If you’re in your 30s or 40s, you probably think the chances of breaking your bones are low because osteoporosis only comes later in life, when you’re starting to become incontinent and frail with age.
And the good news – for you at least – is that you’re right.
According to Dr Chionh Siok Bee, senior consultant with National University Hospital's Division of Endocrinology, the risks pick up for those in their 50s – a one-in-three lifetime risk of a fragility fracture for women, and one in five for men.
The bad news? You’re not immune to osteoporosis. “We are seeing younger patients with osteoporosis due to a generally more sedentary lifestyle and higher frequency of partially lifestyle-linked diseases like diabetes, breast cancer and other cancers," said Dr Chionh, who’s also president of the Osteoporosis Society (Singapore).
She added that younger men and women may also have brittle bones if they have rheumatoid arthritis or hyperthyroidism. "Some common medications, such as the anti-gastric omeprazole, can also contribute to bone loss."
Roughly beyond the age of 30, bone mass gradually decreases.
What’s even more worrying is that many people aren’t even aware they may have it – because there are no symptoms until one actually sustains a fracture, said Dr Ramesh Subramaniam, an orthopaedic surgeon at Mount Elizabeth Hospital.
So when should one start to think about osteoporosis and bone health? The sooner, the better.
According to Dr Subramaniam, your body reaches peak bone mass – the maximum amount of bone you’ll have in your lifetime – in your early 20s if you’re female, and late 20s if you’re male. “After that, or roughly beyond the age of 30, bone mass gradually decreases,” he said.
Dr Chionh added: “If there is inadequate exercise or a period of immobility caused by illness, substantial amounts of bone can be lost. If there is a gross inadequate intake or absorption of calcium, the body will actually take calcium out from the bones to keep the blood calcium level normal." Calcium in the blood is necessary for our well-being and also helps with functions such as clotting.
We are seeing younger patients with osteoporosis due to a generally more sedentary lifestyle and higher frequency of partially lifestyle-linked diseases like diabetes, breast cancer and other cancers.
If there’s at least one thing many of us know about osteoporosis, it’s that one’s calcium intake is very important. The catch is that some of our everyday activities have an effect on the amount of calcium in our body, which might make you prone to osteoporosis later on. Are you guilty of these scenarios?
- YOU ACCOMPANY EACH MEAL WITH A SOFT DRINK
They’re not only sugar bombs, drinking a lot of soft drinks has also been attributed to lower bone mineral density at the hip joint in some studies, pointed out Dr Subramaniam. The bone-robbing factor is phosphorus, which is found in high amounts in some soft drinks. “This leads to an imbalance between phosphorus and calcium levels in the body. Many cola beverages also contain caffeine, which is known to contribute to increased calcium excretion.”
Furthermore, studies on fluid consumption trends have found that you’re less likely to drink milk if you drink soft drinks – provided you’re not avoiding milk because you are lactose intolerant.
- YOU DRINK ALCOHOL – SOMETIMES A LITTLE TOO MUCH
Alcohol interferes with your body's absorption of calcium and the action of Vitamin D, said Dr Chionh. "It’s a toxic substance that kills osteoblasts (bone formation cells). It also damages the nerves that control balance and prevents a person from falling. It disrupts hormones, particularly oestrogen, that control bone health, too."
Not only that, Dr Subramaniam said that women with "chronic alcohol intake can trigger irregular menstrual cycles, a factor that reduces oestrogen levels and increases the risk for osteoporosis". Men who drink excessively may produce less testosterone, a hormone linked to the production of osteoblasts.
So, how much alcohol is too much? For the sake of your bone health, keep it to not more than 2 units of alcohol per day for an adult male, said Dr Subramaniam. One unit of alcohol translates to a half pint of beer, one standard pour of hard liquor, or half a glass of wine.
- YOU REALLY LIKE SALTY FOOD
You love to give your sashimi a good dunking in soya sauce. You won’t say no to bacon or a cold cut platter. And you sure won’t turn down a supper of Teochew porridge and its accompanying dishes of salted and preserved food.
But you might want to hold back. “Sodium directly or indirectly influences renal re-absorption of calcium, and results in increased calcium excretion,” said Dr Subramaniam. “This is correlated with the mobilisation of calcium stores from the bones.”
It is recommended not to exceed sodium intake of 2.3g per day, which is about one teaspoon of salt. “The American Heart Association is moving towards recommending an ideal limit of 1.5g per day,” said Dr Subramaniam.
- YOU'RE A SMOKER
Nicotine and other toxic substances in cigarettes can damage bones in many ways, said Dr Subramaniam. Among them, smoking can reduce the blood supply to bones, slow the production of osteoblasts, decrease the absorption of calcium from your diet, and in women, break down bone-essential oestrogen in the body, he said.
This major risk factor of osteoporosis has no safe minimum, said Dr Chionh. "It is estimated that smoking contributes to one eighth of all hip fractures."
- YOU’RE STRESSED
Cortisol, the hormone produced by your body when you’re stressed, is known to decrease bone formation and increase bone breakdown. When you’re rushing to finish a report at work, for instance, your body’s hypothalamic-pituitary-adrenal (HPA) axis and the sympathomedullary (SAM) pathways are activated by cortisol.
“In chronic stress, the HPA-axis becomes dysregulated and results in suppressing the secretion of gonadal hormones and growth hormones,” said Dr Subramaniam. This increases inflammation levels in the body, which inhibit bone formation and eventually lead to bone loss.
If you're interested to find out more about osteoporosis, click here for the list of events organised by Osteoporosis Society (Singapore) in October and November.