SUNDAY STAR, 20 OCTOBER 2019
WORLD OSTEOPOROSIS DAY
AS Malaysia has a growing ageing
population, osteoporosis is
recognised as a major health issue.
If you think you’re in the clear, you
may want to think again.
“Malaysians are at a higher risk of
developing osteoporosis because of
our median weight,” shares Dr
Ainon Mohd Mokhtar, consultant
physician and rheumatologist at
Ara Damansara Medical Centre.
Osteoporosis, known as a silent
disease, is a condition where bones
become weak because of a
decrease in bone density. They may
fracture or break easily from a fall
or low-impact injury.
What are the risk factors?
Some of the factors that
generally increase the risk of
developing osteoporosis are:
l If you are a woman who has
experienced menopause, you are
at a greater risk of developing
osteoporosis compared with men
l Low body weight
l Family history of osteoporosis
l Smoking
l Steroid usage (especially in
high doses over a prolonged
period), including prescription
steroids and traditional medicines
containing steroids
However, these are not the only
factors. “Osteoporosis can also
occur in premenopausal women
because of certain endocrine,
neurological, haematological and
rheumatological diseases, as well
as cancer,” says Dr Ainon.
What are the signs?
Osteoporosis generally tends to
be asymptomatic. However, here
are some clues you can look out
for:
No one is safe from bone loss
ACCORDING to the International
Osteoporosis Foundation, one in
three women and one in five men
get osteoporosis in their lifetimes.
Dr Yeap Swan Sim, consultant
rheumatologist and physician at
Subang Jaya Medical Centre
explains that women are more
prone to osteoporosis because
once they hit menopause,
production of oestrogen, which
prevents bone loss and thus
osteoporosis, reduces significantly,
causing bone density loss at a
faster rate than normal.
On the other hand, men have
higher levels of testosterone. Dr
Yeap says, “Testosterone helps the
body build bone, so in general,
men have higher bone density
than women. Besides that, men do
not go through menopause and
therefore do not experience a
dramatic dip in testosterone levels
as they get older.”
Less likely, but not
impossible
Men can still get osteoporosis
even though their risk is lower. Dr
Yeap observes that some men are
in denial when diagnosed with
osteoporosis, as they think it is
something that only affects
women.
Be informed, stay healthy
Dr Ainon Mohd Mokhtar.
l Fractures – Even though
fractures can happen at any time,
pay close attention to those that
occur in the spine, wrist and hip
without much impact
l Dowager’s hump – Usually
occurs because of a microfracture
of the spine, which causes a
reduction in height
l Back pains – Can occur when
osteoporosis has begun to affect
the spine
How is it diagnosed and
treated?
Dr Ainon says, “The gold
standard of diagnosis is by using
the DEXA scan, which measures
the bones’ mineral density. And
osteoporosis diagnosis is only
formed when the bone density is
below -2.5. An X-ray can also be
done to look for complication of
osteoporosis, such as fracture.”
Dr Yeap Swan Sim.
Osteoporosis occurs similarly
in men, displaying no initial
symptoms when their bones start
to thin, and are usually diagnosed
when they experience a low-
trauma fracture (fracture from
falling at standing height or lower).
Dr Yeap notes that men usually
show osteoporosis symptoms from
the age of 70, but various causes
can lead to it manifesting earlier.
For example, medications such as
steroids and testosterone blockers
can increase the risk of
osteoporosis. Excessive alcohol can
be detrimental to the bones as
well.
Osteoporosis can gradually interfere with your daily activities without you even realising it, till one day you find
you cannot climb stairs without experiencing pain.
Upon diagnosis, medication can
be taken either orally or through
injection to improve bone density,
with the aim of preventing
fractures. Medicine such as
bisphosphonates or hormone
therapy are available for women
who experienced early menopause
or other types of treatment for
osteoporosis.
How can it be prevented?
With age, you will naturally
experience bone loss.
“Take care of your bone health
Upping your chances for
healthy bones
Dr Yeap describes the process of
bone health throughout a person’s
lifetime. “Your bones grow as you
age. Maximum bone growth
occurs during your teenage years,
and it will peak when you are
around 30 to 35 years old.”
Unfortunately, she says, after
reaching peak bone mass, there
will be gradual loss of bone. Thus,
it is crucial to maximise peak
bone mass and reduce age-related
bone loss to increase your
chances of preventing
osteoporosis later in life.
“If you have higher peak bone
mass, the chances of you reaching
the danger zone of low bone
mass/high fracture risk with age-
related bone loss will be lower
compared to those starting with a
lower peak bone mass,” she
explains.
To ensure higher bone mass, Dr
Yeap recommends adequate
exercise and sufficient calcium
and vitamin D intake. If you are
taking medication with side
effects that may increase your risk
of developing osteoporosis, ask
your doctor for alternatives or
ways to reduce your risk.
Smoking and drinking alcohol
should be avoided as well.
during your teenage years. To
maintain peak bone mass, you
should take enough dietary
calcium and vitamin D, and
exercise to strengthen your bones
and muscles,” says Dr Ainon.
Doctors should be aware of the
potential risk of osteoporosis if
they prescribe steroids for more
than six months. If steroid usage is
required for a longer period, your
doctor should advise you to
take vitamin D and calcium
supplements to help prevent
bone loss.
Osteopenia is a condition where
Manageable with long-
term treatment
As with many diseases, there is
no cure for osteoporosis, but
there are effective treatments
available. Dr Yeap refutes the
misconception that once you are
diagnosed with osteoporosis, you
only need to take calcium
supplements and change your
lifestyle. These are only
preventative methods and you
need medication to treat your
osteoporosis. Even so, your bones
will never recover their original
strength and mass.
Should you go for osteoporosis screening?
Osteoporosis is definitely a
threat to all ageing men and
women. Dr Yeap Swan Sim,
consultant rheumatologist and
physician at Subang Jaya Medical
Centre, encourages those with an
increased risk of osteoporosis to
undergo bone density
measurement.
“There is no point in waiting
until a fracture happens to finally
get yourself checked for
osteoporosis,” she says.
The Malaysian Osteoporosis
Society advises all men above 70
bone loss occurs, but not at levels
as severe as with osteoporosis.
Precaution and treatment with
medication is sometimes necessary
to prevent further bone loss.
Osteoporosis is a disease that, if
not treated, can lead to immobility.
It is estimated that one in every
three women and one in every
five men will have an
osteoporosis-related fracture.
Don’t let osteoporosis creep up on
you.
n For more information, call
03-5639 1212.
She says, “Most people would
have lost 30% of their bone mass
by the time they are diagnosed.
Taking medication can restore
bone mass, but bone density
increments are modest. At best,
there will be a 10% increase after
three years of treatment.”
Hence, it is crucial for men to
be aware that they too can
develop osteoporosis, and
everyone should start taking steps
to raise or maintain their bone
mass as much as possible.
n For more information, call
03-5639 1212.
to get their bone density
measured. In addition, if you have
the risk factors listed below, you
should visit a doctor to check your
bone health and bone density.
l Intake of steroids
l Intake of testosterone
blockers
l Rheumatoid arthritis
l Family history of osteoporosis
l Regular alcohol consumption
(a few drinks a day)
l Smoking
l Immobility or lack of physical
activity
2 World Osteoporosis Day
For joint health
A HEALTHY, active lifestyle is the
goal of many modern consumers.
Essential to achieving this are
strong bones and joints.
As you grow older, age-related
stiffness and discomfort in the
joints become a fact of life.
Activities once routine become a
challenge as limited mobility
hampers your every move. To
protect your joints, practise healthy
lifestyle habits. Use your joints the
right way.
These tips can help you have
healthier joints now and for years
to come.
l Lose weight (if you need to) –
One of the kindest things you can
do for your joints is not to carry too
much body weight.
l Stay active – Regular exercise
helps your joints work like they
should, eases stiffness, relieves
fatigue and strengthens the
muscles that support your joints.
l Practise good posture –
Proper posture protects your
shoulder, hip and knee joints.
l Eat for joint health – Choose
a diet with calcium content,
omega-3, type 2 collagen peptides
or hyaluronic acid to protect your
joints. Opceden Fortigen is
formulated with type II collagen
peptides, hyaluronic acid and
vitamin C to keep people physically
active and mobile.
What is type II collagen?
Cartilage is composed of a
variety of biomolecules including
proteins, water and small
molecules that help reduce friction
and keep joints healthy. One of
those proteins is collagen, which
makes up the bulk of the cartilage
in your joints.
Type II collagen is the basis for
cartilage. Type II collagen forms
fibrils. This fibrillary network of
collagen allows cartilage to entrap
the proteoglycan aggregate as well
as provide tensile strength to the
tissue.
Opceden Fortigen uses German
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peptides. It has a small molecular
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In a healthy joint, a thick
substance called synovial fluid
provides lubrication, allowing
bones to glide across one another.
The critical substance in synovial
fluid known as hyaluronic acid
breaks down, and loss of
hyaluronic acid appears to
contribute to joint pain and
stiffness. It is a substance that is
naturally present in the human
body and found in the
highest
concentrations
in fluids in the
eyes and joints.
Hyaluronic
acid works by
acting as a
cushion and
lubricant in the
joints and other
tissues. In
addition, it
might affect the
way the body
responds to injury.
Vitamin C is a water-
soluble vitamin, meaning it
is not stored in your body and you
must consume adequate amounts
from your diet throughout the day.
Vitamin C is required as a cofactor
in a number of biochemical
reactions and it is also an
important antioxidant.
Vitamin C is required for the
proper development and functions
of many parts of the body, such as
helping to boost the immune
system, and may also help in
building collagen.
Opceden Fortigen is specially
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KKLIU No.0320/2017
MAL 15065001NC
Silent, deadly disease
OUR bones become thinner and
lose some strength as we grow
older. Osteoporosis, a disease in
which bones grow fragile,
exacerbates the problem. In most
instances, it goes unnoticed for
many years as there are no
symptoms or pain. People often
learn they have osteoporosis only
when they seek treatment for a
suspected fracture.
Vertebral or spinal fracture is the
most prevalent indicator of
osteoporosis. It happens to between
30 and 50% of people with
osteoporosis over 50. According to
International Osteoporosis
Foundation (IOF), it is estimated
that a new vertebral fracture occurs
every 22 seconds worldwide. While
there are no available statistics in
Malaysia regarding vertebral
fractures, it is estimated that at least
700,000 vertebral fractures occur
each year in the United States
alone.
Strong predictor of
fracture risk
Vertebral fractures because of
osteoporosis are a strong predictor
of further fracture risk and cause a
significant increase in morbidity
and mortality. In fact, all
osteoporotic fractures increase
SUNDAY STAR, 20 OCTOBER 2019
patient disability, with fractures of
the hip and vertebrae associated
with increased mortality in both
men and women. A single vertebral
fracture can lead to a progressive
loss of height, increased kyphosis
(stoop), severe and chronic back
pain, reduced mobility and reduced
pulmonary function.
At the same time, the
psychological impact of vertebral
fractures because of osteoporosis is
profound. Loss of mobility, pain and
noticeable spinal deformity often
leads to depression, fear of falling
and social isolation.
Vertebral fractures because of
osteoporosis are linked to problems
in many daily activities, including
forward bending, getting up from a
chair, getting dressed and climbing
steps. They lead to a slower pace,
use of walking aids and less control
– all of which have a serious
adverse effect on their quality of
life.
People with vertebral fractures
are at increased risk of death
compared to people of similar age
with no vertebral fractures. In
comparison with females with five
years of survival after a vertebral
fracture, the enhanced risk of death
is 72% higher in males and 84% in
females.
> TURN TO PAGE 4
SUNDAY STAR, 20 OCTOBER 2019 3
4 World Osteoporosis Day
The right protein type
for muscle and bone health
PROTEIN is built from building blocks called
amino acids. Quality protein contains all 20
amino acids, including the nine essential
amino acids our body cannot produce and
must obtain from dietary sources.
High consumption of animal protein could
result in many adverse health effects such as
osteoporosis and long-term risk of developing
diabetes, according to a 2012 study titled
Macronutrient intake and risk of urothelial
cell carcinoma in the European prospective
investigation into cancer and nutrition
published in International Journal of Cancer.
A recent study done in Singapore revealed
that poultry, fish and shellfish as main
sources of dietary protein led to an increased
risk of gout, while plant-based protein
reduced the risk, as found in a 2006 study
titled The underappreciated role of muscle in
health and disease published in The American
Journal of Clinical Nutrition.
Animal protein contains higher amounts of
acid-based amino acids that can cause
greater loss of calcium through urine and
their weakening effect on the bones,
according to a 2011 study titled Dietary
protein and skeletal health: a review of recent
human research published in Current Opinion
in Lipidology and a 2007 study titled Effects of
protein on the calcium economy published in
International Congress Series.
Plant protein, on the other hand, can
provide all the essential amino acids
packaged with plenty of fibre when
consumed in the right combination such as
from non-genetically modified soy and pea. A
2006 study titled The underappreciated role of
muscle in health and disease published in The
Biogrow HPF-5 PLUS is an improved formula with a blend of plant protein and digestive fibre.
American Journal of Clinical Nutrition
showed that people who meet their daily
protein requirements maintained bone
health better than those eating less than the
recommended levels.
Calcium is a key nutrient for bone tissues,
as it constitutes a great part of them.
However, supplementation with calcium
alone is not enough to maintain optimal
bone density.
A combination of calcium with other
nutrients such as magnesium, vitamin D3
Vital to be on the lookout
> FROM PAGE 2
Vertebral fractures typically appear earlier
than hip fractures in life and can, therefore,
be significant early signs of bad skeletal
health. Vertebral fractures because of
osteoporosis are strong predictors of future
spine and hip fractures, so exact diagnosis
and clear reporting of these fractures is vital,
yet only one-third of vertebral fractures
come to clinical attention.
Furthermore, there is substantial evidence
that vertebral fractures are under-reported,
and even when they are reported,
appropriate intervention is often not
initiated.
Studies show that vertebral fractures are
often misdiagnosed and only about 30% of
vertebral fractures come to medical
attention. Approximately 84% of the time,
during a routine examination of back pain,
vertebral fractures are detected.
There are several reasons why so many
vertebral fractures do not come to medical
attention:
l Spinal or vertebral fractures do not
SUNDAY STAR, 20 OCTOBER 2019
and vitamin K2 significantly improved bone
health, as magnesium and vitamin D3
facilitate the absorption and utilisation of
calcium while vitamin K2 helps improve
bone density by effectively depositing
calcium in bones and teeth for proper
storage, according to a 2017 study titled The
Synergistic Interplay between Vitamins D and
K for Bone and Cardiovascular Health: A
Narrative Review published in International
Journal of Endocrinology.
Hence, they all work synergistically with
one another for effective calcium utilisation
and metabolism.
According to the European Food Safety
Authority, vitamin K2 (menaquinone, MK-7)
is a highly bioavailable form of vitamin K
that helps maintain healthy bones.
Biogrow HPF-5 PLUS is an improved
formula with a blend of plant protein and
digestive fibre, enhanced with nutrients for
bone health such as calcium, magnesium,
vitamin D3 and vitamin K2. Biogrow HPF-5
PLUS provides more than just protein and it
is suitable for all ages.
It contains no lactose, cholesterol or added
sugar, and is low in saturated fats. Take one
scoop of Biogrow HPF-5 PLUS (≈16g) daily for
plant protein, calcium, magnesium, vitamin
D3 and vitamin K2 for the development of
stronger bones and muscles and body
strength.
This article is provided by Legosan
(Malaysia) Sdn Bhd.
n For more information, call 03-7956 2220 or
email info@biogrow.com.my
require emergency treatment in general,
unlike hip and other osteoporotic fractures
l The patient may suspect the sudden
backaches to be arthritis, muscle strain or
any other causes
l A physician does not recognise that
height loss, back pain and an increased stoop
as signs that a fracture has occurred
l Vertebral fractures are not on the radar
of the patient or physician even after doing
X-rays as it is often not visible
l Some vertebral fractures are of slow
onset and difficult to detect
Only one-fifth of patients identified with
vertebral fractures receive appropriate
treatment for osteoporosis despite the fact
that evidence-based guidelines for
osteoporosis have been published in most
countries. This clearly highlights the need for
continuing education of both healthcare
professionals and patients.
If your parents ever complain about
sudden backaches or extreme pain, it is best
to bring them in for a medical checkup
immediately.