Osteoporosis

Frontier Healthcare

Understanding Osteoporosis

Osteoporosis is a bone disease where bone density and mass decrease, or bone structure changes, making bones weaker and more likely to fracture. 1 With advancing age, the bone density normally decreases. However, in some people, it decreases faster. If bone density declines below a certain level, it is called osteoporosis. 2 Osteoporosis is the leading cause of fractures in postmenopausal women and older men. 1 Due to effective family planning policies since the 1960s, Singapore, a multi-ethnic country in Southeast Asia, has one of the fastest-ageing populations in Asia. 3 The proportion of citizens aged 65 and above increased from 9.9% in 2009 to 16.0% in 2019 and is projected to reach about 23.7% by 2030.4 In Singapore, the prevalence of osteoporosis ranges from 9.3% to 19.4% among postmenopausal women. The condition has a 0.7% prevalence among men aged 50 and older. 5,6 In a population-based Singaporean study in 2020, researchers found that the risk level for starting osteoporosis treatment rises with age, from a 2.96% chance of a major fracture at age 50 to 32% at age 90. They also noted that 7% of the 29,323 women had previously experienced a fragile bone fracture. 7

Key Risk Factors for Osteoporosis

Osteoporosis affects individuals of all races, genders, and ethnicities. Here are some important risk factors to consider: 1
PES-OP_Rec_v1.0_12Aug24-02

Recognising the Tell-Tale Signs of Osteoporosis

Osteoporosis is often called the “silent disease” because it typically has no obvious signs or symptoms. Symptoms usually appear only after a fracture. In severe cases, spontaneous fractures may occur. The most common fracture sites are: 1,2
PES-OP_Rec_v1.0_12Aug24-03

Diagnosis of Osteoporosis

The cornerstone of the diagnosis of osteporosis is the bone mineral density assessment (BMDA). 8,9
PES-OP_Rec_v1.0_12Aug24-04
Other methods that can help in the assessment of osteoporosis include: 8,9
PES-OP_Rec_v1.0_12Aug24_ (2)

Osteoporosis Self-assessment Tool for Asians 

The Osteoporosis Self-Assessment Tool for Asians (OSTA) score is designed to help identify women, especially postmenopausal women, at risk of osteoporosis. It serves as a simple and effective method to determine if further bone health evaluation is needed. OSTA is a self-assessment tool, so you can easily do this evaluation on your own. The OSTA score is calculated using just two factors—age and weight. The formula is provided below: 8,10
PES-OP_Rec_v1.0_12Aug24-06
BMD: Bone mineral density; DXA: Dual-energy X-Ray absorptiometry

Strategies for Osteoporosis Treatment

Treatment options for Osteoporosis include the following: 11
PES-OP_Rec_v1.0_12Aug24_

IV: Intravenous; RANKL: Receptor activator of nuclear factor kappa-B ligand; SERM: Selective oestrogen receptor modulator.

Ways to Prevent Osteoporosis

Your healthcare provider may suggest the following steps to prevent the development or further progression of osteoporosis: 1,2,8,9,11,12
PES-OP_Rec_v1.0_12Aug24-08
Early identification of individuals at high risk is key to fracture prevention. 8
References

1. Osteoporosis. National Institute of Arthritis and Musculoskeletal and Skin Diseases. Available at: https://www.niams.nih.gov/health-topics/osteoporosis. Accessed on: 14 May 2024.

2. Overview: Osteoporosis and bone fractures. In: InformedHealth.org [Internet]. Institute for Quality and Efficiency in Health Care (IQWiG). Available at: https://www.ncbi.nlm.nih.gov/books/NBK279529/. Accessed on: 15 May 2024.

3. Chan A. Singapore’s changing age structure: Issues and policy implications for the family and state. In: Tuljapurkar S, Pool I, Prachuabmoh V, (eds). Population, Resources and Development. International Studies in Population, vol 1. Springer. 2005, pp. 221–242.

4. Population in Brief 2019.pdf. Available at: https://www.strategygroup.gov.sg/files/media-centre/publications/population-in-brief-2019.pdf. Accessed on: 26 June 2024.

5. Chen KK, Wee S-L, Pang BWJ, et al. Bone mineral density reference values in Singaporean adults and comparisons for osteoporosis establishment: The Yishun Study. BMC Musculoskelet Disord. 2020;21:633.

6. Chandran M, Brind’Amour K, Fujiwara S, et al. Prevalence of osteoporosis and incidence of related fractures in developed economies in the Asia Pacific region: A systematic review. Osteoporos Int. 2023;34:1037–1053.

7. Kanis JA, Chandran M, Chionh SB, et al. Use of age-dependent FRAX-based intervention thresholds for Singapore. Arch Osteoporos. 2020;15:104.

8. Appropriate Care Guide. Osteoporosis: Identification and management in primary care. Available at: https://www.ace-hta.gov.sg/docs/default-source/acgs/osteoporosis—identification-and-management-in-primary-care-(nov-2018).pdf?sfvrsn=95758f4e_2. Accessed on: 15 May 2024.

9. Ministry of Health Singapore. Osteoporosis. Clinical Practice Guideline. Available at: https://www.moh.gov.sg/docs/librariesprovider4/guidelines/cpg_osteoporosis.pdf. Accessed on: 15 May 2024.

10. Muslim D, Mohd E, Sallehudin A, et al. Performance of Osteoporosis Self-assessment Tool for Asian (OSTA) for primary osteoporosis in post-menopausal Malay women. Malays Orthop J. 2012;6(1):35–39.

11. Supplementary-guide-on-available-treatment-options-(nov-2018). Available at: https://www.ace-hta.gov.sg/docs/default-source/acgs/supplementary-guide-on-available-treatment-options-(nov-2018)ecd01456d0bc4c3581d805b12a46c143.pdf?sfvrsn=396c5820_0. Accessed on: 8 July 2024.

12. Porter JL, Varacallo M. Osteoporosis. In: StatPearls. Treasure Island (FL): StatPearls Publishing. Available at: http://www.ncbi.nlm.nih.gov/books/NBK441901/. Accessed on: 14 May 2024.