Osteoporosis – just for the elderly?

By: Dr Valerie Druon

Star Vista clinic
Posted on: 19 Jan 2022

Why should you care about your bones?

Having healthy bones is vital to our general physical health. Strong bones are part of the skeletal system providing structural support, body shape and they protect our vital organs. Bone marrow produces about 95% of the bodies red and white blood cells.

What do we mean by healthy bones?

Healthy bones consist of a dense matrix style structure. The denser your bone matrix, the healthier your bones are, allowing you to absorb shocks from minor trauma and falls without fractures.
The development of strong bones starts in childhood. There is a growth spurt during puberty and throughout your adulthood bones are constantly “remodeled” and rebuilt. Babies are born with 300 bones which eventually fuse together to form 206 bones in the adult skeleton. Healthy bones require good nutrients and minerals, while maintaining regular physical activities and rest.

What is osteoporosis?

Poor bone health or bone mineral density (BMD) loss can lead to two common conditions called osteopenia (the stage before osteoporosis) and osteoporosis. Osteoporosis means “porous bones”. Bones become more brittle by losing their mass and density. As your bones become weaker you are more susceptible to fractures. With lower bone mineral density, a minor trauma can cause you to sustain a fracture.

What can lead to osteopenia and osteoporosis?

– Aging and a decline in the oestrogen hormone commonly seen in menopause are common causes of osteoporosis. A lower oestrogen hormone level will cause a higher bone resorption with a lower bone formation rate resulting in a net decrease in bone mass and density.

– Chronic health conditions such as diabetes, thyroid disorders, liver disease, kidney disease, malabsorption syndromes such as Coeliac disease, eating disorders, mental health disorders can contribute to further bone loss. Extreme ranges of body mass index as in the underweight and obese ranges can lead to bone loss.

– Some medications like chronic steroid use, thyroid replacement hormones, medicines for epilepsy, some antivirals and antibiotics can all lower BMD.

– Lifestyle choices can impact greatly on accelerating the onset and progression of osteoporosis. A sedentary lifestyle, smoking, chronic alcohol consumption, diet that is low in calcium, high in salt and excessive caffeine intake.

– Nutritional deficiencies mainly in calcium, and vitamin D in childhood can lead to early onset of osteoporosis.

– Previous fractures and a family history of minimal fracture or osteoporosis can also increase your risk.

Can men develop osteoporosis?

Certainly. Men can be susceptible to osteoporosis from the age of 50 but more commonly from 60. Osteoporosis is often called the “silent disease” meaning that it progresses without symptoms. It is often disregarded in men as it is believed that postmenopausal women would be exclusively susceptible.

The mechanism is not well understood but it is found that bone formation activity is reduced with advanced age. With age, there is a declined in hormones such as testosterone and oestrogen. Unlike in women, who experience an abrupt decline in oestrogen levels at menopause that leads to faster bone loss, men have slower bone loss with a smaller overall decrease in bone mineral density.

Chronic steroid use, smoking, excessive alcohol consumption, a diet high in salt and caffeine, low calcium intake, vitamin D deficiency, high body mass index, sedentary lifestyle are common contributing factors of osteoporosis in men.

How does osteoporosis impact on our quality of life?

It is estimated that worldwide, 1 in 3 women and 1 in 5 men, over age 50, will experience osteoporosis fractures in their lifetimes. With osteoporosis being more common with increased age, it is found that men are twice as likely to die after a hip fracture than women.
The commonly seen hip and vertebral (bones of your spine) fractures are unfortunately associated with reduced quality of life. There is increased frailty, higher risks of falls, poor mobility, reduced balance, low physical activity with low muscle mass and strength.
Vertebral fractures occurs with loss of height as the vertebrae (the back bones) “compress” on themselves causing a reduce in height. You may experience chronic back pain and a common posture called kyphosis – where you are leaning forward because your upper back is exaggeratedly curved forward.

How can osteoporosis be detected?

Discuss with your family doctor if you are at risk of osteoporosis. Your doctor may order a dual x-ray absorptiometry (DEXA). A DEXA scan measures your bone mineral density with low levels of radiation. Most DEXA scans check your BMD of your hips and spine.

How can osteoporosis be prevented?

  1. Adequate intake of calcium and vitamin D should be encouraged in all children, men and women to build and maintain bone mass.
  2. Healthy lifestyle measures need to be adopted at a very young age and maintain throughout life. This includes a diet low in salt, caffeine, limiting alcohol consumption, and smoking cessation.
  3. Aim for a healthy body mass index range. Regular and frequent physical activity in the form of aerobic and resistance training exercises are particularly encouraged. Increasing muscle mass with weight bearing and resistance training exercises can lead to an increase in bone mineral density. Balance and core activities will help further with preventing falls. Research have found that low levels of physical activity are associated with bone loss and over 2-fold risk of fracture.

Your doctor can further assess your nutritional intake and blood levels of calcium and vitamin D. If you are concerned please come and visit the doctor for an assessment of health check up.

Dr Valerie Druon is a French speaking family doctor located at Osler Health International – Star Vista clinic. T: 6339 2727
Raffles Hotel Arcade Star Vista