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Protecting Your Bones for Life

Osteoporosis & Bone Health

A Guide to Understanding, Preventing and Managing Osteoporosis

What is Osteoporosis?

Osteoporosis is a condition where bones become weak and brittle, making them more prone to fractures. It’s often known as a “silent disease” because bone loss happens gradually without symptoms until a break or fracture occurs.

Who Does it Affect?

Osteoporosis is common among older adults, particularly postmenopausal women, but it can affect anyone, including men and younger individuals with risk factors.

Why Does It Matter?

Bone Growth and Loss

Bones continuously remodeling — old bone breaks down (resorption), and new bone forms (formation). In younger years, new bone formation outpaces resorption — ensuring our bones are healthy and strong enough to withstand the stresses of daily activities. However, with age, bone resorption outpaces formation, resulting in a gradual decrease in bone density.

Peak Bone Mass

By around age 30, most people reach their peak bone mass – the maximum strength and density that their bones will achieve in their lifetime. The higher this peak mass, the less vulnerable a person may be to osteoporosis later in life.

Risk Factors for Osteoporosis

  • Age: Risk of osteoporosis increases with age due to a natural decrease in bone density over time.
  • Gender: Women are more prone to osteoporosis, especially post-menopausal women. This is due to the decrease in oestrogen, which protects bone density.
  • Genetics: Genetics play a significant role in determining bone health. Having a parent or sibling with osteoporosis, especially a parent who experienced a hip fracture, increases your risk.
  • Ethnicity: People of Caucasian and Asian descent have higher risks of osteoporosis compared to African American and Hispanic populations.
  • Diet: A diet low in calcium and vitamin D results in weaken bones. Vitamin D aids in calcium absorption in the body.
  • Sun exposure: Vitamin D can be naturally derived from sun exposure. Daily mid-day sun exposure for 10 - 30 minutes is recommended. Ultraviolet rays from the sun stimulate the conversion of vitamin D precursors from our skin, these are subsequently converted in the liver and kidneys to become active vitamin D.
  • Physical Inactivity: Bone formation occurs at sites of bone stress and loading. Lack of weight-bearing exercise weakens bones.
  • Lifestyle: Both smoking and alcohol reduce bone density.

Signs and Symptoms

Osteoporosis is often silent. Most patients do not exhibit any symptoms until a fracture occurs. Fractures associated with osteoporosis often occur after a low

Possible Signs

  • Loss of height over time
  • Stooped posture
  • Bone fractures from minor falls

Diagnosis of Osteoporosis

Bone Density Test

  • Dual-Energy X-ray Absorptiometry (DEXA): Is a bone density scan is the gold standard method to objectively diagnose osteoporosis and assess fracture risk.
  • DEXA scans can also be performed periodically (every 1 - 2 years) to assess the efficacy of osteoporosis medical treatment.

Laboratory Tests

Blood tests may be done to rule out other causes of bone loss. Common blood tests assesses kidney, liver and thyroid function.

Treatment Options

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Calcium and Vitamin D Supplements

Essential for bone health, these help strengthen bones and prevent further loss.

  • Calcium: Adults generally need 1,000-1,200 mg of calcium daily, depending on age and sex. If dietary sources are insufficient, supplements may be recommended.
  • Vitamin D: Crucial for calcium absorption and bone health, adults typically need 600-800 IU of vitamin D daily, though needs may vary based on individual health factors and sunlight exposure.

When calcium and vitamin D supplements do not adequately improve bone health. In the setting of severe osteoporosis, medical options include bisphosphonates, hormone therapy, and bone-forming agents to slow bone loss and increase density.

  • Bisphosphonates: Often the first line of treatment, these drugs slow bone loss by inhibiting bone resorption. Examples include alendronate, risedronate, and zoledronic acid.
  • Hormone Therapy / Selective Estrogen Receptor Modulators (SERMs): Drugs like raloxifene mimic estrogen’s positive effect on bone density in postmenopausal women. Oestrogen therapy may help maintain bone density in postmenopausal women, though it’s often prescribed at the lowest possible dose and for the shortest duration due to associated cancer risks.
  • and are generally prescribed for individuals with severe osteoporosis.
  • Bone forming agents:
  • RANK Ligand (RANKL) Inhibitors: Denosumab is a medication injected every 6 monthly. It inhibits a protein involved in bone resorption, thereby reducing bone loss.
  • Parathyroid Hormone (PTH) Analogues: Teriparatide, stimulate bone formation and are prescribed for patients with severe osteoporosis.
  • Novel bone stimulating agents: Romosozumab is a new agent that is used to promote bone formation.

For other HPV-related cancers, there is no standardized screening, but regular check-ups and vigilance for symptoms are encouraged.

  • Weight-Bearing Exercises: Activities like walking, hiking, dancing and low-impact aerobics help to stimulate bone formation.
  • Resistance Training: Lifting weights or using resistance bands can strengthen bones and improve muscle support - reducing fall and fracture risk.
  • Balance and Flexibility Training: Tai chi, yoga and balance exercises improve stability and reduce the risk of falls.
  • Nutrition:
  • Calcium-rich foods: Dairy products, leafy greens, almonds, and fortified foods
  • Vitamin D sources: Can be from (1) Dietary and (2) Non-dietary sources.
  • Dietary: Fatty fish, fortified milk, and supplements if necessary
  • Non-dietary: Sunlight

Activities like walking, hiking, dancing, and weightlifting help maintain bone density.

Both are linked to increased bone loss.

Prevention Tips

  • Ensure adequate calcium and vitamin D intake daily through a balanced diet. Calcium can be derived through a calcium rich diet. Calcium can be derived through dairy products (e.g. milk, yoghurt and cheese) as well as non-dairy products. (Refer to table below)
Dairy ProductsNon-Dairy Products
  • Milk
  • Yoghurt
  • Cheese
  • Leafy green vegetables (e.g. Kale, collard greens, bok choy)
  • Tofu and Tempeh
  • Fish (especially canned sardines with bones)
  • Nuts and Seeds
  • Stay active with weight-bearing and muscle-strengthening exercises
  • Avoid smoking and excessive alcohol or caffeine consumption
  • Get regular bone density screenings if you are at risk

When Should You Seek Medical Advice

  • If you experience a fracture from a minor fall or strain
  • If you notice height loss or a stooped posture.
  • If you have risk factors and are concerned about your bone health
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Additional
Learning Resources

  1. Keeping Bones Strong With Exercise and Calcium-Rich Foods. Source: HealthHub.
  2. Osteoporosis. Source: SingHealth.
  1. 14th Annual Osteoporosis Public Forum – Singapore General Hospital.
  2. Dr Leong Keng Hong – Prevention of Osteoporosis – Ministry of Health Singapore.
  1. Cosman, F., de Beur, S. J., LeBoff, M. S., et al. (2014). Clinician’s Guide to Prevention and Treatment of Osteoporosis. Osteoporosis International, 25(10), 2359–2381.
  2. Rizzoli, R., Bianchi, M. L., Garabédian, M., McKay, H. A., & Moreno, L. A. (2010). Maximizing bone mineral mass gain during growth for the prevention of fractures in the adolescents and the elderly. Bone, 46(2), 294-305.
  3. NIH Osteoporosis and Related Bone Diseases National Resource Center. (2020). Osteoporosis Overview. Retrieved from NIH Osteoporosis Center.

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