IN FOCUS: OSTEOPOROSIS

Orthopaedic surgeon Dr.Alan Cheung gets to the root of the problem — defining what osteoporosis is, identifying who is susceptible to the silent disease, and how to manage it For the unfamiliar, what is osteoporosis?

Osteoporosis literally means ‘thinning of bone’ and becomes a big problem as we age. People with osteoporosis are at a much bigger risk of breaking a bone with a simple slip or fall, which can result in a broken wrist, spine, or rib. The most serious complication however is a broken hip. If your parents or relatives are over the age of 65, then osteoporosis is something that you need to be aware of, so take them to the doctor to be screened with a simple set of X-rays called a DEXA (dual energy x-ray absorbitometry) scan. This scan measures their bone mineral density (BMD) which is an indicator of osteoporosis. If you detect osteoporosis early enough, it can be treated with medication and an exercise program.

Are there any tell-tale signs to look out for?

Osteoporosis is a silent disease. Often, people don’t know they have it until they break a bone and it’s too late. After you or a loved one break a bone, it’s important to consider screening for osteoporosis with a DEXA scan to reduce the risk of further bone breakages (also known as ‘fractures’) occurring in future. There are many risk factors for osteoporosis. These include ageing, being female, low body weight, having a relative who has had osteoporosis, excessive smoking or alcohol consumption, a poor diet low in calcium and vitamin D, low oestrogen, which can be affected by early menopause or lack of menstruation. Certain diseases affecting the gut, liver, and thyroid gland, as well as certain medications, particularly long term corticosteroid usage, may lead to osteoporosis.

Are both men and women susceptible to osteoporosis? Some say it occurs more in women, but is that a myth?

Both men and women can have osteoporosis, but women are more prone to it. This is because men (in general) have bigger, denser bones and can lose more bone density as they age before it becomes a problem. Oestrogen levels in women decrease after menopause, whereas in men, oestrogen levels tend to stay the same or increase as they age. Also, women tend to live longer than men and are more likely therefore to experience significant bone thinning as they reach their 80s and 90s.

How does osteoporosis affect one’s physical fitness? If someone is suffering from it, are there particular exercises they should do and avoid?

Lack of exercise and general immobility can lead to osteoporosis. Once osteoporosis has been detected, a supervised, graduated exercise program is important, in combination with medications, to increase bone density. In general, a supervised regular program of progressive resistance training, high impact exercise, and balance training is used to increase bone density.

Is osteoporosis curable or is it a condition that one must live with and manage as they get older?

Once I am aware of osteoporosis, I am in a much better position to treat it. Medical treatment is not a quick fix and may take at least one or two years before bone density increases significantly. Despite this, prevention is much better than cure, as surgery to fix broken bones has risks and can take time to recover from. A common term that the doctor may use is ‘osteopaenia’, which means thinning of the bone, but not to the extent that it is osteoporotic. He or she may prescribe calcium and vitamin D and an exercise program.

How does seeing an orthopaedic surgeon benefit someone suffering from osteoporosis?

For any doctor you see, it’s important that they are aware of the risks of osteoporosis and the possibility of it occurring. You or your relative may see an orthopaedic surgeon after a fracture, which could be due to osteoporosis. It is also important for an orthopaedic surgeon to be aware of the risk of osteoporosis as special implants designed for thinner bone exist and may be used in surgery. The other reason is that the orthopaedic surgeon is in a good position to screen for osteoporosis through a DEXA scan and can reduce risk of further injury happening in future.

Dr Alan Cheung is a British Consultant Orthopaedic Surgeon, Events Team Doctor of the Singapore Cycling Federation and Wrestling Federation of Singapore, and Director of the International Orthopaedic Clinic, 05-24 Mount Elizabeth Novena Hospital, 38 Irrawaddy Road, Singapore www.ioc-ortho.com @dralancheung