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Brittle bones

Too late: An X-ray is not the best way to detect osteoporosis because by the time it shows up on X-ray (as very thin and lighter bones), at least 30% of bone has been lost.

Osteoporosis leads to brittle bones that are more prone to fractures.

MY aunt went for a routine medical check-up. She had some X-rays and the doctor told her that she has osteoporosis. What is osteoporosis?

Osteoporosis is a condition that is caused by decreased density in your bones. This causes your bone to be abnormal and porous, and thus much weaker and more fragile.

When your bones are weak, they fracture a lot more easily, especially with small injuries that would not otherwise break normal bone.

Osteoporosis is very, very common. In fact, every one out of two white women will experience a fracture due to osteoporosis in her lifetime.

After age 35, we start to lose 0.3 to 0.5% of our bone density every year as we age. If you are a woman, as long as you have your periods, you are protected by oestrogen.

But as soon as you hit menopause, this loss of bone density increases exponentially, as much as 2 to 4% loss per year.

But my aunt never knew she had osteoporosis before this. She certainly didn’t have any pain in her bones.

Unfortunately or fortunately, osteoporosis can be there for a long, long time without causing any symptoms, and you don’t know you have it until you have the first fracture.

Worse still, osteoporotic fractures can be present for years without any symptoms either.

Osteoporosis can cause fractures in your hips and spine, two places that can cause severe discomfort and disability. Hip fractures usually occur after a fall. A fracture of your spine can cause severe pain that radiates from your back to the sides of your body, causing chronic back pain.

For some people, osteoporosis can cause repeated spinal fractures, resulting in them losing their height. Their spines can also start to curve, giving a “dowager hump” hunchback appearance in their upper back. This is more commonly seen in older people.

And because your bones are so weak, even your feet can develop stress fractures during walking or stepping off a sidewalk.

Other than causing fractures, osteoporosis is not dangerous, is it? I mean, it’s not like heart disease.

Well, think again. Once you have a fracture, you lose mobility. If you are elderly, you can develop pneumonia and blood clots in your leg veins a lot more easily.

Pneumonia can kill you, especially if you are older. And these blood clots that develop in your leg veins can travel up to your lungs and get stuck there. This is called pulmonary embolism.

Studies have shown that osteoporosis is linked with an increased risk of death. In fact, 20% of women who have a hip fracture will die within the year as an indirect result of the fracture.

Scary, but true.

Is every woman at risk of osteoporosis, then?

Yes. As long as you are female, you are at risk. Other risk factors include:

> Being Asian

> Being thin and having a small body frame

> Menopause

> Having a family history of osteoporosis, such as if your mother and grandmother had osteoporosis

> If you have had a fracture as an adult

> If you smoke

> If you consume alcohol excessively

> If you don’t exercise

> If you don’t eat much calcium-containing foods, such as milk and other dairy products

> If you have vitamin D deficiency

> If you have malabsorption in your gut

> If you don’t have periods in your young age, such as if you exercise severely

> If you have been immobile because of disease, such as a stroke

> If you have diseases like chronic rheumatoid arthritis, hyperthyrodism

> If you take certain long-term medications like steroids and heparin

Factor: Smoking increases the risk of osteoporosis. —Reuters

Is X-ray the only way to diagnose osteoporosis?

No. An X-ray is not even the best way to detect osteoporosis because by the time it shows up on X-ray (as very thin and lighter bones), at least 30% of bone has been lost.

A DEXA scan or dual-energy X-ray absorptionmetry scan is the best test to perform. This test gives you your T score. If you have a T score of -2.5 and below, you have osteoporosis.

There’s a condition called osteopenia that is somewhere between normal and osteoporosis. This has a T score of -1 and -2.5

Is there anything I can do to combat osteoporosis?

You can take calcium supplements, but they are often not enough. You also need vitamin D. When you have menopause, you can take hormone replacement therapy.

And there are plenty of drugs such as the bisphosphonates that can prevent osteoporosis. Be careful though. Once you take a bisphosphonate, you must stay upright for at least 30 minutes or they can cause serious gastro-esophageal side effects.

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