We hear so much about Osteoporosis these days. Have you ever wondered whether you are at risk and what you can do if you have Osteoporosis?

 

What is Osteoporosis?

If you think Osteoporosis only affects older people, have we got news for you. It can start when you are in your 30s and your bones can get gradually weaker without you even knowing it. The nasty thing about Osteoporosis is that most people only discover it after breaking a bone!

The reality is that our bone tissue progressively stops growing from around the age of 30. There should be a balance between bone tissue loss and bone tissue replacement. This is a natural process occurs within the body. However, when the bone tissue replacement is not fast enough, our bones get thinner and weaker. The depletion is imperceptible, and you could be completely unaware of it until you fracture your hip, spine or wrist after a minor knock or fall.

 

Are You at Risk?

It is wise to recognise risk factors early, get tested and take preventive action. Here are some factors that might put you at risk of Osteoporosis:

• Women aged 65 years and older
• Early menopause before age 45
• History of low-impact injury resulting in fractures
• Long-term use of corticosteroids
• A family history of Osteoporosis
• Suffering from chronic illnesses such as thyroid disorders, liver disease or malabsorption (failure to absorb food nutrients)
• Alcoholism

“It is a common misconception that Osteoporosis is a disease that only occurs in elderly women. In fact, it can affect both men and women at any age, it is just more common in women over the age of 50.” says Dr Chong Kian Chun.

 

Why are Women More Susceptible to Osteoporosis?

Unfortunately for our lady friends, nature is not in your favour in this instance. To begin with, women tend to have lower bone mass and a smaller frame than men. This leaves women more vulnerable to Osteoporosis as bone density decreases with age. The rate of bone loss increases after menopause as production of Estrogen, the hormone that keeps bones strong, slows down.

 

3 Ways to Determine if You Have Osteoporosis

“It is advisable to consult your doctor early to have your bone mass checked if you are at a higher risk of Osteoporosis. Early intervention of the disease not only prolongs the quality of life; it can save your life.” advises Dr Chong.

 

There are several ways to measure bone health:

• Bone Mineral Density (BMD) test – a gold standard for measuring bone quality or bone loss in the hip and lower back spine
• Osteoporosis Self-Assessment Tool for Asians (OSTA) – a reference chart which helps to assess the risk of Osteoporosis by comparing weight to age for Asian women
• X-rays – detects the thinning of bone tissue

 

How to Prevent Osteoporosis

Building healthier and stronger bones should start from childhood. So, parents, take note! For the rest of us, it’s not too late. Here are some ways to keep this disease at bay:

1. Good Nutrition
Increase your calcium intake to about 800 to 1000mg per day.

Rich sources of calcium include:

• Dairy products such as milk, yoghurt and cheese
• Green leafy vegetables like broccoli
• Meats
• Nuts such as almonds
• Supplements.

Vitamin D intake of about 400 IU daily.

Rich sources of Vitamin D include:

• Milk
• Eggs
• Sunlight

 

2. Weight-bearing Exercises

Weight-bearing exercises two to three times a week for about 30 minutes keeps the disease at bay.

Examples of weight-bearing exercises are:

• Brisk walking
• Strength training
• Running
• Aerobics
• Tai Chi

3. Regular exercise

Regular exercise will raise your general sense of well-being, balance, coordination and muscle strength.

4. Stop smoking

Smoking has been found to be linked to reduced bone mass, as well as a slew of other health problems. Quitting smoking will lead to better health overall, including bone health.

5. Avoid excessive alcohol consumption

Heavy drinking is also associated with many serious health problems, including affecting bone health and risk of Osteoporosis. This is due to the effects that alcohol has on calcium absorption, causing bones to deteriorate from lack of calcium.

Treatment and Medication

Eating properly and exercising regularly can save you from painful, disabling and even life-threatening fractures that can result from Osteoporosis. Being aware of risk factors, getting assessed by a doctor, and seeking treatment are crucial in preventing and controlling the disease.

Dr Chong Kian Chun

Orthopaedic Surgeon, Island Orthopaedic

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“Don’t despair if you are diagnosed with Osteoporosis. Many drugs, such as Bisphosphonates, Hormone Replacement Therapy (HRT), Calcitonin and Vitamin D analogues, are available to manage the illness. They will either help to slow down the rate of bone loss or stimulate new bone formation. The drugs may be combined with Calcium and Vitamin D Supplements. The choice of drugs will depend on the patient’s medical condition, compliance, the risk of complications and cost,” says Dr Chong.

Dr Chong Kian Chun is a Consultant Orthopaedic Surgeon from Island Orthopaedic Consultants, a member of Healthway Medical Group.

Arthritis refers to the condition that affects joints. It causes pain and swelling in large joints, such as the knee and hip, and smaller joints, such as in the fingers. Joints can become stiff or deformed as Arthritis progresses, resulting in decreased mobility, affecting quality of life. In Singapore, Arthritis is a common problem that affects 10% to 20% or more of middle-aged and elderly people.

The two main groups of Arthritis are Osteoarthritis and Inflammatory Arthritis. Osteoarthritis is more common and is a degenerative type of Arthritis. It primarily affects the soft bone, called the cartilage. Osteoarthritis of the knee is very common. When the cartilage progressively softens and wears away, the knee will develop chronic pain. Over time, a bow-legged deformity may occur. Inflammatory Arthritis is less common and is characterised by uncontrolled persistent inflammation of the joints. Rheumatoid Arthritis, Gout and Psoriatic Arthritis are examples of Inflammatory Arthritis.

Risk Factors

• Age – arthritis usually starts between the ages of 30 and 50
• Gender – women are more likely to develop osteoarthritis
• Obesity
• Smoking
• Family history of Inflammatory Arthritis
• Previous joint injury

Signs & Symptoms

• Pain and swelling of the joint for three days or longer
• Stiffness of the joint
• Morning stiffness
• Difficulty in moving a joint or doing daily activities

Feeling that the joint is warmer than the surrounding skin at least three times a month

 

Treatment Options

Dr Ang Chia Liang says: “Different effective treatment methods exist for different stages of the condition. Mild conditions can be treated with medication and injections, while more severe conditions can have excellent results with appropriate surgery. Oral supplements like glucosamine or collagen help in early stages of the condition. It is important to have an accurate diagnosis by doing X-rays and sometimes MRI. The patient should discuss the available treatment options with an Orthopaedic Surgeon to determine what works best.”

Non-surgical:

• Oral Medications such as nonsteroidal anti-inflammatory drugs (NSAIDs)
• Topical applications that contain menthol or capsaicin
• Physiotherapy
• Artificial gel injection for pain relief
• Supplements such as glucosamine, collagen, or krill oil
• Exercises such as yoga, Pilates or brisk walking
• Steroids

 

Types of surgery

If the above conservative measures do not help to improve the condition, your doctor may suggest more invasive procedures, such as:

• Key-hole surgery – a minimally invasive surgery that treats a wide variety of wear-and-tear problems of the knee, shoulder and hip, useful for people with joint injuries from sports activities
• Bone alignment procedure – for younger patients to straighten bow-leggedness and reduce pain
• Joint replacements – a common procedure to remove damaged knee, hip or shoulder joint and replace it with an artificial one
• Joint fusion – reserved for very severe conditions, most commonly related to the wrist and fingers, this procedure fuses the joint and removes any movement of the joint, thereby eliminating pain

 

Dr Ang Chia Liang

Orthopaedic Surgeon, Island Orthopaedic

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Dr Ang Chia Liang is a Consultant Orthopaedic Surgeon from Island Orthopaedic Consultants, a member of Healthway Medical Group

A sprained ankle is essentially damage to the ligaments that tie the bones of the ankle together. The function of these ligaments is to prevent the ankle from turning inwards or outwards excessively. A sprain happens when excessive force is applied to the ligaments, such as when one slips and twists their ankle. The damage is likened to when one pulls on a rubber band too much, and the rubber becomes soft. At times, the force is so much, a rubber band snaps, which is the same concept when one applies too much force on the ankle ligaments, leading to ligament ruptures.

The symptoms of an ankle sprain include pain, bruising and swelling, which is at most times, immediately evident after the slip. The severity of the symptoms varies with how much damage the ligaments sustained. Sometimes, when the ligaments are completely ruptured, the ankle might feel unstable.

Treating ankle sprains follows the popular mnemonic – RICE

• R: Rest – do not put excessive stress on the ankle. One should not be running or jumping on a sprained ankle. Rest encourages healing and prevents further damage to the ligament.
• I: Ice – Apply a cold pack of ice, or a pack of frozen peas on the swelling. This reduces pain and swelling.
• C: Compression – If you have access to a bandage, applying a simple ankle bandage, firmly but not tightly, may alleviate swelling.
• E: Elevation – Elevating your leg on 2 pillows under the heel, or propping your legs up on the coffee table, can help to reduce swelling.

Painkillers and anti-inflammatories can help as well.

Doctors usually look out for signs of fractures with regards to ankle sprains. At times, the force applied to the ankle during a slip is so great, that it transfers to the bones and fractures them. The signs and symptoms are mostly the same as that of a normal ankle sprain, however these few red flags are indicative of fractures rather than sprains.

If you are:

• Unable to bear weight on the affected ankle
• Unable to stand on both legs or walk – even a little – on the affected ankle
• Experiencing tenderness on the bony hard surface of the ankles. There are 2 bony protrusions on the ankle – one on the inside and one on the outside of the ankle. These are the lateral (outside) malleolus, and medial (inside) malleolus. If either of the two surfaces are exquisitely tender on touching them, it might suggest a fracture.
• Experiencing bone pain around the knee as well, or around the feet.

Do consult your friendly neighbourhood doctor or present yourself to the emergency department for an X-ray of the ankle.

One should walk as normally as possible but try to limit long walks to a minimum. The recovery period of a sprain usually takes anywhere from 1-4 weeks, with more severe sprains taking a longer time to heal. Pain and swelling usually subsides eventually, however if you encounter symptoms of instability of the ankle, tendency to get sprains after the initial injury, or chronic pain of the ankle, a referral to a foot and ankle surgeon may be required for further assessment.

Dr Chua Chong Bing

Family Physician, Healthway Medical Group

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Dr Chua Chong Bing is a General Practitioner at Healthway Medical Group.