Living with Osteoporosis
Introduction Osteoporosis can be a silent disease. A person with osteoporosis has bones that are brittle and fragile. These fragile bones can break very easily from a simple fall, or even without spontaneous injury. •
1 in 3 people with a hip fracture suffer considerable loss of function and become dependent on others.
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1 in 5 people die within a year of sustaining a hip fracture
Singapore has the highest incidence rate of hip fracture in Asia. Osteoporosis is fast becoming a common problem in Singapore especially with the ageing population. What is osteoporosis? Osteoporosis means ‘porous bone’. This condition is a result of bones losing too much calcium and becoming weak. Osteoporosis is hard to detect and is usually discovered only after a fracture occurs. Some other symptoms include a reduction in height, a hump developing on the back or lower back pain.
The bones in your hip, wrist and spine are at greatest risk of breaking. If the bones in your upper back are fractured, your spine may curve to form a hump. Osteoporosis may result in chronic pain, decrease your mobility and affect your quality of life. In severe cases, hip fracture due to osteoporosis may lead to death.
What cause osteoporosis? The bone is a living tissue. When we are young, any loss of bone is easily replaced. At around the age of 30, our bones are at their strongest. However as we age, the bone replacement rate slows. Both men and women can suffer from osteoporosis, but women of menopause age or who have had their ovaries removed are more susceptible. After menopause, the body’s estrogen supply decreases and the rate of bone loss increases even further. This is why postmenopausal women are most likely to suffer from osteoporosis. Estrogen and the male hormone testosterone are important for bone health in men. There are also many other factors, such as illnesses, medications and lifestyle choices that contribute to bone loss.
Am I at risk? Everyone, regardless of gender, is potentially at risk. However, some people are at a higher risk than others. The risk factors include: • A previous low impact fracture •
Early menopause before 45 years of age, whether natural or as a result of surgery
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Having an immediate family member with osteoporosis or a hip fracture
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Being underweight or undernourished
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Being frail or having a long-term illness (e.g. Rheumatoid Arthritis)
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Smoking
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Excessive alcohol intake
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No exercise or being inactive for a prolonged period
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A diet that is deficient in calcium or Vitamin D
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Certain medicines (e.g. corticosteroids, thyroid medication)
How do we diagnosis osteoporosis? Osteoporosis is diagnosed either by detecting the presence of a fragility fracture or a bone mineral density (BMD) test. BMD measurement: Dual Energy X-ray Absorptiometry(DEXA) is the test that helps your healthcare provider to assess your risk of obtaining a fracture or detect existing fractures. They can then make recommendations for treatment or advise on preventive measures. This test can be done on different parts of your body. It is usually performed on the hip and spine. It measures the amount of bone minerals that you have in a certain section of bone. It is a painless and non-invasive test, and usually takes less than 15 minutes.
Name of the medicine
Bisphosphonate - Alendronate - Risedronate
What it does
Works by binding directly to the bone, preventing breakdown of bone material
Teriparatide
Once a week (Alendronate, Risedronate) Once a month (Risedronate)
Once a year
Bisphosphonate - Zolendronate
Denosumab
Routine
Works by reducing bone resorption and increasing bone mass and strength of the bone Helps to regulate calcium metabolism, promotes the growth of new bone
Route Oral - To take with a full glass of water in the morning on an empty stomach before breakfast. - Do not lie down after taking the medication for at least half an hour
Intravenous This is injected over 15-30 mins via a cannula through a vein
Once every 6 months
Subcutaneous This is injected usually into the fatty tissues of the abdomen
Once a day
Subcutaneous This is injected usually into the fatty tissues of the abdomen
Side effects Common side effects
Less common side effects
Heartburn, nausea, musculoskeletal aches, diarrhoea, belly ache
Atypical femoral fracture, osteonecrosis of the jaw
Flu-like symptoms e.g. fever, malaise, headache, musculoskeletal aches, hypocalcaemia
Worsening renal function Atypical femoral fracture, osteonecrosis of the jaw
Cost (Yearly)
$
$$
Musculoskeletal aches, hypocalcaemia
Cellulitis Angioedema Atypical femoral fracture
$$
hypercalcemia
osteosacoma
$$$$
How to protect your bones: • Eating a diet with adequate calcium and Vitamin D • Doing regular weight-bearing exercise • Staying smoke-free • Limiting alcohol intake Calcium A balanced diet will provide your body with enough nutrients, including calcium, to build strong bones. So, remember to eat foods rich in calcium. Adults aged 51 and above require at least 1,000mg of calcium every day. The Singaporean diet averages about 700mg of calcium per day. To have enough calcium, aim to add 1 more calcium-rich food item to your daily diet. (Refer to page 6 to find out the calcium content in common foods.) Vitamin D Vitamin D strengthens your bones by increasing the absorption of calcium from your small intestines and regulating the amount of calcium in your blood. There are dietary sources of Vitamin D such as salmon, liver, eggs, cod liver oil and fortified
foods such as margarine and some brands of low-fat milk. However, these are unable to contribute sufficient amounts of Vitamin D to the diet. The best way to obtain sufficient Vitamin D is 15 mins of daily sunlight exposure. However, avoid outdoor activities during the hottest period of the day. Exercise Exercise will help prevent falls by increasing muscle strength, improving flexibility and balance, and building up endurance and coordination. Regular weight-bearing exercises are important at all ages. These are the best way to keep you bones strong and healthy. Examples of weight-bearing exercises: • Dancing • Tai chi • Brisk walking • Hiking • Stair climbing • Racquet sports • Jogging For older adults, it is important that the type of exercise you choose is suitable for your age and health condition. When in doubt, consult your doctor.
Calcium content of some common foods Source
Serving Size
Calcium(mg) per serving
Milk and milk product Low fat milk Low fat yogurt Cheese High-calcium milk powder
1 glass (250ml) 1 carton (200g) 1 slice (20g) 4 scoops (25g)
300 420 130 450
Fish/Meat/Bean/Nuts Dried ikan bilis (with bone) Soya beans (cooked) Beancurd, firm (tau kwa) Soya bean with syrup (tau huay) Egg Soya bean drink Canned sardines with bones Almonds
2 tablespoons (40g) 1 mug (180g) 1 small cake (90g) 1 bowl (540g) 1 (50g) 1 glass (250ml) 1 fish (50g) 1/4 mug (40g)
270 205 150 80 30 25 190 100
Fruits/Vegetables Kailan (cooked) Spinach (cooked) Chye sim (cooked) French beans (cooked) Broccoli Papaya Dry figs
¾ mug (100g) ¾ mug (100g) ¾ mug (100g) ¾ mug (100g) ¾ mug (100g) 1 wedge (130g) 5 wholes (95g)
195 140 140 55 50 40 240
Calcium fortified products High-calcium soya bean milk Bread
1 glass (250ml) 2 slice (60g)
450 100
Almost everyone on medication for osteoporosis is given calcium and Vitamin D supplements. This is to make sure that the body has enough nutrients in order for the medications to work as well as they can. However, calcium alone is not an effective treatment for osteoporosis.
Prevent fall = prevent fracture Reduce the risk of falls to prevent fractures. This is very important for elderly persons who have osteoporotic bones. Wear well-fitting non-slip shoes
Exercise regularly
Go for regular eye checks
Keep your bones strong
Keep your home safe & neat
Bedroom • Sit for a while before standing up to prevent dizziness • Make sure your feet can touch the floor when you sit on the edge of your bed • Use a night light Bathroom • Install grab bars • Use a commode chair • Use non-slip mats Living room • Arrange furniture to make a clear pathway • Tie up loose wires • Keep your home well lit Kitchen • Keep commonly used items in lower shelves • Avoid climbing on chairs and stools to reach for things • Keep the floor dry
Yishun Health is a network of medical institutions and health facilities in the north of Singapore, under the National Healthcare Group. Admiralty Medical Centre • (65) 6807 8000 • www.admiraltymedicalcentre.com.sg Khoo Teck Puat Hospital • (65) 6555 8000 • www.ktph.com.sg Yishun Community Hospital • (65) 6807 8800 • www.yishuncommunityhospital.com.sg The information is correct at the time of printing and subject to revision without further notice.
IP.PE.72.0419