Avoid a fracture

by | September 10, 2012

Early action to protect bone health is encouraged instead of delaying till after the first bone fracture.


BY: Eleanor Yap


Singapore has the highest number of osteoporotic fractures in Asia yet many post-menopausal women are leaving it to after they have their first fracture before taking action. By then, they will suffer the consequences such as lose of their quality of life or worse, they suffer from complications such as pneumonia which can cause death.

Agelessonline finds out more about this sobering issue with Prof Lau Tang Ching, president of the Osteoporosis Society of Singapore (OSS):


You mentioned during the press conference that in the last three decades since 1960s, the number of osteoporotic hip fractures in Singapore rose five times among women over the age of 50. Could you share what the current figures are? What about the figures for men?

The figures for 1999 to 2010 for women in Singapore are currently still being evaluated and not available. Previous studies on hip fractures in men aged 60 years and above in Singapore reported rates of 75 per 100,000 in the early 1960s and 150 per 100,000 in 1990s.


Why such an increase for women?

We do not know the definite reason. It could be due to the ageing population and the increasing sedentary lifestyle.


Why do women get osteoporosis than men?
Post-menopausal women who are more prone to osteoporosis can lose up to 20 percent of their bone mass in the five to seven years after the onset of menopause, which usually occurs between the ages of 40 and 55. This bone loss is more rapid than seen in men.


Could you explain what the risk factors are for osteoporosis?

The well-established risk factors include white or Asian women, advanced age, early menopause, chronic corticosteroid use and having a family history of osteoporosis. The less well-established factors include low weight/height ratio, prolonged bed rest, high alcohol consumption, low calcium intake, cigarette smoking, high protein/phosphate intake, and high caffeine consumption.


Another worrying point is that many patients tend to find out that they have osteoporosis only after they suffer a bone fracture. So what should women at 40 and those at 50 do?

They should do regular weight bearing exercise, have a diet that is adequate for calcium and vitamin D intake, avoid cigarette smoking and excessive drinking of alcoholic beverages. For Asian female after menopause, they should also check their OSTA (Osteoporosis Self-Assessment Tool which compares weight to age) to determine if they should do their BMD (bone mineral density) test. After the BMD test, they should consult their doctor to determine using FRAX test) if their risk of fractures is high and if they will need medication.


Can you explain the difference between OSTA and FRAX tests and why women should do both clinical risk estimation tests? Is one more than sufficient?

OSTA is to determine the risk of low BMD; FRAX is to determine the risk of fractures. Therefore both tests complement each other.


How often should women do the tests?

The OSTA can be calculated once in one to two years. The FRAX can be estimated whenever there is a BMD done.


What about the BMD test?
The BMD test costs about S$110 to S$120 in Singapore. The FRAX is best done with the BMD test result. The BMD test should be done whenever there is a risk of osteoporosis, therefore it is still useful for pre-menopausal women (e.g. if they are taking long-term corticosteroids).


So how can one prevent osteoporosis? What is the dietary recommendation for calcium for women over 40 and 50 and beyond?

Osteoporosis can be prevented by regular weight bearing exercise, having a diet that is adequate for calcium and vitamin D intake, avoiding cigarette smoking and excessive drinking of alcoholic beverages. The dietary calcium for women over 40 should be 800mg a day, and about 1,000mg a day after menopause.


You mentioned earlier about weight bearing exercises (such as Tai Chi, brisk walking, jogging, dancing, stair climbing and racquet sports) – how often and how long should women exercise?
Weight bearing exercises should be done at least three times a day, for about half an hour each time.


What about one’s intake of sodium?
This is not related to osteoporosis in a direct manner.


It is preferably that women get enough calcium through their food intake. If they don’t have enough, should they take calcium supplements? Are there side effects to calcium supplements?
Yes, they should consider calcium supplements. However, excessive amounts of calcium may result in constipation and renal stones.  


How do you choose the best calcium supplementation?
Most individual should be able to obtain their full daily calcium requirement from diet.  However, if they have dietary restrictions and therefore cannot consume a diet that is sufficient in calcium intake, they ought to discuss with their doctor to decide on the form of calcium supplementation that is most suitable for the individual patient.


Let’s talk about men. At what age should they start taking the OSTA and FRAX tests?
OSTA is only suitable for post-menopausal Asian women. For men, they may want to consider doing the one-minute test for osteoporosis (on the International Osteoporosis Foundation website). They can then do the BMD and the FRAX after that.


The importance of sticking to prescribed medication

The International Osteoporosis Foundation reported that patients on medication can reduce their risk of fracture by about 30 to 70 percent. However, not all patients are found to be compliant. Many stop taking their prescribed medication or fail to take it regularly.

Explained A/Prof Leong Keng Hong, a consultant rheumatologist at Gleneagles Medical Centre and an adjunct associate professor at the Yong Yoo Lin School of Medicine, National University of Singapore, “Patients tend to stop medicine on their own in illnesses where they have no symptoms. Percentage varies from study to study. … Patients who find it hard to comply to oral medication regularly, can consider intravenous infusions once a year or injections under the skin once in six months.”

He advised that patients need to stick to their medication regime to not only prevent the first fracture or future fractures. “Without medication, their risks of further fractures doubles or rises as high as four times.”


(** PHOTO CREDITS: Health Promotion Board)



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