Osteoporosis : What Is It?

While we live in an age where sneezing without a mask can lead to lockdowns, people with severe osteoporosis have another thing to worry about when they have the sniffles. Their bones breaking.

This underrated condition is generally present in the elderly population. It is often overlooked when compared to other diseases such as heart disease, hypertension or diabetes.

With the Malaysian elderly population expected to increase over the next few decades, it is important to take bone health seriously and learn more about osteoporosis.

Our Consultant Orthopaedic Surgeon, Dato’ Dr Lee Joon Kiong explains more about the most common chronic bone disease.

Literally, osteoporosis means “porous bones”. This condition causes bones to become porous, eventually making them weak and brittle. When the bones get too weak, even simple acts such as sneezing can cause them to break.

Our bones continuously undergo changes, breaking down old bones and forming new ones. This process is also referred to as bone remodelling. However, as we age, we break down bones faster than we are able to form new ones.

As a result, bone strength decreases due to the loss of bone mass and bone density.

Inside the bone are small tissue elements in the form of vertical and horizontal connectivity lines called trabeculae.

“Trabeculae are important in terms of providing bone strength. In osteoporosis, all these connectivity lines become thinner and break down which affects the microarchitecture of the bone.”, Dato’ Dr Lee Joon Kiong explains.

While it is known that osteoporosis affects the porosity inside the bone, the outer layer (cortical layer) is also affected.

“Similar to termites damaging a wooden furniture, osteoporosis causes holes to form on the cortical layer, increasing the porosity of the bone.” Dato’ Dr Lee added.

Risk factors for osteoporosis are divided into non-modifiable and modifiable.

Non-Modifiable (Risk factors that cannot be controlled)

• Age – After reaching peak bone mass around the age of 30, production of new bones declines.
• Gender – Women have a higher risk for fractures because of their lighter, thinner bones and longer life spans.
• Ethnicity – Research shows that Caucasian and Asian women are more likely to develop osteoporosis than women of other ethnic backgrounds.
• Premature menopause – Changes in oestrogen level during menopause can lead to a raid decrease in bone density.
• Family history of osteoporosis or fracture in first degree relative.
• Personal history of fracture as an adult.

Modifiable (Risk factors that can be controlled)

• Low calcium and/or vitamin D – Calcium is crucial for healthy bones while vitamin D improves the body’s ability to absorb calcium.
• Sedentary lifestyle – People who spend a lot of time sitting have a higher risk of osteoporosis.
• Smoking – Tobacco is known to contribute to weak bones.
• Excessive alcohol intake – Consuming more than 3 alcoholic drinks a day, regularly, increases the risk of osteoporosis.
• Excessive caffeine intake – Studies show that excessive caffeine intake reduces calcium retention.
• Low BMI – Low BMI (<19) is associated with low bone mineral density, less soft tissue and muscle weakness. These factors increase fracture risk.
• Oestrogen deficiency – Low oestrogen levels affect bone density negatively as oestrogen is essential for healthy bones.

In treating osteoporosis, it is crucial to assess the modifiable risk factors and make necessary changes to improve bone health. This includes having an active and healthy lifestyle and having a diet consisting of sufficient calcium and vitamin D.

In general, there are no symptoms or warning signs associated with osteoporosis.

“Osteoporosis is also known as a silent epidemic as you won’t get any warnings, such as coughing or fever,” said Dato Dr Lee.

However, gradually signs of bones weakened by osteoporosis will start to show such as

• Loss of height over time.
• Back pain in the lower back area.
• A stooped posture.

In order to diagnose osteoporosis and risk of fracture, bone mineral density (BMD) needs to be measured. This can be done by performing a bone density scan, also known as a bone DEXA scan or bone densitometry.

Patients aged 50 or more and have experienced a broken bone are encouraged to participate in the Fracture Liaison Service (FLS) Programme to prevent subsequent fractures. Beacon Hospital is the only private hospital in Malaysia to implement this programme.

While osteoporosis is more likely to occur as you get older, it is still preventable. We have a dedicated team of specialists in our Bone and Joint Centre of Excellence, always ready to assist you in preventing osteoporosis and maintaining good bone health.

Original video link

Book for an appointment with any one of our orthopaedic specialists now!