Osteoporosis is a disease which weakens bones until the point where they break easily — most often, bones in the hip, backbone (spine), and wrist. Osteoporosis is called a “silent disease” because you may not notice any changes in your body until your bones start to break. However, all the while, your bones have been losing strength and becoming more brittle over the years.
According to the International Osteoporosis Foundation, worldwide, one in three women and one in five men aged 50 years and over will suffer an osteoporotic fracture.
In line with World Osteoporosis Day on 20th October, we have interviewed Dr Bernard Lee, Chief Consultant Pain Specialist from Singapore Paincare, to ask him more about the condition of osteoporosis and to address some misconceptions as well as tips on how to take care of your bones.
Q: Can osteoporosis affect younger people?
Yes, it is called non-degenerative (non-aging) osteoporosis, which affects younger people. This form of osteoporosis is usually related to the use of certain medication. For example, steroids – used to treat conditions such as juvenile rheumatoid arthritis, systemic lupus erythematosus and asthma – can cause non-degenerative osteoporosis. For patients suffering from epilepsy, the long-term use of anti-convulsant medication such as Epilim and Lyrica can cause non-degenerative osteoporosis too.
Other factors can also cause non-degenerative osteoporosis in younger people. One who is severely underweight with BMI of below 18 is at risk of early onset osteoporosis. Genetic conditions – such as osteogenesis imperfecta, of which the bone formation is genetically faulty resulting in brittleness and easy fracture – can cause non-degenerative osteoporosis too.
Q: How can we prevent osteoporosis when we are older?
There are two ways to prevent osteoporosis when one gets older: increase intake of calcium, vitamin D, magnesium and phosphate through supplement tablets or foods rich in these minerals; and increase weight bearing exercises.
These steps are important because as one gets older, the osteoblastic cells – which control bone formation and mineralisation throughout life – are slowing down. At the same time, the osteoclastic cells – which are responsible for aged bone resorption – continue to be active. This results in an imbalance between osteogenesis (building of bone) and osteoclastic (breakdown of bone) activities, leading to reduced bone density.
With a higher intake of calcium, vitamin D, magnesium and phosphate, the osteoblastic cells receive more raw materials to increase osteogenesis. On the other hand, weight bearing exercises – such as running and jumping – will help to increase osteoblastic stimulation. For instance, 30-45 minutes of brisk walking between three to five times a week can improve bone mineral density.
Q: Is it true that beyond a certain age, our body is unable to absorb calcium as efficiently even if we take calcium supplements?
Yes, that is true. Our body typically absorbs calcium through a process called concentration gradient in passive transport. This process diffuses calcium down a concentration gradient, from areas of higher concentration to areas of lower concentration, until it is on par.
This process, unfortunately, becomes less efficient as one gets older. For example, our body absorbs 25% of calcium from an intake of 1,000 mg, compared to an absorption of 50% previously. Even if the intake is increased above 1,000 mg, the absorption of calcium does not increase in tandem.
This, however, does not mean that increasing intake of calcium and other minerals is ineffective. On the contrary, it is the first step towards treating osteoporosis. Subsequently, in cases where the higher intake of calcium does not result in higher absorption, bisphosphonates and/or anabolic osteoblastic medication may be needed to boost the bone mineral density.
Q: What foods can we eat to increase our calcium intake besides drinking milk and eating supplements?
| Food items | Quantity | Calcium content (mg) |
| Milk and milk products | ||
| full cream milk | 1 cup (240ml) | 271 |
| low-fat milk | 1 cup (240ml) | 288 – 338 |
| high calcium nonfat milk | 1 cup (240ml) | 490 |
| cheese (Cheddar cheese) | 1 match box size (25g) | 104 – 238 |
| processed cheese | 2 slices (40g) | 222 – 326 |
| plain yoghurt | 1 tub (150ml) | 278 |
| Soy beans and soy bean products | ||
| calcium-fortified soy milk | 1 carton (around 240ml) | 220 – 400 |
| regular soy milk | 1 cup (240ml) | 14 – 72 |
| firm tofu | ½ block (200g) | 232 – 402 |
| soybean curd dessert | 1 bowl (302g) | 260 |
| soybean curd slab | 3 pieces (around 100g) | 308 |
| soy chicken | 1 whole piece (110g) | 351 |
| Vegetables | ||
| collards | 100g | 145 |
| Chinese kale | 1 bowl, boiled (160g) | (stalk) 110 – (leaf) 336 |
| spinach | 1 bowl, boiled (160g) | 158 – 276 |
| bok choi | 1 bowl, boiled (160g) | 140 – 224 |
| choy sum | 1 bowl, boiled (160g) | 112 – 176 |
| okra | 1 bowl, boiled (160g) | 72 – 154 |
| yardlong beans | 1 bowl, boiled (160g) | 70 – 80 |
| green soybeans (Edamame) | 1 bowl, boiled (160g) | 216 – 232 |
| Dried beans or legumes | ||
| soy beans | ½ cup, boiled (86g) | 65 – 88 |
| pinto beans | ½ cup, boiled (85g) | 39 |
| chick peas | ½ cup, boiled (82g) | 40 |
| Seafood | ||
| dried anchovies | 1 tablespoon (10g) | 59 |
| dried small shrimps | 1 tablespoon (10g) | 40 – 56 |
| canned sardines with bones | 3 pieces (160g) | 294 |
| Nuts and seeds | ||
| almond | 1 tablespoon (around 15g) | 32 – 44 |
| black sesame sweet soup | 1 bowl (289g) | 214 |
| sesame (black or white, whole) | 1 tablespoon (around 9g) | 56 – 89 |
| Fruits | ||
| orange | 1 piece, medium size | 60 |
| dried figs | 40g (around 3-4 pieces) | 65 – 80 |
Q: What are some osteoporosis-related myths that you have helped your patients debunk over the years?
- Myth 1 – “The body and back pain are caused by osteoporosis.”
- That is not true because osteoporosis is painless. The truth is that the fracture of the spine resulting from osteoporosis causes pain, which is easily identifiable.
- Myth 2 – “Osteoporosis will be reversed after taking calcium supplements.”
- Increasing calcium supplement intake may not change the bone mineral density as up to 40% of osteoporotic patients need some form of treatment via osteoclastic inhibition or osteoblastic medications.
Q: Besides going for a health check-up, how can we tell if we are suffering an onset of early osteoporosis?
Osteoporosis is asymptomatic. So, there is no visible indication of early osteoporosis without a medical check-up. One needs to undergo a DEXA scan (dual-energy x-ray absorptiometry), which measures bone mineral density using spectral imaging.
Hopefully this short interview with Dr Bernard Lee has also helped you to clear up some misconceptions on osteoporosis and taught you how to take care of your bones better!
Interview responses by Dr Bernard Lee, Chief Consultant Pain Specialist, Singapore Paincare Center. Dr Lee is also CEO and Executive Director of Singapore Paincare Holdings Limited.
Images: Envato
