The International Osteoporosis Foundation held its Sixth Asia-Pacific Osteoporosis Meeting November 4 – 6 2016 in Singapore.
What Therapy was invited to attend a private presentation by Dr Lau Tang Ching (Singapore), Professor Peter Ebeling (Australia), and Dr Ambrish Mithal (India) on osteoporosis in Singapore and the region, including recent advances in medicine. The aim of their work is to promote greater awareness and and to advocate the implementation of additional and more integrated healthcare programs.
Osteoporosis is a condition in which bone density is lost over time, rendering the bone more brittle and prone to breakage. Fractures are most known in the hips and can happen in other areas such as the spine, ribs, and wrists. This is a concern as urbanization has led to decreased physical activity which is correlated with a higher incidence and an aging population who may be more subject to falls and osteoporosis. It can lead to a loss of independence and mobility which has emotional and mental health dimensions that can reduce the quality of life. The panel shared some statistics, pointing to the seriousness of this condition, as well as how common it is.
According to these experts, Singapore is taking a lead in several aspects. An example of this is OPTIMAL which stands for Osteoporosis Patient Targeted and Integrated Management for Active Living. This Fracture Liaison Services is a care program created in 2008 that is now available in all restructured public hospitals for those above age 50 with more than one fracture. The aim is to reduce the incidence of secondary fractures through education on diet and exercise. The effectiveness of this program was studied and published in 2013 (Secondary Prevention of Osteoporotic Fractures – an “OPTIMAL” model of care from Singapore).
In Singapore Medisave can now be used for osteoporosis under the category of chronic disease, including tests. Dr Lau would like to see more integrated and bundled healthcare programs as well as more awareness campaigns.
Osteoporosis is called a “silent disease” as it is unclear someone has it until a fracture occurs. Professor Mithal reminded the participants that it starts in the womb; osteoporosis is a “paediatric disease, with a geriatric manifestation.” He suggests that kids start to build a “bone bank” with optimal nutrition, exercise/movement such as Tai Chi and yoga, sufficient Vitamin D (supplementation and sunlight) as well as calcium, and good lifestyle choices such as no smoking, minimal alcohol consumption. He noted that the lowest levels of Vitamin D intake in the world are found in Asia. For those who traditionally live near the equator, being out in the sun with skin exposed for 15 minutes at noon is safe and a good way for the body to manufacture Vitamin D, which is necessary for calcium absorption. Professor Ebeling further suggests progressive resistance exercise. While walking is overall good for health, exercises such as climbing stairs, skipping, dancing, and weight-lifting are better for building muscle tone and muscle mass. With good fitness and stronger muscles, bone is better protected in case of falls.
While many people associate osteoporosis with women, approximately 30% of men in some countries and 45% in Singapore have been diagnosed. The mortality rate in the first year after a fracture, according to these experts, is also higher in men. Some causes include infection and cardiovascular disease.
Immobility unmasks all the other issues.
According to Professor Ebeling, the two approaches are to stop the breakdown of bone mass and to build new bone. Previously the focus was on the first with hormone replacement and the current research has shifted to developing targeted biological agents to build new bone, for example.
Maximum bone mass gain occurs in the teenage years and while genetics can play a role, Professor Ebeling reminds us that we can always improve what we’ve got by making healthy choices as suggested above.
The takeaway? Choose a holistic approach with good nutrition (sufficient protein, Vitamin D, and calcium), activity/movement/exercise, and a healthy lifestyle. It is about better health in all aspects.
Dr Lau Tang Ching is a consultant Rheumatologist, President of the Osteoporosis Society (Singapore) and the Vice-Chairman of the National Arthritis Foundation (Singapore). He is helping to coordinate OPTIMAL.
Professor Peter Ebeling is a board member of the International Osteoporosis Foundation, Australia, medical Director of Osteoporosis Australia, and head of the Department of Medicine, School of Clinical Sciences at Monash Health, Faculty of Medicine, Nursing, and Health Sciences. He has published hundreds of peer-reviewed publications and mentors medical students.
Dr Ambrish Mithal is an endocrinologist, diabetologist, and Chairman and Head of Endocrinology and Diabetes division of vedanta, the Medicity, a specialty hospital in Haryana, India. He has received multiple awards and recognition in India and overseas.