Silent disease: beware of the hidden risk of osteoporosis

SINGAPORE – Ms Muthiah Vasanthakumari, 73, does yoga every day. However, in recent months she has had to avoid extreme twists or backbends.

Ms. Kumari, as she is known, has osteoporosis, or brittle bones. The condition typically presents without any warning symptoms and puts patients at risk of becoming immobile due to spine or hip fractures.

In May, she developed sudden and painful back pain after lifting something heavy. It turned out to be a spinal fracture.

“If I had known, I would have been more careful,” says Ms Kumari. She now receives monthly injections to promote bone formation and has been asked to walk more slowly to reduce the risk of trips and falls.

The married mother of three discovered thirteen years ago that she had low bone density, which could indicate osteoporosis.

Until recently, she didn’t think it would affect her much. She made sure to take calcium supplements and eat green leafy vegetables that were rich in calcium.

She walks regularly and takes 10,000 to 15,000 steps a day. She can climb stairs and make pilgrimages in hilly regions of India.

However, endocrinologist Caroline Hoong of Woodlands Health says: “By the time you are diagnosed with osteoporosis or have broken a bone due to osteoporosis, simply taking calcium and vitamin D supplements is not enough.”

Treatment may also include oral or injectable medications to reduce bone loss and promote bone formation, added Dr. Hoong, who is treating Ms. Kumari.

Steep condition

General practitioner Gabriel Ding says people with osteoporosis have bones that have become brittle and vulnerable, usually due to hormonal changes or deficiencies in calcium or vitamin D, which promote the absorption of calcium by the bones.

There are usually no warning signs in the early stages of bone loss, says Dr Ding, consultant and head of the Khatib Outpatient Clinic. Still, he says: “Osteoporosis causes bones to become so weak and brittle that a fall or even mild stress such as bending or coughing can cause a fracture.” The most common such fractures are those of the hip, wrist and spine.

Endocrinologist Chew Chee Kian sees 30 to 40 patients with osteoporosis every week. Some may have had lower back pain or a decrease in height over time. But mostly, says Dr. Chew, osteoporosis is a silent disease. “People may not realize they have the disease until after they have had a fracture.”

The senior consultant from Tan Tock Seng Hospital’s department of endocrinology says osteoporosis in Singapore is estimated to affect 0.7 percent of men over the age of 50, according to a 2023 study on the Asia-Pacific region.

In postmenopausal women, the prevalence is estimated at 9.3 to 19.4 percent.