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Bone Health: Preventing Osteoporosis as We Age 

According to the World Health Organization, osteoporosis is defined as a systemic skeletal disease characterized by low bone mass, deterioration of bone tissue microarchitecture, increased fragility, and a higher risk of fractures. Osteoporosis affects women more commonly than men. In general, women begin losing bone mass at a younger age. From age 50 onwards, women have a 4-fold higher rate of osteoporosis and a 2-fold higher rate of osteopenia compared to men. Fractures in women also tend to occur 5-10 years earlier than in men. Globally, an estimated 200 million people are affected by osteoporosis, with more than 8.9 million fractures occurring each year. 

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FAQs: Quick Guide

1. What are the risk factors for developing osteoporosis?

• Nutritional factors (low calcium intake, vitamin D deficiency, inadequate protein intake)

• Lifestyle factors (sedentary lifestyle, excessive caffeine or alcohol consumption, cigarette smoking)

• Long-term use of certain medications (anticonvulsants, glucocorticoids, chemotherapy)

• Endocrine factors (premature menopause, estrogen deficiency)

• Genetic predisposition

• Advancing age

• Low body weight (low BMI)

   

2. Are men affected by osteoporosis too, or only women?

Yes. Although osteoporosis is more common in women (1 in 3 women), about 1 in 5 men over the age of 50 will experience an osteoporotic fracture during their lifetime.

3. At what age should I start worrying about osteoporosis?

In the first three decades of life, bone resorption (breakdown) and bone formation are usually in balance. Bone density remains fairly stable from about age 25 to 50. After the age of 50, bone resorption begins to outpace formation. In women, bone loss accelerates significantly around menopause.

4. What are the early signs of weak bones?

Osteoporosis is often called the “silent” disease because it has no obvious symptoms. The first warning sign is usually a fracture caused by a minor fall or even normal activities such as bending, lifting or coughing.

5. If there are no noticeable symptoms, how can I know if I have osteoporosis?

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Preventive orthopedic screening is recommended as part of regular check-ups from midlife onwards. Screening typically includes evaluation of bone strength, joint health, muscular balance and orthopedic risk factors. According to the Clinical Practice Guidelines on Management of Osteoporosis (2022, 3rd edition) by the Ministry of Health Malaysia, bone mineral density (BMD) testing using dual-energy X-ray absorptiometry (DXA) is the gold standard for diagnosing osteoporosis. A diagnosis is made if the T-score is -2.5 or lower at the femoral neck, total hip, or lumbar spine.

6. What are the current screening guidelines in Malaysia?

The Clinical Practice Guidelines on Management of Osteoporosis (2022, 3rd edition) recommended screening for individuals with prior low-trauma fractures, those with clinical risk factors, secondary osteoporosis, height loss or falls risk, as well as all postmenopausal women aged 50 and above. In addition, all older persons aged 65 and above should be screened annually for fall risk.

7. Can osteoporosis be prevented?

Yes! Regular weight-bearing exercises such as brisk walking or light strength training help slow age-related bone loss. Adequate intake of calcium (from low-fat dairy products and leafy greens) and vitamin D (from sunlight or supplements) is important for prevention. Avoiding cigarette smoking, excessive alcohol and high caffeine intake also supports bone health.

8. How much calcium and vitamin D do I need daily?

Adults over 50 generally need about 1,000 - 1,200 mg of calcium and 600 - 800 IU of vitamin D per day.

9. Should I take calcium supplements for osteoporosis prevention?

Evidence on the benefit of calcium supplements on bone health in adults and postmenopausal women is limited. Some studies suggest supplements may increase the risk of cardiovascular events, kidney stones, and gastrointestinal issues. It is best to obtain calcium through a balanced diet unless otherwise advised by a doctor.

10. If I already have osteoporosis, what can I do?

You can still strengthen your bones through lifestyle changes, osteoporosis medications prescribed by your doctor, fall prevention measures at home, and safe exercise routines that improve muscle and bone strength. Osteoporosis is not a natural part of ageing. It is preventable and can be managed effectively to reduce the risk of fractures in older adults. By paying attention to bone
health from age 40 onwards, we can proactively lower the risk of osteoporosis and maintain independence and mobility well into later life.

Ageing Well Starts Today!

(Written by Dr Lau Tze Pheng)