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Treating Osteoporosis

Treating Osteoporosis

Prevent and Treat Osteoporosis Now!

MEDICATION

If you have been diagnosed with osteoporosis, or are at high risk of it, you will need to be treated to prevent fractures. Although calcium and Vitamin D intake, exercise and lifestyle modifications are essential steps for osteoporosis patients, they are not able to stop the excessive bone loss process. Your doctor may recommend a treatment plan that includes medication.

  • Bisphosphonates
Bisphosphonates are non-hormonal drugs that inhibit bone resorption and bring about an increase in bone mass. They are commonly used to treat osteoporosis in post-menopausal women and in men. They come in a once-weekly tablet for convenience and compliance, and have been found to help prevent osteoporotic bone fractures of the hip and spine.
In order to avoid oesophagitis (inflammation of oesphagus), you are advised to remain upright for about half an hour after taking the medicine.
Bisphosphonates include alendronate sodium, etidronate and risedronate sodium. Etidronate is available in once daily dosing which needs to be taken cyclically at 2 weeks apart. Risedronate sodium is available in daily and once weekly formulation. Alendronate sodium is available in daily and weekly formulation. A dual-therapy of alendronate and colecalciferol (vitamin D) is also available as a once-weekly tablet.
  • Calcitonin
Calcitonin is a hormone that inhibits bone loss – the removal of bone calcium into the blood – and helps to retain the levels of these materials in the bone. It is available in nasal spray and injectable forms.
  • Hormone Replacement Therapy (HRT)
HRT provides supplementary female hormones, including oestrogen, that were naturally produced by the ovaries before menopause. Nonetheless, the long-term use of combined HRT has been linked to various health risks. Women whose sole indication for using HRT is to prevent osteoporosis should be aware that there are currently many non-HRT alternatives (like bisphosphonates and SERMs) which may be effective both in preventing as well as treating osteoporosis.
FURTHER CARE AND SUPPORT
If you are a recently diagnosed osteoporosis patient, you and your family may feel greatly concerned by the discovery. Give yourself some time to sort out your feelings and make suitable adjustments. While the immediate goal is to be safe from fractures, the good news for the long term is that osteoporosis is treatable and preventable with a combination of medication, adequate vitamin intake, exercise and lifestyle modifications. Learn more about preventive and treatment options, and adhere to the doctor’s advice to ensure optimal results.
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Preventing Osteoporosis

Managing Osteoporosis

DIET AND VITAMINS

Your doctor may advise you to change your diet or add dietary supplements. To ensure that your body can counteract osteoporosis, medications for osteoporosis are often accompanied by calcium and vitamin D supplements:

Calcium

Adequate calcium intake is essential in restoring bone health, as calcium is a major building block of bone. Choose calcium-rich foods and if dairy products upset your stomach, try other calcium-rich foods such as fish with soft bones (ikan bilis, sardines) or tofu. To maximise calcium absorption,  avoid eating too much protein or salt, as large quantities of these are related to a loss of calcium.

Vitamin D

Vitamin D is the key to unlocking the benefits of calcium – it helps the body absorb calcium. The best way to obtain sufficient vitamin D is 30 minutes of outdoor sunshine a day. Nonetheless, a recent study conducted in 18 countries worldwide found vitamin D inadequacy to be widespread among postmenopausal women with osteoporosis, even in countries where there is ample sunlight.

Important Reminder

Even if you have a calcium-enriched diet, your body cannot absorb the calcium consumed unless you have enough vitamin D. Inadequate vitamin D in the body contributes to bone loss and hinders efforts to combat osteoporosis.

Exercise

Moderate Exercises

Exercise at Moderate Intensity

You should aim to exercise at moderate intensity, at least 5 times a week, for 30 minutes each time, and always with warm-up and cool-down exercises. Include a variety of activities to keep all parts of the body exercised, and discuss with our doctor an exercise program that is suitable for you. It may include:

  • Resistance exercises such as light weight-training, which may help maintain bone health by strengthening the muscles around them.
  • Weight-bearing exercises including brisk walking, stair climbing, dancing, or those that require your bones and muscles to work gently against gravity.
  • Non-weight-bearing exercises such as tai chi, swimming or other water exercises, which may help prevent back strain and pain by building your trunk and leg muscles.

Lifestyle Modifications

Lifestyle modifications can be crucial to successfully treating and preventing osteoporosis – your doctor may suggest that you:

  • Stop smoking – smoking may increase your chance of getting osteoporosis, and many other diseases
  • Reduce your alcohol intake – heavy alcohol intake is associated with a higher risk of osteoporosis, and injuries that can cause fractures.

How to prevent falls:

  • Always anchor rugs and carpets
  • Ensure that rooms are well-lit
  • Conceal all electrical and telephone cords to avoid tripping over them
  • A flashlight by your bed is helpful at night. Check the batteries often
  • Stairways should have railing and non-slip surfaces
  • Grab bars and other aids, such as night-lights, are especially helpful in bathrooms
  • Use non-slip mats or adhesive strips in your tub or on your shower floor
  • Ensure chairs and couches are easy to get in and out of

Further Prevention of Spinal Problems

Osteoporosis can cause the vertebrae in your spine to collapse. To prevent or lessen such spinal problems:

  • Practice good posture
  • Use proper techniques if you need to lift heavy objects – bend your knees instead of your back to reach low down items
  • Do back exercises to help your posture
  • Lie on your back when you have pain

Detecting Osteoporosis

Osteoporosis is also known as ‘the silent crippler’ because it can occur without symptoms. This is where the danger lies, as most people would not know about their osteoporotic condition until a major fracture occurs, often with devastating effects.

The Osteoporosis Self-Assessment Tool for Asiana (PSATA) is a 1-minute guide, formulated to help assess an Asian woman’s risk of osteoporosis – by simply comparing weight measurement (in kilograms) to age for an indication of the individual’s risk profile.

If your risk is medium or high, it is very important that you see Dr. Kevin Yip for help as soon as possible.

Those with medium or high risks, or those who may have symptoms of osteoporosis, are advised to see a doctor as soon as possible.

Our doctor may recommend a dual energy X-ray absorptiometry (DEXA) test to help determine your bone mineral density (BMD), a reading that is indicative of your bone health.

Unlike bone scans that require an injection of a radioactive material, the DEXA test requires no special preparation, medication, or injection. Its test result, known as T-scores, compare your bone density with that of a normal young adult of your gender.

An individual with bone mass of 2.5 standard deviations or more below the normal density (which also means 25-30% or more below) is diagnosed as osteoporotic.

Osteoprosis Around Us

  • Osteoporosis is not just an ‘old women’s’ disease. According to the International Osteoporosis Foundation, younger females too need to take note, as bone loss in women can begin as early as age 25, and a woman’s lifetime risk for osteoporotic fracture is 30-40%. The prevalence of osteoporosis in men is also higher than previously thought – affecting approximately one in five men.
  • And, the incidence of osteoporosis is increasing in Singapore’s ageing population – since the 1960s, hip fractures have risen 1.5-fold in men aged over 50 years and 5-fold in women older than 50.
  • In the United States, Europe and Japan, about 1 in every 3 post-menopausal women are osteoporotic – in 50 years time, more than half of all hip fractures in the world are projected to occur in Asia.

Consequences of Osteoporosis

Sometimes, nothing happens, as osteoporosis is asymoptomatic. However, the lower your BMD, the higher your risks of bone fracture. Most alarmingly, osteoporosis can cause sudden fractures during everyday activities that would not have otherwise affected normal bone.

The devastating and painful fractures usually occur at the spine, wrist, hip, pelvis or upper arm. They can lead to:

  • chronic pain
  • reduced height
  • considerable deformity including hunching of the back
  • loss of mobility
  • a need for surgery, hospitalisation and after-care
  • reduced physical independence and quality of life
  • death in severe cases of hip fractures

Osteoporosis is a treatable condition. It is preventable too.

With effective medication, osteoporosis can be treated and its risks prevented. But calcium alone is not enough to achieve this. Understanding, managing and preventing your risks of osteoporosis can improve your risk profile, enhance your quality of life, and reduce your burden of care.

Discuss early with our doctor the appropriate medicine, diet and vitamin intake, exercise and lifestyle modification that an effectively help to reduce your risk of osteoporosis.

Related Articles:
Understanding Osteoporosis
Preventing Osteoporosis
Treating Osteoporosis
Bone Mineral Density Test (DEXA Scan)

Understanding Osteoporosis

A Healthy Bone

Osteoporosis vs Normal Bone
Osteoporosis comparing with normal bone

Bone is a living tissue. The body is always making and losing (resorbing) bone. While the bone-making cells form new bone using calcium and other minerals from the food we eat, the bone apart so that its minerals can be sued to repair an injury or make new bone. The bone-making cycle is in balance so long as the same amount of bone is built and resorbed.

An Osteoporotic Bone

Osteoporosis is characterised by an imbalance in the bone-making cycle, triggered by changes in the body’s hormonal levels, activities, medications, or dietary patterns. It results in bone being broken-down faster than the bone-making cells can replace it. This reduces bone density.

Left untreated, the weakened and brittle bone can easily fracture with a simple slip or fall, or even under the body’s own weight. When a fracture occurs in the vertebrae due to body weight, parts of the spine compress, causing the back to bend or hunch over time. Some symptoms (eg, cyfosis, unsolved backpain, protruding abdomen) may be indicative of your risk osteoporosis.

Bone Density through the Ages

When we are young, any loss of bone is easily replaced. Our bones are their strongest from the mid-20s to the early 30s. However, as we age, more bone is lost that it is made.

Osteoporosis and Aging

Osteoporosis and Aging

In the first 6 years of menopause, a woman can lose up to 1/3 of her spinal bone mass as her ovaries stop producing oestrogen, a female hormone that keeps her bones strong during the reproductive years.

Later in life, both men and women’s bones are at risk of becoming weakened, brittle, and prone to fractures.

Related Articles:

Detecting Osteoporosis
Preventing Osteoporosis
Treating Osteoporosis