Osteoporosis is the most common bone disorder to affect the elderly. It causes bones to become porous, soft and brittle.
ParkCity Medical Centre consultant orthopaedic surgeon Dr Lee Chee Kuan says osteoporosis commonly affects women, especially post-menopausal women. Osteoporosis can also be caused by prolonged immobilisation, hormonal imbalance or reduced physical activity.
According to Dr Lee, osteoporosis does not present any symptoms, with the exception of when a bone breaks. “Most of the time, the patient will not notice even when there is a minor crack or fracture in the bone and will only start experiencing pain when the injury becomes more serious," he says.
Too often, it is usually the pain that the patient experiences that brings them to see doctor.
Change What Can Be Changed
“You are at higher risk of osteoporosis if you are a small-framed elderly Asian or Caucasian woman. However, you can still prevent or slow down the progress of osteoporosis with a few steps,” says Dr Lee.
These include a healthy diet high in calcium, exposure to sunlight for Vitamin D and regular exercise, particularly weight-bearing exercises to strengthen the bones. Brisk walking is often recommended as it is easy and effective.
Dr Lee believes that if your diet is rich in calcium and you are taking in enough dairy products and green vegetables, there is no need for supplements.
However, he adds that postmenopausal women can take 1,000mg-1,500mg of calcium supplements a day to further reinforce their calcium needs and store inside the bone and recommends Vitamin D3 to aid the absorption of calcium in the body.
Taking Life Into Your Hands
Prevention is still better than cure, so Dr Lee asserts that healthy living will curb the progress of osteoporosis. Studies have shown that between 30% and 40% of women aged 65 and above who have had proximal femur fractures will die within one to two years.
“These women did not die because of the fracture, but rather from the other complications that arise from said fracture, such as pneumonia and cardiac disorders. Therefore, it is better to avoid getting osteoporosis and prevent fractures to ensure a good quality of life," says Dr Lee.
He advises people, especially women, to stay physically active, get enough Vitamin D and maintain a high-calcium diet, either through eating dairy or green vegetables. While we cannot stop osteoporosis from happening, we can slow it down.
Bringing Back Life To Degenerated Joints
Osteoarthritis can lead to the need for joint replacement surgery. A common one is total knee replacement (TKR) surgery.
“Contrary to its name, TKR is a procedure that does not replace the knee entirely but resurfaces the joints of the knee. It is commonly performed to relieve pain caused by osteoarthritis," says Dr Gandhi Nathan Solayar, consultant orthopaedic surgeon at Ara Damansara Medical Centre.
“However, it would be wrong to assume that TKR is only needed by elderly patients, since it can also relieve pain caused by other kinds of arthritis which also affect young people, such as rheumatoid arthritis and traumatic arthritis caused by severe sports injuries or accidents.”
Having said that, not everybody with arthritis needs TKR. Dr Gandhi says it is performed only as a last resort to relieve the patient’s pain and improve his quality of life, after exhausting all conservative methods such as medication, physiotherapy and weight loss.
“Even if X-rays show that a patient is suffering from extreme degeneration of the knee surface but it is not causing much discomfort or pain, we will suggest conservative treatment options instead of TKR.”
Going Under The Knife
“An important part of TKR is counselling,” says Dr Gandhi. “The healthcare professional in charge of a patient should first discuss the procedure, risks involved, benefits and their medical history.”
Like every other kind of surgery, TKR also involves certain risks, however small. The main risks associated with this procedure includes developing an infection and blood clots and may increase if someone already has medical issues such as hypertension, diabetes or cardiac problems.
“TKR surgeons need to weigh the risks against the benefits for a particular patient before performing the procedure. It differs from case to case because each patient may have different sets of risks. Before going through with the procedure, doctors would first need to optimise their patients medically," Dr Gandhi says.
Despite the risks, Dr Gandhi assures that TKR has a more than 95% success rate over five years and severe complications are rare.
The procedure takes around one to two hours, depending on how complex the surgery is but according to Dr Gandhi, patients can usually start working their knees right afterwards. It would, of course, be painful to move the knee right after surgery, but the pain is controlled with the help of medication.
“I strongly suggest engaging a physiotherapist during this stage to help rehabilitate the new joint. This is advisable because these are professionals who know how to work the joint properly and would be able to tell right away if there is something wrong, such as the knee not bending as much as it should,” adds Dr Gandhi.
Regaining complete mobility post-surgery may take around six weeks, if there are no complications along the way. Dr Gandhi strongly recommends taking utmost care during this time so as not to further injure the knee and to keep the place of incision clean to prevent infection.
He adds, “It is advisable that patients do not stay alone during this time and do not put undue pressure on the knee that has been operated on. It is good to work the joint, but one should not go overboard such as starting to run immediately post operation, even if they are capable of doing so.”
He also mentions that while patients can perform all normal daily chores after the surgery, they should be wary of taking on heavy-duty activities such as hiking.
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