An often-overlooked aspect of women’s health is osteoporosis and its potential complications, including medication-related osteonecrosis of the jaw (MRONJ).
Osteoporosis is a common condition characterised by low bone density and deterioration of bone tissue which lead to an increased risk of fractures, particularly in the spine, hips and wrists.
An Asian Federation of Osteoporosis Societies study projected that the number of hip fracture cases in Malaysia would increase from 5,880 in 2018 to 20,893 cases in 2050. This directly affects the estimated medical cost of hip fractures, from RM167.3mil in 2018 to RM594.3mil in 2050, which does not include the cost of rehabilitation and prolonged nursing care service after injury.
While osteoporosis can affect both men and women, postmenopausal women are at a significantly higher risk due to hormonal changes (estrogen) that occur during menopause, with a prevalence of 42.4% compared to 11.1% in premenopausal women in Malaysia.
For many women, the management of osteoporosis involves non-pharmacological and pharmacological measures. The non-pharmacological treatments are adequate weight-bearing exercise, vitamin D, calcium supplement, healthy lifestyle modification and prevention of fall.
For high-risk groups, the use of anti-resorptive medications called bisphosphonates and denosumab are recommended. These medications help to strengthen bones and reduce the risk of fractures by inhibiting bone resorption.
However, like all medications, they carry potential side effects, one of which is MRONJ – a rare but serious condition characterised by the death of jawbone tissue. The risk of developing MRONJ might be low among the osteoporosis group (<1%) but for those involved with the disease, the consequences are devastating.
MRONJ typically presents persistent jaw pain, swelling or infection which is often triggered by dental procedures or trauma to the jaw. While the exact cause of MRONJ is not fully understood, it’s believed that bisphosphonates may interfere with the normal healing process of the jawbone, particularly in individuals with poor dental health or those undergoing invasive dental procedures.
Prevention is better than cure, hence the early detection of MRONJ can be treated conservatively with antibiotics, antiseptic mouthwash and pain relief medications. Advanced cases of MRONJ may necessitate surgical intervention for wound debridement.
Why exercise?
In the 19th century, German orthopaedic surgeon Julius Wolff proposed the famous Wolff’s Law: as the load on bones increases, they naturally become thicker and stronger. Conversely, if bones bear too little load, they become thinner and more brittle, making fractures more likely to occur.
Exercise is the simplest and cost-effective way for women to protect their bone health. Engaging in regular physical activities can regulate bone maintenance, stimulate bone formation, and improve balance and coordination, which help in reducing the overall falls and fractures.
Suitable types of exercises include weight-bearing exercises like brisk walking, jogging, dancing and climbing stairs (for those without joint problems), which apply tension from muscles and tendons toward the bone and stimulate new and denser bone formation.
Resistance training exercises, such as weightlifting with dumb bells/weight machine and working with resistance bands, stimulate increased bone density.
Balance exercises like yoga, step-ups, walking on an unstable surface (wobble board), walking backward and tai chi can help improve the balance and coordination of the body, reducing the risk of falls. Flexibility exercises, such as yoga and stretching exercises, can assist in maintaining the suppleness and agility of your muscles and joints to prevent falls.
Performing regular exercises at least 2.5 hours a week is particularly important for improving bone density and prevention of osteoporosis. For older adults, the 150 minutes of exercise should include the mix of the above moderate-intensity exercises as their health allows.
By prioritising their own health, women can better care for those they love. Together, we can raise awareness, promote prevention, and ensure that every woman can enjoy a life of strength and vitality.
DR TAN CHUEY CHUAN, DR GOH YET CHING, ASSOC PROF DR DANIEL LIM KHIM HOCK
Dept of Oral and Maxillofacial Clinical Sciences
Faculty of Dentistry
Universiti Malaya
