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長者常見骨折及其護理 骨質疏鬆治療的最新發展

What is Osteoporosis?

Osteoporosis is a bone disease which is asymptomatic at first but may lead to an increased risk of fracture. The bone mineral density (BMD) is reduced and bone microarchitecture is disrupted in osteoporosis.

In Hong Kong, along with aging of our population, osteoporosis is becoming a social burden. According to recent research data, more than 30% of female Hong Kong citizens that is above the age of 50 are suffering from the disease. Above the age of 70, the chance increase to more than 40%.

Osteoporosis by itself may not cause any trouble but its main complication, i.e. fracture will. Among all the osteoporotic fractures, fracture hip is the most serious to have. About 10% of patients with fracture hip will die within 1 year after the fracture.

Prevention is by far the most effective way to treat osteoporosis. A health life style, which included intake of enough calcium and protein, adequate amount of exercise and avoid alcohol, is mandatory.

Bone density checking is now safely and accurately (and pain free) performed by DEXA (Dual energy X-ray absorptiometry). It can guide the doctor in selecting treatment methods for osteoporosis.

Prevention, diagnosis and treatment
The prevention of osteoporosis depends very much on one's general lifestyle. Regular and frequent exercise is recommended and is helpful at all ages. Attention must be paid to an adequate amount of calcium and protein intake. One should also avoid smoking and excessive alcohol intake.

Osteoporosis is diagnosed by measuring the bone mineral density. The most standard method is dual energy x-rays absorptiometry (DEXA). This method is highly advantageous as it is accurate, non-invasive, pain free and with very few radiation risk.

The aim of osteoporosis treatment is to prevent fracture. The following medication might be used.

Bisphosphonates help slowing down the natural bone resorption, thus maintaining bone density and strength. It is now available in a once weekly or even 3-monthly preparation.

Estrogen is essential to female bone health because it promotes the activity of osteoblasts, which are cells that produce bone. During and after menopause, a woman's body slowly produces less of the estrogen and progesterone hormones, which in turns affects the bone density. For those taking estrogen replacement medication, one advantage is the slowing down of body bone mass loss.

Selective estrogen receptor modulator (SERM)
SERM is indicated for the prevention and treatment of osteoporosis in postmenopausal women. It mimics estrogen's bone retaining effects to prevent bone loss.  With bone density increased, fractures are less likely to happen. Moreover, SERM can also lower the risk of breast cancer.

Calcitonin can be given by injection or more commonly by nasal spray For those with fractures due to osteoporosis, Calcitonin can also relieve pain.

Recombinant Parathyroid hormone (PTH)
Recombinant PTH is administered through injections. It stimulates bone formation. However, it should not be used by patients with cancer or Paget's Disease.

** A doctor should be consulted for recommended medication.

Misconception 1
Osteoporosis is associated with bone pain and joint pain.

Correct Concept:
There is no significant bone pain even in severe osteoporosis, unless fracture occurs. In elderly female, both osteoporosis (a bone problem) and osteoarthritis (a joint problem, and thus causing joint pain) are common, and therefore are easily confused with each other. However, the two conditions need to be differentiate as each has its own treatment.

Misconception 2
Osteoporosis can be diagnosed using plain Xrays

Correct Concept:
Unless it reaches the very late stage of osteoporosis, the affected bone can appear perfectly normal on plain Xrays. The world wide standard of diagnosing osteoporosis is DEXA (Dual energy X-ray absorptiometry) which is both accurate and safe and involves very low dose of radiation, and it is generally recommended for menopause females.

Misconception 3
Osteoporosis only affects elderly female

Correct Concept:
Mostly osteoporosis affects elderly lady but it can affects female and male of all age, e.g. those with chronic illness like rheumatoid arthritis or chronic renal failure.

Misconception 4
Osteoporosis can be successfully treated by calcium alone

Correct Concept:
Treatment of osteoporosis involves adequate calcium absorption and measures to prevent bone loss. Oral in take of adequate calcium is of course important but it cannot guarantee enough absorption. We now know that adequate in take of Vitamin D, exposing the skin to appropriate amount of sunlight, and exercise are essential to improve calcium absorption. There are also drugs to reduce bone loss e.g. bisphosphonates

Related Prosthetic & Orthotic Services
Since osteoporosis weakens the strength of spinal vertebral, there is a high risk of compression fracture of spine. Spinal support can be used to provide extra protection to the weakened spine without affecting one's appearance.