Women at increased risk of osteoporosis after menopause

With severe osteoporosis, you don't even have to fall or suffer a serious injury to break a bone. — Novartis

With International Women’s Day being marked on March 8 to celebrate the economic, cultural, social and political achievements of women, there is no better time to focus on important conditions that affect women’s health.

One of the major, but often underappreciated, health issues in women is that of post-menopausal osteoporosis.

Osteoporosis is a systemic disease affecting the skeleton, which is characterised by low bone mass and poor bone microarchitecture, leading to an increased likelihood of fractures occurring.

It is a silent disease in the sense that there are usually no symptoms until the bone breaks.

Bones in the spine, hip and wrist are especially prone to fractures, even if the affected person does not fall or sustain any serious injury.

In patients with osteoporosis, the bones can be so brittle that normal activities like lifting objects, bending over and coughing, can cause an unexpected fracture.

I had a patient who was bending down to help her husband lift an object when she heard a cracking sound.

Despite worsening pain in her back, she delayed seeking medical care for a month (mainly due to the movement control order last year), and by the time she went for an X-ray, she was found to have two fractures in her spine.

Her bone mineral density (BMD), when assessed, was found to be very low.

Osteoporotic fractures cause a significant healthcare burden on individuals and their families, as well as society.

Fractures can lead to chronic pain, deformities and disability, resulting in poor quality of life, and ultimately, an increased risk of death, especially in patients who have suffered from hip fractures.

Having a broken bone can also mean depending on other people for help with activities of daily living and higher medical bills.

Women are known to be more likely to develop osteoporosis compared to men, with the most common cause being post-menopausal osteoporosis.

There is a phase of accelerated or increased bone loss after the onset of menopause.

This is attributed to the decrease in oestrogen levels during this phase.

Women also tend to have a lower peak bone mass compared to men.

Other risk factors for the development of osteoporosis are cigarette smoking, excessive alcohol use, leading a sedentary lifestyle, low calcium intake in the diet and having a family history of osteoporosis.

The importance of screening and early detection of osteoporosis cannot be overemphasised.

If we can detect and treat this condition appropriately, we can reduce the risk of developing fractures significantly.

The best screening test we can do currently for this disease is a dual energy X-ray absorptiometry scan, also known as a Dexa scan.

This is a simple and quick procedure that allows doctors to measure the density of your bones, i.e. BMD.

Endocrinologists and other appropriately trained and qualified healthcare professionals are able to manage this important metabolic bone disease.

It is recommended that all women aged 65 and above (and men aged 70 and above) go for a BMD measurement.

Screening should be done earlier in patients with strong risk factors for the development of osteoporosis, e.g. premature menopause, being on prolonged steroid treatment, and having anorexia nervosa and certain other medical conditions.

If osteoporosis is diagnosed, appropriate investigations need to be performed to look for other secondary causes or medical conditions that can cause or contribute to the worsening of the osteoporosis.

Treatment can help to improve or prevent the decline in bone density.

Its aim is to prevent and reduce the risk of future fractures happening.

Adequate calcium and vitamin D intake is important, and measures to minimise the chances of falling are essential.

There are a number of approved medical treatments available for the management of osteoporosis, which will be recommended based on the individual patient’s characteristics.

Leading a healthy lifestyle by getting adequate exercise, limiting caffeine and alcohol intake, and abstaining from cigarette smoking will help as well.

Protect your bone health to protect your future.

Having strong and healthy bones will allow you to continue to be active and mobile, so that you can be independent and have good quality of life in your golden years.

Dr Chooi Kheng Chiew is a consultant endocrinologist and physician. For more information, email [e-mail]. The information provided is for educational purposes only and should not be considered as medical advice. The Star does not give any warranty on accuracy, completeness, functionality, usefulness or other assurances as to the content appearing in this column. The Star disclaims all responsibility for any losses, damage to property or personal injury suffered directly or indirectly from reliance on such information.

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