The silent disease
HUMANS build and lose bone mass all throughout life. However, for patients with osteoporosis, bone deteriorates faster than it can be built, which leads to a negative balance of bone mass and porous bones. Thus, the bone becomes fragile and brittle, easily broken with or without trauma.
However, Datuk Dr Lee Joon Kiong, founder, former president and current vicepresident of Osteoporosis Awareness Society of Kuala Lumpur and Selangor (OASKLS), believes osteoporosis is often considered a lower priority in healthcare throughout the world. He says, “People treat it as a natural ageing process in comparison to other conditions such as heart disease and diabetes. The actual fact is that one in three women and one in five men will develop osteoporosis, and the incidence and morbidity rates of osteoporosis in women is higher than breast cancer and cervical cancer combined.”
Because osteoporosis occurs without symptoms and is considered a natural ageing process, many people overlook the high morbidity and mortality rates of the condition. Dr Lee who is also a consultant orthopaedic surgeon says that sometimes, even doctors or general practitioners are not aware of these rates.
“Morbidity is high because fractures affect the quality of life of the patient, and many die following hip fractures and surgical complications,” he says.
Dr Lee believes osteoporosis is less emphasised when it comes to awareness and media attention, therefore calling on practising doctors to lower the morbidity and mortality rates of osteoporosis in Malaysia.
It can be seen in Malaysia itself, which currently only has two osteoporosis-focused societies – OASKLS and the Malaysian Osteoporosis Society. This is why there is still a need to spread awareness for osteoporosis as the country’s ageing population continues to grow.
It is hard to determine the true prevalence of osteoporosis in Malaysia because of its hidden nature, but Dr Tan Kit Mun, consultant geriatrician and OASKLS treasurer, predicts numbers will rise because of the growing ageing population in Malaysia.
She says, “According to the Malaysian Statistics Department, 7% of Malaysians are currently above 65 years old. However, this percentage is projected to increase to 14.5% by 2040.” She adds that in relation to the growing ageing population worldwide, the World Health Organization has declared the years 2020 to 2030 a decade of healthy living. The mission is to spread awareness to the younger generation to prepare for and prevent future conditions, osteoporosis being one of them.
The bleak reality
Osteoporosis is generally only diagnosed after the patient suffers a fracture. Because of that, patients are illprepared to face the consequences of the condition. Dr Tan elaborates, “When a person falls and has a fracture, he will become frail and lose physical independence. This situation may be temporary or even permanent in some cases, and will take most people several months or years to return to normal.”
The toll on the patient do not just affect the patient physically, but psychologically and emotionally as well. One example observed by Dr Tan in patients is that they develop a fear of falling. This indirectly leads to the fear of going outdoors or carrying out their usual daily tasks and hobbies. Most patients then end up with a degree of social isolation which can cause depression from a range of reasons – pain, fear, the feeling of burdening others and financial strain.
She says, “One in four patients enter nursing homes within a year of fracturing, sometimes even immediately after fracturing and receiving surgery. Some cannot even have surgery because of financial reasons, physical conditions, fear of surgery or objections from their families. Therefore, daily activities are affected, such as bathing, cooking and walking around, thus reducing independence.”
Choose to beat the odds
Fractures are common among the elderly, with one in 12 who have falls ending up with fractures every year. This may be one sign of osteoporosis, especially if the fracture is from a fall of standing height.
This is why Dr Tan advocates the prevention of fractures. The first thing she recommends is bone density screening in addition to assessing risks for potential hazards, both in the environment and the patients themselves. Examples of hazards are: ● Environment – Wires on the ground, wet or uneven floors, staircases without markings, lack of grab rails in toilets and stairs, loose rugs and visiting the toilet in the dark
● Person – Poor vision and hearing, slow reflexes, dementia, sarcopenia (shrunken muscles) and medical problems such as anaemia, low blood pressure, stroke, Parkinson’s disease and arthritis
Besides that, physiotherapy is crucial for improving balance to reduce the risk of falling, and strengthening muscles to protect the body should one fall. A healthy diet with adequate calcium and vitamin D intake is also valuable for the patient’s bone health.
Dr Lee notes there is a misconception in Asia that because we get so much sunlight all year round, there is no issue with our vitamin D intake. However, the clinical practice community has noticed that many seniors do not have enough vitamin D in their systems. “This is because many of us stay indoors and do not get exposed to sunlight at all,” he explains.
Vitamin D is crucial for calcium absorption and he therefore recommends morning or evening sunlight exposure for around 20 minutes a day for the elderly. Should they have kidney or liver problems that prevent vitamin D from being converted to its active form, supplements can also be taken to compensate. He cautions that the patient will grow weaker should her vitamin D intake continue to be low.
Osteoporosis may feel like a life sentence, but it is up to you to live the best life possible to your best ability. Continue to strive in living out your passions and build relationships with your loved ones. Illness may not be a choice, but how you face it is up to you.