Osteoporosis Treatment

How is Osteoporosis treated?

Osteoporosis is often called a silent condition, because bones can quietly become weaker for years without any warning signs. Many people only find out when a minor fall or even a sudden movement leads to a broken bone. The encaouraging news is that osteoporosis is very treatable. With the right medication, nutrition, exercise, and a few simple precautions at home, you can strengthen your bones and greatly reduce the chance of a fracture.

Understanding Osteoporosis

Bone is living tissue that is constantly being broken down and rebuilt throughout life. When we are young, the body builds bone faster than it loses it. In later life, and especially after menopause, bone is lost faster than it can be replaced.

Osteoporosis occurs when bones lose their strength and thickness because minerals such as calcium are lost at a rate higher than the body can replace them. The bones, especially in the hip, spine, and wrist, become porous and more fragile, and can break more easily, sometimes from a minor bump or a fall from standing height. Fractures of the hip and spine in particular can lead to long-term pain, loss of height, reduced mobility, and loss of independence.

As Singapore’s population ages, osteoporosis is becoming a growing concern, particularly among post-menopausal women, although men can be affected too. Although we live in a sunny country, many of us spend most of the day indoors, and a lower intake of dairy in some diets means that vitamin D and calcium levels can still fall short. Understanding your bone health early makes a real difference.

The Aims of Treatment

Treating osteoporosis involves treating and preventing fractures and using medicines to strengthen bones. The goal is not only to protect your bones but also to keep you active, steady on your feet, and independent. Treatment usually combines several approaches.

• Medication: Medicines that slow bone loss or build bone, together with calcium and vitamin D to support bone health.
• Hormone Replacement Therapy (HRT): Sometimes considered for women going through menopause, as part of an individual treatment plan.
• Lifestyle management: Weight-bearing and muscle-strengthening exercise, good nutrition, fall prevention, and avoiding smoking and excessive alcohol.
• Fracture care: Treatment for any fractures that occur, along with rehabilitation to help you recover and regain mobility.

How Your Treatment is Planned

Your doctor will take into account your age, whether you have had any previous fractures, your family history, your medications, and other health conditions to estimate your risk of breaking a bone. A bone density scan, known as a DEXA scan, is a quick and painless test that measures the strength of your bones and is commonly used to diagnose osteoporosis and guide treatment. Blood tests may also be done to check your calcium, vitamin D, and kidney function, and to look for other conditions that can affect your bones.

Medication

Bisphosphonates

Bisphosphonates, such as alendronate, risedronate, and zoledronic acid, slow down the rate at which bone is broken down in your body. This helps to maintain bone density and reduces your risk of a broken bone. They come in tablet form, or as an injection.

• Taking tablets: Bisphosphonate tablets need to be taken in a specific way to be absorbed and to protect your food pipe and stomach. Your doctor or pharmacist will explain the instructions, which typically include taking them on an empty stomach with a full glass of plain water, and staying upright for a period afterwards.
• Injections: Some bisphosphonates are given by injection, usually once a year, which can be a convenient option for people who find tablets difficult to take. Some people feel a little unwell with flu-like symptoms for a day or two after the first dose.
• Possible side effects: Most people tolerate these medicines well. Occasionally, they can cause heartburn or stomach upset. Rarely, long-term use has been linked to problems with the jaw or unusual thigh bone fractures, so let your dentist know that you are on treatment, and your doctor will review how long you need to continue.

Calcium & Vitamin D

Calcium and vitamin D may also be prescribed. Calcium is the main mineral found in bone, and having enough of it is important for healthy bones. Vitamin D helps the body absorb calcium. Your doctor may prescribe them as supplements alongside your other treatment if you do not get enough from your diet and sunlight.

Other Bone-Strengthening Medicines

If bisphosphonates are unsuitable for you, or if your risk of fracture is high, your doctor may discuss other medicines that slow bone loss or help to build new bone, some of which are given as injections. Your doctor will explain the options, benefits, and possible side effects that are relevant to you.

Please take your medicines exactly as prescribed, even though you may not feel any difference, as the benefits are in the protection of your bones over time. Do not stop without speaking to your doctor.

Hormone Replacement Therapy (HRT)

Hormone Replacement Therapy, or HRT, is sometimes taken by women with osteoporosis who are going through menopause, which sees a higher incidence of osteoporosis. This is because the drop in oestrogen at menopause speeds up bone loss. HRT has been shown to keep bones strong and reduce the risk of breaking a bone during treatment.

HRT is not suitable for everyone, and it carries its own benefits and risks. Your doctor will discuss whether it is right for you, taking into account your age, your menopausal symptoms, your medical history, and your family history.

Lifestyle Management

Medication works best when it is supported by healthy daily habits. These steps help to strengthen your bones, improve your balance, and lower your risk of falling.

Exercise

Weight-bearing exercises, such as walking and dancing, and muscle-strengthening exercises improve bone strength and balance. Gentle forms of exercise such as tai chi are also helpful for balance. Aim to build up gradually and be regular rather than occasional. If you already have osteoporosis, or have had a spinal fracture, it is best to check with your doctor or physiotherapist about which exercises are safe for you, as some movements, such as bending forward sharply or twisting, may need to be avoided. Our Rehab Centre can provide guidance on exercise programmes.

Nutrition

• Get adequate calcium: Calcium can come from food, or from supplements if needed. Good sources include milk, yoghurt and cheese, tofu, calcium-fortified soy milk, small fish eaten with the bones such as ikan bilis and sardines, and green leafy vegetables such as kai lan and choy sum.
• Get adequate vitamin D: Vitamin D helps the body absorb calcium. It is found in some foods, such as oily fish, egg yolks, and fortified foods, and is made by the skin with sun exposure. Your doctor may check your level and suggest a supplement if it is low.
• Eat enough protein: Bones need protein too, so include fish, eggs, lean meat, beans, and tofu in your meals.
• Take supplements wisely: More is not better. Too much calcium from supplements can cause constipation and, in some people, kidney stones. Your doctor or dietitian will advise on the right amount for you.

Fall Prevention

Preventing falls is one of the most important ways to prevent fractures. This involves improving home safety, correcting vision, and doing balance training to reduce the risk of falls and fractures.

• Make your home safer: Keep floors dry and clear, use non-slip mats in the bathroom, install grab bars, and make sure that lighting is good, including at night. Remove loose rugs and tidy up cables.
• Have your eyes checked: Get regular eye tests, and keep your glasses up to date.
• Wear suitable shoes: Choose supportive footwear with non-slip soles, particularly on wet surfaces after rain.
• Review your medications: Some medicines can cause dizziness or drowsiness, so ask your doctor to review them if you feel unsteady.
• Practise balance training: Exercises that train your balance, guided by a physiotherapist, can improve your stability and your confidence.

Avoid Smoking and Limit Alcohol

Both smoking and drinking excessive amounts of alcohol accelerate bone loss. Quitting smoking and keeping alcohol to a minimum are valuable steps for your bones, and for your general health. Ask your doctor for support if you need help to stop smoking.

Treating Fractures

If you do break a bone, it will be treated according to where it is and how severe it is. Treatment may involve pain relief, a cast or brace, or surgery, such as to repair or replace a broken hip, and is followed by rehabilitation to help you regain strength and mobility as quickly and safely as possible. A fracture is also an important signal that your bones need protection, so your doctor will review your osteoporosis treatment to help prevent further fractures.

Follow-Up and Long-Term Care

Osteoporosis is a long-term condition, so regular follow-up matters. Your doctor will see you regularly to check how you are getting on with your medication, repeat your bone density scan from time to time to see how your bones are responding, and review how long you need to continue treatment. Many people stay on treatment for several years, and with consistent care, most are able to keep active, stay independent, and reduce their risk of fractures.