Understanding Osteoporosis: Causes, Risk Factors, and Treatment Options
Understanding Osteoporosis: Causes, Risk Factors, and Treatment Options
02 June 2023 | Article is written by Dr Gregory Low Jia Hao (Medical Officer, BP Healthcare Johor)
(Image credit: Jcomp/Freepik)
Osteoporosis is a condition characterized by weakened bones and reduced bone density, leading to an increased risk of fractures. Bone density is defined as bone mass composition, whereas bone quality consists of architecture, turnover, degree of damage and mineralisation rate.
As the population increases and life expectancy rises, this silent threat to bone health is becoming a growing public health concern in Malaysia. Malaysia has a growing number of elderly individuals. Osteoporosis-related fractures is a major health problem among the elderly.
In 1997, the incidence of hip fracture among Malaysians aged 50 years and above was 90 per 100,000, and the number is growing annually. Morbidity and mortality rate of up to 20% within the first year among those who suffered a hip fracture. Osteoporosis leads to increased risk of fractures, hence increased morbidity and mortality rates, leading to reduced life expectancy and quality of life. Not taking into account cost of hospitalisation, rehabilitation and long-term nursing care.
| Incidence by age group (per 100,000) | |||
|---|---|---|---|
| Age Group | Male | Female | Overall |
| 50-54 | 10 | 10 | 10 |
| 55-59 | 20 | 30 | 20 |
| 60-64 | 40 | 50 | 40 |
| 65-69 | 60 | 100 | 80 |
| 70-74 | 100 | 230 | 170 |
| 75 | 320 | 640 | 510 |
Osteoporosis classified into 2 types:
1) Primary osteoporosis
This type of osteoporosis occurs among women after menopause due to decreasing estrogen level. Estrogen is important in maintaining bone level density with its reduction leading to bone loss.
- Post-menopausal osteoporosis
This type of osteoporosis occurs among women after menopause due to decreasing estrogen level. Estrogen is important in maintaining bone level density with its reduction leading to bone loss.
- Age related osteoporosis
This type is common among elderly men and women. Advanced age leads to bone mass reduction, increasing the risk of fracture and other types of bone injury.
2) Secondary osteoporosis
Secondary osteoporosis is a type of osteoporosis that is caused by an underlying medical condition, medication, or lifestyle factor. It is not primarily caused by the aging process.
| Endocrine |
|
| Drugs |
|
| Chronic diseases |
|
| Nutrition |
|
| Others |
|
Osteoporosis is influenced by a combination of modifiable and non-modifiable risk factors. The non modifiable risk factors are those that cannot be changed while modifiable risk factors are those that can be changed or controlled. Here is an overview of both types of risk factors:
| Non modifiable | Modifiable |
|---|---|
|
|
Diagnosis and Screening of Osteoporosis
Osteoporosis can be diagnosed by measuring bone mineral density (BMD). The most common diagnostic tools and devices for measuring BMD includes:
1) Dual Energy X-ray Absorptiometry (DEXA)
This non-invasive technique measures bone mineral density (BMD) at specific sites, usually the hip and spine. DEXA scan is simple, quick, emits low radiation levels and is affordable.
2) Quantitative Ultrasound Calcaneum
This technique uses sound waves to measure bone density at peripheral skeletal sites, such as the heel or shin. This scan does not involve any radiation, portable, simple to use and low cost.
Seek consultation and continued care from medical doctors. There are various treatment choices available, including bisphosphonates, denosumab, teriparatide, activated vitamin D, and raloxifene.
Non pharmaceutical ways of reversing osteoporosis
1) Dietary and supplementation: Ensure a balanced diet that includes sufficient calcium and vitamin D, which are essential for bone health
2) Exercise
- Practise resistance training to improve muscle strength and enhance bone density.
- Conduct balance training to improve coordination and reduce the risk of falls.
- Get at least 30 minutes of low-impact weight-bearing exercises everyday (walking, elliptical machine)
- Perform muscle-strengthening exercises at least 2-3 days in a week, hitting every major muscle group.
- Avoid high impact exercises or exercises which involve flexion-extension motion of the spine such as sit-ups or jumping exercises.
- Seek physiotherapist advice for a tailored exercise program which can be scaled according to individual strength level and capabilities.
Calcium is the major component of the bone and provides the skeleton strength and structure. Sufficient calcium intake throughout life is crucial for optimizing bone density and reducing the risk of osteoporosis.
The principal function of vitamin D is to increase calcium absorption from the intestine. It is also produced in the skin when exposed to sunlight.
Both calcium and vitamin D work synergistically to support bone health. Adequate intake of both nutrients through diet, sunlight exposure, and supplementation if needed, helps maintain strong and healthy bones throughout life.
BP Healthcare has a diverse team of healthcare professionals, including physicians, pharmacists, and physiotherapists, who collaborate to support the screening, diagnosis, and preventive efforts related to osteoporosis.
Our health screening packages provide a multitude of tests which include blood tests (to screen for risk factors such as kidney, liver and thyroid disease, as well as for nutrient deficiencies such as Vitamin D levels).
Our centers also provide the screening tools to assess BMD such as DEXA scan and QUS scans in which the test results will be interpreted and explained by our team of doctors. Moreover, the doctors will also provide consultation on how to maintain bone health.
Assessment and risks of disease progression will be done by doctors who will then recommend the best course of management for each patient. Our supplement lines also consist of Calciluv as well as Vitamin D supplements which come in two types (2000iu/capsule and 25000iu/capsule) which will be recommended according to individual vitamin D levels.
BP Healthcare’s team of physiotherapists are also well-qualified to provide physical assessment and to recommend a suitable individualised training program.