​Osteoporosis, which means porous bones, causes bones to be weak and brittle.

In severe cases of osteoporosis, bones can become so brittle that even coughing, or lifting shopping bags, can cause a fracture.

"Women have a higher risk of osteoporosis than men. To begin with, women have a lower bone mass than men. After menopause, a woman’s oestrogen levels drop sharply, accelerating bone loss,"  shares Professor Manju Chandran, Senior Consultant and Director of the Osteoporosis and Bone Metabolism Unit (from the Department of Endocrinology) at Singapore General Hospital (SGH), a member of the SingHealth group.

"However, osteoporosis should not be thought of as a woman’s condition. Men too can suffer from this condition, and those who have low levels of the male hormone testosterone have a higher risk of osteoporosis" she added.

Very often, many are unaware that they have osteoporosis until an incident occurs such as a hip fracture during a fall.

In fact, Singapore has the highest reported incidence of hip fractures within Asia. Also, the International Osteoporosis Foundation Asian Audit showed that one in three Singaporean women over 50 years old has osteoporosis.

10 Ways to prevent osteoporosis and protect your bones

1. Eat enough calcium and vitamin D

Calcium is important for preventing bone loss. For adults between the ages of 19 and 50, a daily intake of 1,000mg of calcium is recommended. Those who are 65 and older should eat at least 700mg of calcium a day. Good sources of calcium include milk, cheese, certain vegetable greens and calcium-fortified food such as juices, cereals and breads.

For our bodies to absorb the calcium, vitamin D is required. Those who are above 50 years of age should aim to have an intake of between 400 and 800 IU of vitamin D daily. Apart from getting vitamin D from our food, another good source is sunlight. Our skin makes vitamin D from the ultra violet light (UVB) in sunlight and stores it for later use.

2. Eat a balanced diet

Eating a balanced diet ensures you get enough phosphorus and other minerals, like magnesium, vitamin K, vitamin B6 and vitamin B12 that are also essential for healthy bones.

3. Limit your alcohol intake

Alcohol is thought to decrease bone formation and reduce the body’s ability to absorb calcium. So keep to two drinks a day or less.

4. Moderate your intake of caffeine

Caffeine, found naturally in coffee and tea, ‘leeches’ calcium from our bones. So it is best to keep to two to three cups of coffee or tea a day, especially if you do not eat enough calcium. Also keep in mind that caffeine is often added to soft drinks.

5. Cut down on salty food

Eating too much sodium can inhibit absorption of calcium in our bodies.

6. Do weight-bearing and strengthening exercises

Weight-bearing exercises make our bones stronger and denser. Exercises such as dancing, jogging and rope jumping are all weight-bearing exercises. 

To strengthen our bones, try weight lifting, weight machines and elastic bands. 

For those who cannot do high impact exercises, low impact exercises such as walking, low impact aerobics or exercising on cross-training machines are alternatives.

7. Improve your balance and flexibility

Better balance and flexibility will reduce your risk of falls. Exercises such as tai chi, pilates and yoga improve balance and flexibility.

8. Maintain a healthy weight

A low body weight increases the risk of osteoporosis, as does a previous history of anorexia nervosa. But this does not mean that heavier people don’t get osteoporosis. Having a normal weight is beneficial for general health and reduces the risk of other chronic conditions such as heart disease and diabetes.

9. Don’t smoke

Smoking is thought to increase bone loss by reducing the absorption of calcium in our bodies. In women, smoking may reduce the amount of oestrogen produced.

10. Consult a doctor if you have lost height over the years

All of us lose some of our height as we grow older, but if you lose 6cm or more, there is a high chance you may have osteoporosis. It is advisable to consult a doctor, especially if you belong to the high-risk group.

How to determine your risk of osteoporosis

An easy way to know your level of risk for osteoporosis is to use the chart below according to your age and weight.

Osteoporosis Self-Assessment Tool for Asians (OSTA) chart

Who has increased risk of osteoporosis?

The following puts one at increased risk of osteoporosis: 

  • Previous fractures through normal falls (not involving violent force such as in car accidents)

  • Early menopause (before 45 years of age)

  • Family history of osteoporosis

  • Small and slender body frame

  • Smoking

  • Excessive consumption of alcohol

  • Inactive lifestyle

  • Inadequate calcium and vitamin D in diet

  • Certain illness such as rheumatoid arthritis or hyperactive thyroid (hyperthyroidism

  • Medication such as steroids (oral or injected)

Is it too late for me to protect my bones?

From birth, our bodies continuously build bone mass until we are in our 30s when it peaks. So, is it too late to do anything about our bones once we are over that age?

Not so, explains Prof Chandran, "Even though we reach our peak bone mass in our mid-30s, we should still aim to reduce bone loss and encourage new bone growth. It is only when bone loss is greater than new bone growth that osteoporosis sets in."

FAQs about osteoporosis

These commonly asked questions and answers will help you understand osteoporosis and what you can do to strengthen your bones.

1. How do I know if I have osteoporosis?

As osteoporosis is a silent disease, it causes no specific pain or symptoms. Some signs you can look out for are: 

  • Receding gums 

  • Decreased strength in your grips 

  • Weak and brittle nails 

  • Cramps and muscle aches 

  • Height loss 

If you think you may be at risk of developing osteoporosis, consult your doctor.

2. Besides calcium, what are other essential nutrients that are good for bone health?

When it comes to healthy bones and preventing osteoporosis, calcium alone is not enough. There are a number of vital nutrients that your body needs for strong bones. 

The most important of these are magnesium, vitamin D, phosphorus and vitamin K. Other nutrients such as vitamin C and vitamin B12 may also play an important role in bone development. 

Magnesium is found in nuts, seeds, whole grains, seafood, legumes, tofu and many vegetables. Our skin, when exposed to sunlight, also produces vitamin D, which helps in the absorption of calcium and phosphate. We can also get vitamin D from oily fish such as salmon, mackerel, herring and sardines, as well as red meat and eggs.

3. At what age should I start strengthening bone health?

Getting enough calcium in your diet is not just important for older people. It’s vital for children, teens, and adults under the age of 30 to get enough calcium to build bone mass. 

Making smart choices now will help you avoid serious bone loss later in life. No matter your age, you can take steps to protect your bones and prevent the onset of osteoporosis.

4. Should I consider taking health supplements to boost my calcium intake?

Although diet is the best way to get calcium, calcium supplements may be an option if your diet falls short. Before you consider calcium supplements, be sure you understand how much calcium you need and which type of supplement to choose. Consult your doctor about calcium supplements.

5. How is osteoporosis treated?

There is no standard treatment for osteoporosis. Treatment depends on specific needs. Generally, the overall risk of fracture will help the doctor decide on the best course of treatment. 

In addition to maintaining a healthy lifestyle and participating in regular weight-bearing exercise, some medications can reduce the risk of future fractures from osteoporosis.

Ref: I23 (edit)

Check out other articles on osteoporosis:

Osteoporosis: Foods to Avoid

Better Bone Health for Women: Tips for Every Age Group

Osteoporosis Treatment

Osteoporosis in Men: Causes, Symptoms, Treatment

Osteoporosis in Singapore