visiting your family doctor. If required, your doctor may send you for a bone mineral density (BMD) test, which will help your doctor find out if your bone mass is normal, slightly deficient (osteopaenia) or very deficient (osteoporosis). Your doctor will then be able to advise whether you need an anti-fracture treatment.

I have osteoporosis. What should I do?

Prevent and treat osteoporosis - Reduce fracture risk
The main problem with osteoporosis is the risk of easily fracturing your bones. Treatment is therefore centered on reducing your chance of fractures.

Regular strength training and weight-bearing exercise such as brisk walking and taichi (a type of Chinese martial art) can help reduce the rate of bone loss. Such activities improve muscle strength and coordination, and reduce the risk of falling. A healthy diet with sufficient calcium and vitamins such as D and K2 may help reduce the risk of developing an osteoporotic fracture.

In severe cases, special medication to decrease the rate of bone loss or to build bone density may be prescribed. These drugs need to be taken for many years to reduce the risk of fractures. However, these drugs also carry risks and side effects, such as atypical fractures in your thigh bones.

I have osteoporosis and have fallen and broken a bone. What should I do?

You should see a doctor to have your fracture assessed. Some fractures of the spine and pelvis do not require much medical treatment apart from painkillers, while some fractures such as simple wrist fractures will be able to heal with the help of a cast.

While treatment in a cast may sometimes facilitate healing, restricted movement and limited weight-bearing may result in rapid loss of muscle and bone strength. In an elderly individual, this may result in loss of function, mobility, and independence.

Other more serious fractures, however, may require surgical treatment to restore function and to prevent future complications from developing. Fortunately, with modern orthopaedic techniques, an experienced surgeon may be able to fix your fracture well enough to allow early use of the injured limb in order to preserve its function. Enabling patients to walk reduces the chance of deconditioning, which could result in the patient becoming wheelchair or bed-bound. In some severe cases, where the bone is not fixable, a joint replacement may be required to restore function. This commonly occurs with fractures of the hip, shoulder, and elbow.

Physiotherapy can also help to restore function to injured limbs after the fractures have healed, helping to improve muscle strength, coordination and balance to reduce the chance of falling in the future.

Finally, your doctor will advise you if you need to take medication to reduce the risk of further osteoporotic fractures. Other medical problems that predispose you to falling, such as visual impairment, giddiness or low blood pressure, may need to be treated as well. Your doctor may also need to review the medication you are taking, as some drugs may affect balance and conscious levels.

Important points to remember

Prevent and treat osteoporosis - Remember
Prevention is better than cure.

Build your bones when you are young with regular exercise, strength training, and a healthy balanced diet.

Reduce your risk of falling.

Maintaining muscle strength, coordination and balance can help prevent you from falling and fracturing a bone.

Oral medication can help reduce the risk of fractures.

Calcium, vitamin D, and specialised medication for osteoporosis can help reduce the risk of fractures after a fall.

Thigh pain when taking osteoporosis medication is a warning.

See your doctor quickly and avoid excessive walking if you develop thigh pain when taking medication for osteoporosis.

Early surgery is beneficial.

Early surgery can restore function, preserve independence, and improve quality of life.

 

Article reviewed by Dr Bernard Lee, orthopaedic surgeon at Gleneagles Hospital

13.NOV.2018
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Lee Chee Siang Bernard
Orthopaedic Surgeon
Gleneagles Hospital

Dr Bernard Lee is an orthopaedic surgeon practising at Gleneagles Hospital, Singapore.