THERE are many things that come with ageing, but it's wrong to assume osteoporosis is one of them or that the condition can't be addressed.
Osteoporosis is often described as a "silent disease" because it develops progressively, gradually weakening bones and often goes undiagnosed until a fracture happens.
Osteoporosis related fractures have been globally recognised as a major health problem among older persons and postmenopausal women, causing significant disability, reducing the quality of life, and can even lead to death in severe cases.
In the local context, less than 1 in 4 Malaysians who sustained a fracture were able to walk independently six months after discharge from a medical facility, while the remainder were immobile or required a walking aid.
The pandemic, which impacted all aspects of life, also took a toll on the bone health of Malaysians.
Being confined indoors for almost two years due to lockdowns and movement restrictions, led to long periods of sedentary behaviour and this, coupled with the lack of sun exposure which provides crucial vitamin D, had an impact on bone health.
Studies show that the global pandemic greatly affected the prevention and care of osteoporosis worldwide, with decreased bone mineral density (DXA) assessments, interruptions in medication supply, and disrupted treatments.
"Malaysians must be aware of bone health related post-pandemic issues that need to be addressed.
Reduced physical activity drastically increases the risk of falls and fractures, and reduced vitamin D levels due to the lack of sun exposure has a negative impact on bone health," says Fragility Fracture Network Malaysia president and consultant orthopaedic surgeon, Dr Lee Joon Kiong.
Increased social isolation during lockdowns may also have resulted in cognitive impairment among older persons leading to a lack of adherence to proper treatment or dietary care and engaging in activities that pose a greater risk for falls and fractures, adds Dr Lee.
FRACTURE BEGETS FRACTURE
A fragility fracture is a broken bone caused by a fall from a standing height or less and often affects the hip, spine or wrist.
It's estimated that 1 in 3 women and 1 in 5 men over the age of 50 are at risk of a fragility fracture and having one such fracture greatly increases the risk of a subsequent one within 1-2 years. The risk of a second fracture is up to 86 per cent.
Taking steps to prevent the next fracture is crucial and this includes a healthy and balanced diet with sufficient intake of calcium, protein and vitamin D and regular exercise that improves balance, posture, coordination, and muscle strength.
One must also be proactive about preventing falls, inside the home and out by fall-proofing one's environment.
There are also medications which can be prescribed to improve bone density.
Within the osteoporosis management landscape, it is reported that despite individuals being at heightened risk of osteoporotic fractures, only 12 per cent were on bone health optimising medications and less than 1 in 5 received surgery within the recommended 48-hour time frame from hospital admission owing to the lack of awareness about bone health management.
"Based on Malaysia's growing ageing population along with the highest projected number of hip fractures in Asia, this is expected to cost the country over MYR530 million for health-related services in 2050," says Malaysian Osteoporosis Society president and consultant endocrinologist, Professor Dr Chan Siew Pheng.
Prioritising bone health at the national level and implementing healthcare policies aimed at reducing the burden of osteoporosis is a strategic and systematic approach that will help minimise the negative impact on the population and healthcare system.
A subsequent osteoporotic fracture would not occur if the first fracture had been promptly and adequately treated. Notably in the post-pandemic setting, Malaysians must adopt a positive behavioural change in bone health management by seeking treatment upon a fracture.
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