Silent disease: Watch out for the hidden risk of osteoporosis

SINGAPORE – Madam Muthiah Vasanthakumari, 73, does yoga daily. However, in recent months, she has had to avoid doing extreme twists or backbends.

Madam Kumari, as she is known, has osteoporosis or brittle bones. The condition typically presents without any warning symptoms and leaves sufferers at risk of becoming immobile due to spine or hip fractures.

In May, she suffered a sudden and painful backache after lifting something heavy. It turned out to be a vertebral fracture.

“If I had known, I would have been more careful,” Madam Kumari says. She is now receiving monthly injections to promote bone formation and has been asked to walk slower to reduce the likelihood of tripping and falling.

The married mother of three found out 13 years ago that she had low bone density, which can indicate osteoporosis.

Until recently, she did not think it would affect her much. She made sure to take calcium supplements and ate green leafy vegetables rich in calcium.

She walks regularly, clocking 10,000 to 15,000 steps a day. She can climb stairs and go on pilgrimages in hilly regions in India.

However, consultant endocrinologist Caroline Hoong at Woodlands Health, says: “By the time you have been diagnosed with osteoporosis or broken a bone because of osteoporosis, simply taking calcium and vitamin D supplements is not enough.”

Treatment can also involve oral or injectable medications to reduce the loss of bone and promote bone formation, adds Dr Hoong, who treats Madam Kumari.

Stealthy condition

Family physician Gabriel Ding says people with osteoporosis have bones that have become brittle and fragile, usually because of hormonal changes or deficiencies in calcium or vitamin D, which aids the take-up of calcium by the bones.

There are typically no warning signs in the early stages of bone loss, adds Dr Ding, who is a consultant and head of Khatib Polyclinic. Yet, he says: “Osteoporosis causes bones to become so weak and brittle that a fall or even mild stresses like bending over or coughing can cause a fracture.” The most common such fractures are of the hip, wrist and spine.

Endocrinologist Chew Chee Kian sees 30 to 40 patients with osteoporosis every week. Some may have had lower back pain or a decrease in height over time. But mostly, says Dr Chew, osteoporosis is a silent disease. “People may realise they have the disease only after having a fracture.”

The senior consultant at Tan Tock Seng Hospital’s department of endocrinology says that in Singapore, osteoporosis is estimated to be prevalent in 0.7 per cent of men above the age of 50, according to a 2023 study of the Asia-Pacific region.

In post-menopausal women here, the prevalence is estimated to be 9.3 to 19.4 per cent.