Q&A for osteoporosis

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1. I am not an active person and I am afraid that I will have brittle bones in the future. What type of exercises should I do to have strong bones? Is it too late to build my bone mass? I am 27.

Osteoporosis is a condition where a person gradually loses bone material, resulting in brittle and easily fractured bones. As we age, bone material is lost and our bones become thinner. Bone tissues are constantly being formed and used up in the bone. Up to the age of 30, the maximum bone mass is attained where more bone tissues are formed than being lost. After this age, bone mass is lost more quickly than formed. If your peak bone mass is low, you will have lesser bone tissues to deplete and thus, result in risk of osteoporosis. As you are 27 years old, you have some time to catch up to build a high maximum bone mass.

It is important to care about osteoporosis as your lifestyle now can determine if you get osteoporosis later in life. It is not too late to build up your bone mass. Start to work towards building a high peak bone mass today!

Not only does exercise gives healthy bones, it also improves our general health. For stronger bones, weight-bearing exercises has to be done. Examples include brisk walking, stair climbing, jogging, skipping and weight-lifting. These exercises stimulate the growth of bone tissues, making your bones dense and strong. It is recommended to exercise at moderate intensity at least three a week for 20 to 30 minutes each time, with warm-up and cool-down exercise before and after the activities.

Besides exercises, other aspects to attaining a high peak bone mass include lifestyle modifications and dietary changes. Choose calcium-rich foods and obtain adequate vitamin D by to getting at least 30minutes of sunshine daily. Reduce alcohol intake and stop smoking as these may also protect you from osteoporosis.

 

2. I am in my late 40s and I recently found out I have osteoporosis. Besides taking prescribed drugs and calcium supplements, are there other dietary ways that I can adopt to prevent osteoporosis? I am also not sure what the foods that are calcium-rich are.

Milk and cheese are well-known as a rich source of calcium. Nonetheless, lactose intolerant is a common phenomenon among Asians. If dairy products cause stomach upset for you, you may obtain calcium from other sources. These include dark, green leafy vegetables like chye sim, kailan, spinach, small fish with edible bones (such as ikan bilis and sardines), beans and lentils, beancurd / tofu. Foods fortified with calcium are also good sources, like certain calcium enriched soya bean milk, cereals and orange juice.

Below is a guide of the amount of calcium in some common foods.

 




Fruit / Vegetables

Serving Size

Calcium (mg)per serving

Kailan (cooked)

¾ mug (100g)

195

Spinach/ Chye Sim (cooked)

¾ mug (100g)

140

French beans (cooked)

¾ mug (100g)

55

Broccoli (cooked)

¾ mug (100g)

50

Apricot, dried

¼ mug (60g)

40

Papaya

1 wedge (130g)

40

Raisins

¼ mug (60g)

30

Green peas (cooked)

¾ mug (100g)

30

Beans/Nuts

Serving Size

Calcium (mg)per serving

Soya bean (cooked)

1 mug (180g)

205

Beancurd, firm (Tau Kwa)

1 small cake (90g)

150

Almonds

¼ mug (40g)

100

Dhal (raw)

¼ mug (50g)

85

Soya bean with syrup(Tau Huay)

1 bowl (540g)

80

Milk & Milk Products

Serving Size

Calcium (mg)per serving

High-calcium milk powder

4 scoops (25g)

450

Low-fat yoghurt

1 carton (200g)

420

Low-fat milk

1 glass (250ml)

300

Full cream milk

1 glass (250ml)

280

Cheese

1 slice (20g)

130

Calcium fortified products

Serving Size

Calcium (mg)per serving

High-calcium soya bean milk

1 glass (250ml)

450

Calcium enriched egg noodles

1 portion (100g)

210

Calcium enriched bread

2 slices (60g)

100

Fish/Meat

Serving Size

Calcium (mg)per serving

Dried ikan bilis (with bones)

2 tablespoon

270

Canned sardines (with bones)

1 fish (50g)

205

Source: Health Promotion Board

For prevention of bone fracture due to osteoporosis, a good target for calcium intake for you would be 1200mg per daily. Moderation is the key. Having too little calcium would make your osteoporosis treatment less effective, while having too much would cause problems such as constipation. Given that you are already taking calcium supplements, you should check how much more calcium you need and derive it from your diet. If it gets too confusing, do check with your doctor or pharmacist.

 

3. I’ve been reading up on osteoporosis and it informs me on foods I should eat. But what I would like to know is what should I avoid?

Phosphorus, sodium, alcohol, caffeine and white flour aids the loss of calcium from the body, while too much protein, fat and sugars can have a negative effect with the absorption thereof. Alcohol intake is associated with a higher risk of osteoporosis and injuries that can cause fractures. Excessive sodium in the diet causes calcium loss and weakening of bones with time. Intake of foods high in sodium such as fast foods and processed foods should be limited.

Absorption of certain medications may be affected by calcium supplement or calcium-rich food and vice versa. These include the quinolone antibiotics such as ciprofloxacin and tetracyclines such as doxycycline, minocycline., These medication should be taken two to four hours before or after taking calcium supplements or calcium-rich food.

 

4. My husband had a bad fall last week and had a hip fracture. I am afraid he might have osteoporosis. Is it common in men in their 40s?

Osteoporosis usually occurs in older women (over 55 years old), but this condition is not exclusive to them.

Younger man, like your husband, may be at risk of osteoporosis (and therefore higher risk of fractures)if they have the following risk factors:

  • A previous fracture due to low impact or minor injuries
  • Predisposing illnesses such as liver disease, alcoholism, mal-absorption, thyroid disease, rheumatoid arthritis,
  • A long-term use of oral steroids (for reducing redness and swelling
  • A family history of osteoporosis
  • A loss of height, or those who are becoming increasingly hunched
  • X-rays which suggest osteopenia ('thin bones')

 

5. My mother who is in her late 50s is beginning to hunch. Is there anything she can do to prevent further deterioration?

A loss of height, or being increasingly hunched may be signs of osteoporosis. Apart from checking if poor posture plays a part in this, it would be worthwhile for your mother to check her bone mass density and consult a doctor. Depending on the doctor’s diagnosis, prescription medicines may be part of the solution for her problem. Whether or not she is having osteoporosis, it is a good health practice to have a calcium-rich diet (or supplements if she is unable to obtain enough calcium via her food-intake), consistent vitamin D intake, life-style modifications and regular exercise. Being a senior citizen, her way of practising these measures would differ from a younger individual. When using weigh-bearing exercise, she may not select an intense one as she may end up having knee pain – a common problem among elderly. Unprotected exposure to sunlight for her may accelerate skin aging and increase occurrence of problems like wrinkles and age-spots.

As she ages and as her bone mass density becomes lower, an important measure to adopt is fall prevention.

The following are some tips to prevent falls which can result in fractures:

  • Remove or firmly anchor rugs that may slide or bunch up and cause a fall.
  • Have good lighting in every room.
  • Keep electrical and telephone cords out of walking paths.
  • Keep a flashlight by the bed for night use. Check the batteries often.
  • Make stairways safe with railings and non-slip surfaces. Use handrails when going up or down stairs.
  • Equip your bathroom with grab-bars and other aids, such as nightlights.
  • Apply adhesive strips to your tub or shower floor.
  • Select chairs and couches that are easy to get into and out of.
  • Watch for small pets or objects on the floor.
  • Talk to the doctor or pharmacist about avoiding medications that may impair the sense of balance, e.g sleeping pills, cold medication 
  • Avoid walking around in high heels, socks, or slippers.
  • Exercise caution when walking outside at night, in poorly lighted areas, or on wet surfaces.

 

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