Osteoporosis is a condition where poor bone mass is coupled with poor bone quality, resulting in poor bone strength and an increased risk of fracture. Singapore has the highest hip fracture rates in Asia. This year, Osteoporosis Society (Singapore), Asian Federation of Osteoporosis Societies, International Osteoporosis Foundation and Amgen have come together to spearhead ‘Fight the Fracture’, a regional public education campaign to highlight the seriousness of fragility fractures, their link with osteoporosis and empower patients to proactively prevent fractures. On this occasion, Priyanka Bajpai of BioSpectrum Asia spoke to Dr Chionh Siok Bee, President of Osteoporosis Society, Singapore and Senior Consultant, Division of Endocrinology, National University Hospital on this deadly condition and its management.
Q. Can you please elaborate on some of the leading causes of osteoporosis, fractures and bone-related medical conditions?
A. There are two major causes of osteoporosis – female gender, especially after menopause (due to loss of oestrogen), and ageing (being older than 50 years of age).
Women and Menopause
Women reach peak bone mass in their 20s to 30s. They start to lose bone mass after about 35 years old, at approximately 0.75-1% per year. The rate of bone loss then accelerates to 2-3% a year, especially at the spine, starting about one year prior to menopause to two years after menopause. The rate subsequently slows down five years after menopause to 1% per year.
As men do not undergo a similar sudden dramatic loss of male hormone levels, they do not experience a comparable acceleration of bone loss. They start to lose bone mass at a later age (about 45 years old) at approximately 0.5% a year.
Ageing
Bone loss increases with age, especially above 50 years of age. A sedentary urban lifestyle exacerbates the effects of ageing. The age- and sex- adjusted hip fracture rates (the number of hip fractures per year in each age bracket for males and for females) have exploded in Asia due to urbanization, and the much-improved survival rates in Asians. By 2050, Asia will account for 50% of the world’s hip fractures.
Lifestyle
Other important lifestyle risk factors include cigarette smoking and excessive alcohol consumption - things you can afford more with rising affluence. Epidemiological studies have shown that fragility fracture rates are directly proportionate to the per capita number of mobile phones and per capita GDP. Prolonged bed rest also exacerbates bone loss.
Genetics
Genetic pre-disposition is also important, as a parent or sibling with a fragility hip fracture puts the individual at higher risk of suffering from a hip fracture.
Osteoarthritis is another bone condition which causes pain in the joints during movement, particularly at the knees and spine. This condition is caused by the surfaces of bones "rubbing" against each other, which wears out the cartilage lining around those areas. However, this should not be confused with osteoporosis. Osteoporosis does not cause any symptoms until after a fracture occurs.
Q. Restricted mobility is probably one of the more common outcomes of osteoporosis and fractures. However, what other ways can these outcomes affect individuals, temporarily or permanently?
A. Osteoporotic fractures are associated with significant mortality and morbidity. There is pain, reduced mobility, disability, and an increasing degree of dependence. Vertebral fractures can result in serious consequences, including loss of height, intense back pain and deformity. Kyphosis can be so severe that the ribs touch the pelvic bones and there is difficulty eating and breathing. A hip fracture also often requires surgery and may result in the inability to walk and death.
Other outcomes include:
Greater risk of subsequent fractures. Wh...
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