Bone and joint conditions in seniors are often linked to osteoporosis, hip fractures and falls. Dr Xu Bangyu, Associate Consultant, Department of Post-Acute and Continuing Care at Sengkang Community Hospital (SKCH), answers questions on these and more.
ELDERLY BONES AND JOINTS DOCTOR Q&A
When it comes to seniors worrying about their bones and joints, it often revolves around a variety of issues including:
- Osteoporosis
- Hip fracture
- Falls among the elderly
As the featured doctor for our "Ask the Specialist" forum, Dr Xu Bangyu, Associate Consultant with the Department of Post-Acute and Continuing Care (PACC) at Sengkang Community Hospital (SKCH)*, will be answering your questions on these issues.
Posted by l**********
I am a 47 year old woman suffering from cervical and lumbar spondylosis and cervical and lumbar disk bulges as well as multiple joint problems affecting my knees, elbows, legs, feet and heels. I'm suffering unbearable pain. Is there any cure?
Answered by Dr Xu :
Dear l**********,
I am sorry to hear that you are suffering from unbearable pain. It appears that you have multiple pain sites and this may suggest some other undiagnosed medical conditions. Given how your conditions are affecting you, I would strongly recommend that you consult your Family Physician for a comprehensive review in order to receive appropriate and suitable treatment.
Posted by H****
Does taking glucosamine help in relieving joints pain? Can we take glucosamine when not in pain as a preventive measure ? But glucosamine can increase blood sugar right?
Answered by Dr Xu :
Dear H*****,
Studies evaluating the effectiveness of glucosamine supplements for pain relief, joint repair and as a preventive measure have varying results so far.
There are other effective methods to prevent joint pain. One example is to maintain a healthy weight through regular exercise and a balanced diet because being overweight will strain your joints and increase your chance of getting knee pain. Having enough calcium intake in your diet is another way to encourage healthy joints.
There is no evidence currently that glucosamine supplements increase blood sugar in people without diabetes. Although glucosamine does not appear to affect glucose levels or insulin sensitivity, it can interact with other medications such as Warfarin. I would advise you to check with your Family Physician before taking supplements.
Posted by H*****
Hi Dr Xu, while I am fit and log some 22km or more walking/hiking per month, I am unable to properly squat as I will feel pain in my knee joints. As a matter of fact I am unable to use a squat toilet. Is there any way to improve this situation? Thanks.
Answered by Dr Xu :
Dear H*****,
I am glad to hear that you are maintaining an active lifestyle and clocking regular exercise.
There are different types of knee injuries. For example, a young athlete may feel pain in his knees because of chrondromalacia patellae or patellofemoral pain syndrome (also known as “runner’s knee”) whereas an elderly’s knee pain may be due to osteoarthritis.
While the pain relief options for different types of knee pain are generally the same, the treatment can be very different depending on the root cause. Using the same example, the elderly with severe knee osteoarthritis may require a Total Knee Replacement Surgery whereas that young athlete with chondromalacia patellae may improve with rest and an appropriate physical therapy programme.
I would recommend that you consult your Family Physician for a comprehensive assessment to determine the underlying cause of your symptoms.
Posted by B********
What supplements should an elderly take to prevent hip fractures and osteoporosis Is it safe for elderly person to go for massages if he has pain in leg when he walks Is infrared massage good for leg pain thanks!
Answered by Dr Xu :
Dear B********,
Having sufficient calcium intake is a good way to minimise the risk of getting hip fractures and osteoporosis. An elderly can increase his or her daily calcium intake from natural sources, including milk and tofu. Supplements such as calcium and vitamin D tablets are useful to make sure that the elderly receive their recommended daily allowance of calcium and vitamin to keep their bones healthy.
Women at 65 years old should go for a Bone Mineral Density (BMD) scan to screen for osteoporosis. Women below 65 years old who are concerned about osteoporosis should see their Family Physicians for further assessment.
The elderly patient with pain in his leg should see his Family Physician for a thorough evaluation before he proceed with massages. There are many causes of leg pain, including Deep Vein Thrombosis, that need to be addressed first. Doing massage in a leg with deep vein thrombosis is not recommended!
Posted by J******
Hi Dr Xu Bangyu,
Elderly people have a lot of falls, myself included. Could you advise what exercises we can do so as to maintain a good balance and avoid having falls. Also, does diet play a role please?
Answered by Dr Xu :
Dear J******,
Tai Chi has been proven to be effective as a fall prevention intervention in the elderly. There are also simple exercises that the elderly can do at home to improve their balance.
We need a healthy and well-balanced diet to maintain good general health. For elderly who are frail, I would advise them to visit their Family Physician who can take a comprehensive diet history and prescribe appropriate nutritional supplements if necessary, to tackle problems such as malnutrition and muscle wasting.
Posted by S****
Hi Doc,
Lately I have been having hip bone pain, affecting my walking and also after sitting on the sofa in same position and the pain came back. Went to do an X-ray and report was sign of osteo. Poly doc referred me to SGH orthopaedic for appt in Jul, said may need MRI scan? Nothing serious from X-ray results. I don’t know how to relieve the pain other than using the patch but it’s bone pain not muscle so not sure the patch helps.
Answered by Dr Xu :
Dear S****,
I am sorry to hear that your pain is not well controlled with your current medication. If the pain is seriously affecting your daily wellbeing, I would suggest for you to see your Family Physician to address the issue.
Posted by J*****
Dear Dr Xu
I have been diagnosed with Osteoporosis last week.
Lumbar spine -2.3
Femoral neck -3.4
Hip -2.6
How serious is my condition?
I have to take Al Endronate from now onwards.
What steps can I take to prevent my condition from deteriorating?
Thank you
Answered by Dr Xu :
Dear J*****,
To have a more accurate understanding of your condition, I would recommend you to visit your Family Physician to have your personal Fracture Risk Assessment Tool (FRAX) score calculated. This FRAX score would indicate your 10-year osteoporosis-related and hip fracture risk.
You can prevent your condition from deteriorating by having a healthy lifestyle with regular exercise and a balanced diet with sufficient calcium intake for bone health.
Exercising regularly maintains muscle strength, and improve coordination and balance. This will help to minimise falls. If you exercise during the day, a good exposure to sunlight also provides a natural source of vitamin D.
Lastly, taking your medication as prescribed by the doctor and going for medical follow-ups are also important to ensure that your osteoporosis is well taken care of.
Posted by H**
Why do I wake up with a slight backache but goes away after a while?
Answered by Dr Xu :
Dear H**,
Back pain is a very common complaint among elderly. In majority of the cases, the cause of the back pain is benign and the pain is often self-limited. However, there is a small group of patients whose back pain has a more serious underlying cause, E.g. slipped disc. In an even smaller number of cases, the back pain can be caused by life-threatening diseases, E.g. cancer affecting the back bone.
A comprehensive history and physical examination can identify the small percentage of patients with serious conditions that require further evaluation. I would advise you to consult your Family Physician for your backache.
Posted by n******
Hi,
My mum is diagnosed with Osteoporosis and had been asked to start Prolia injection after she developed allergic reactions to 2 oral medications prescribed.
The doctor told me that she has to be injected twice yearly, for life. And the worrying thing is that the doctor says that if she were to stop injection in any point of time in her life, her osteoporosis condition will become worse off than even before any injection. Is that true?
And, what are the side effects or considerations of the injection?
I hope you can help me to answer these questions. Thank you.
Answered by Dr Xu :
Dear N******,
I am glad to hear that your mother is receiving treatment for her osteoporosis.
The Prolia injection she is receiving every 6 months has been proven in studies to be effective in treating osteoporosis. Basically, when a patient continues to receive Prolia injections, the bones become stronger and are eventually no longer osteoporotic.
However, if the injections stop, the bones may start to regress, get weaker and eventually become osteoporotic again.
Some side effects of Prolia injections include post-injection low serum calcium level, osteonecrosis of the jaw, atypical fractures and skin problems.
Post-injection low serum calcium levels are often seen in patients who have moderate to severe kidney problems or vitamin D deficiency. However, this side effect is countered by making sure that patients who receive Prolia injections are taking calcium and vitamin D supplements regularly before and after the injections. The other reported side effects are very uncommon.
Posted by S*******
Dear Dr Xu
I am on CAVIT- d3 calcium tables once a day - is this sufficient as I have slight osteporosis.
I was advised to take Binosto 70 mg to help absorb the calcium but am afraid that I may have problems with my jaw jones if I visit the dentist for implants in future. Kindly advise. Thank you.
Answered by Dr Xu :
Dear S******,
One tablet of Cavit-D3 contains only 500mg of calcium and 133 IU of cholecalciferol. The Recommended Dietary Allowance for adults age 19-50 years old is 800mg daily and 1000mg daily for those age ≥ 51 years old. I would recommend that you take 2 tablets daily.
You should inform your dentist that you are taking Binosto for your osteoporosis, in addition to regular visits in order to ensure good dental health!
Posted by D*****
Hi Dr Xu
My mum always complains that her hip pain, we would like to know why that causes, is it lack of calcium?
Answered by Dr Xu :
Dear D*****,
Hip pain is a common condition that can affect patients of all ages and can occur because of many reasons. Generally, hip pain can be localised to 3 regions: anterior, posterior and lateral hip.
Anterior hip pain, sometimes felt in the groin, is commonly associated with conditions such as osteoarthritis and hip labral tears.
Posterior hip pain, usually felt in the buttock, is associated with conditions that may not be directly related to the hip joint but are caused by other issues such as muscle or nerve problems.
Lateral hip pain may be due to problems with soft tissues surrounding the hip joint.
Of course, not to forget, patients with osteoporosis may feel pain because of a hip fracture
This usually happens after a fall.
I would recommend your mum to take note of where her hip pain is occurring at and consult her Family Physician to determine the cause of her persistent hip pain.
Posted by B****
I have been diagnosed as having osteopenia in my spine and have been prescribed 1000 mg of calcium per day. I eat a lot of leafy vegetables on a daily basis to boost my calcium level. Is 1000 mg calcium too high and will it lead to calcification?
Is there any difference between calcium citrate and calcium carbonate or other forms of calcium?
Answered by Dr Xu :
Dear B****,
The recommended dietary allowance for calcium intake varies according to our age.
From your description, your daily calcium intake is appropriate and it will not lead to calcification. However, do note that ingestion of an extremely large amount of calcium and absorbable alkali can result in Milk-Alkali Syndrome, which can lead to metastatic calcification and kidney failure.
Calcium carbonate has a higher amount of calcium per tablet as compared to calcium citrate. Calcium carbonate needs to be taken with food because it requires the stomach acid to dissolve and absorb the calcium. Calcium citrate is well absorbed and can be taken on an empty stomach.
Posted by S*
Hi,
My issues :
-
I have aches in my fingers n cannot open bottles properly or press things example paper clips and to release clips for clothes hangers.
-
I have stiff fingers - went to physiotherapist and she suggested finger exercises.
-
Pain around pelvic bones/joints. Few years ago told my GP who sent me for scan for osteoporosis. Nothing wrong but at my age - female, 64 years - susceptible to bone loss. So what is the pain then? Feeling of pulsing comes on and off.
My GP said I don’t have rheumatoid arthritis as I have my regular tests for that. My skins on both palm is darker in skin tone now.
Answered by Dr Xu :
Dear S*
From your description of pulsing feeling that comes on and off, you may be suffering from a nerve problem at the lower spine. Also, the symptoms that you experience in your hands seem to suggest a similar nerve problem but at the upper spine region.
For a more accurate and comprehensive assessment, I would recommend that you consult your Family Physician.
Posted by j*********
Hi Dr Xu,
This question is in realtion to an answer that was given another participant on this forum.
Can deep vein thrombosis be reversed naturually and if so, how? What are the normal medical treatments for thrombosis?
Is eggshell powder good for treatment of osteoporosis?
Answered by Dr Xu :
Dear j*********,
Deep vein thrombosis does not reverse naturally. Treatment is recommended as untreated deep vein thrombosis can lead to pulmonary embolism, which can be life-threatening.
Anticoagulation, in the form of injection or oral medication, is the most common treatment for patients with deep vein thrombosis. Patients need to be evaluated carefully before starting on anticoagulation because it is associated with an increased risk of bleeding. The duration for taking anticoagulation is dependent on several factors, such as presence or absence of provoking events, risk factors for bleeding and patient's preferences, concerns and expectations.
There is no strong evidence to recommend eggshell powder for treatment of osteoporosis.
Posted by S******
Hi Dr Xu
How are you? Thanks for answering our questions.
I am a 57-year-old local Chinese woman. I have fallen a few times for the past 2 years. Is this a sign of osteoporosis? My knees are weak although I have been doing physiotherapies. Should I climb stairs often? My bruises heal very slowly.
Thank you.
Answered by Dr Xu :
Dear S******,
It seems like you may have recurrent falls, which are not a sign of osteoporosis.
There can be multiple reasons causing you to have recurrent falls and for your bruises to heal slowly. I would recommend that you consult your Family Physician for a comprehensive assessment and also to screen for osteoporosis. If you have undiagnosed osteoporosis, you are at risk of getting a fracture with each fall.
I am glad to hear that you are doing physiotherapy! These sessions will definitely be helpful in improving your strength. Climbing stairs also help and I would advise that you discuss with your physiotherapist about a suitable training programme.
Posted by J*********
Why do hip fractures cause death in elderly?
Answered by Dr Xu :
Hi J*********,
Death in elderly from hip fractures can have many causes, mainly due to complications like infections or immobility, or from pre-existing health problems like sub-optimal control of chronic diseases.
Studies have shown that there are certain factors that may increase the risk of death following a hip fracture. Some of these are non-modifiable (E.g. older age, male gender, type of hip fracture) while some are modifiable (E.g. decision to not go for surgery).
Posted by G*****
Hi Dr Xu,
I'm 43 years old woman, married with kids. I would like to know is it necessary to take calcium supplements if someone like me hardly consume any dairy foods?
I'm diagnosed with a rare skin condition called Osteoma Cutis. My calcium level is within acceptable range when my dermatologist did a test for me, however the causes for this skin disease is unknown. Since then, I dare not take any dairy products and calcium supplements anymore but I'm concerned I may get osteoporosis in my later life.
Can you advise what is the preventive measures for osteoporosis?
Thanks.
Answered by Dr Xu :
Dear G*****
The recommended dietary allowance for calcium intake for adults age 19-50 years old is 800mg daily. Besides dairy food, other sources of calcium include green leafy vegetables, tofu and soya beans.
For patients with osteoma cutis, dietary alteration may have minor benefits. Restricting calcium intake is usually recommended when there is high blood level of calcium. Because your calcium level is within the acceptable range, I would not recommend that you restrict your dietary intake of calcium. Nevertheless, please share your concerns with your Dermatologist.
I would also encourage you to lead a healthy lifestyle with regular exercise and a well-balanced healthy diet with adequate calcium intake.
About Dr Xu Bangyu
Dr Xu Bangyu is an Associate Consultant with the Department of Post-Acute and Continuing Care (PACC) at Sengkang Community Hospital (SKCH), which is under SingHealth Community Hospitals (SCH). He has a special interest in patients with complex care needs.
Dr Xu graduated from the Yong Loo Lin School of Medicine, NUS in 2006 and completed his Fellowship Training in Family Medicine in 2018. He is the Clinical Core Faculty Member for SingHealth Family Medicine Residency and the Educational Lead for SKCH, as well as the clinical champion for osteoporosis and orthopaedics-community hospital collaborative and bundled care.
In his current role at SKCH, Dr Xu delivers person-centred care to patients with complex care needs and works with community partners to bridge the care of patients transiting from the hospital back to the community.
* SKCH comes under SingHealth Community Hospitals (SCH), which is a member of the SingHealth group.
Ref: M19
