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Osteoporosis and Calcium Disorders

​Osteoporosis is a condition of low bone mass. ​Calcium disorders ​​can include hypercalcaemia and hypocalacemia.​

 
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About Osteoporosis

Osteoporosis is a condition of low bone mass, or wh​en the quality or structure of the bone changes, resulting in weak and brittle bones. Bone affected by osteoporosis is more fragile and is more likely to fracture spontaneously or with minor trauma such as with minor falls (from standing height or less, which would not normally break healthy bone), or normal stresses such as bending, lifting or even coughing.

Osteoporosis-related fractures often occur in the hip, spine or wrist.
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Osteoporosis is common in Singapore, and the risk increases with age. Women after the age of menopause are more likely to develop osteoporosis. A number of other risk factors are also associated with developing osteoporosis, such as
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  • Smoking
  • Heavy alcohol intake
  • Insufficient sunlight exposure or vitamin D
  • Poor mobility and sedentary lifestyle
  • Malnutrition and anorexia
  • Family history
  • Certain medical conditions, such as overactive thyroid, parathyroid or adrenal glands, chronic ​inflammation, early menopause, etc.
  • Certain medications, such as hormone treatment for breast or prostate cancer, anti-epilepsy drugs, proton pump inhibitors, steroids, etc.​

Osteoporosis is usually a “silent” disease which causes no symptoms or pain, until the weakened bones result in a painful fracture. Sometimes, osteoporosis is incidentally discovered on bone mineral density scan.

Preventing fractures is important because fractures are not only painful, but importantly, they can lead to other medical problems that take away your mobility and independence.

Treatment for osteoporosis may include exercise, calcium and vitamin D replacement, and medications. Interventions aimed at fall prevention, weight-bearing and resistance exercises are all important, as well as maintaining other aspects of a healthy lifestyle such as smoking cessation and drinking less alcohol.

Vitamin D helps your body absorb the calcium in your diet. Apart from taking supplements and foods rich in calcium and vitamin D, your skin can also make vitamin D when exposed to sunlight. 

Foods rich in calcium include:
  • Dairy products such as milk, yoghurt, cheese
  • Green leafy vegetables such as kale, okra, chye sim, broccoli, kailan
  • Soy products e.g. Soya drinks with added calcium, tau kwa, silken tofu
  • Enriched bread
  • Fish where you eat the bones such as sardines and ikan billis

Foods rich in vitamin D include:
  • Oily fish such as salmon, tuna, cod fish, sardines and mackerel
  • Egg yolks

Your doctor will discuss the best options of medications to be prescribed for you. Some examples of common medications prescribed include:

  • Bisphosphonates: These drugs work by slowing down bone loss, which can reduce the risk of fractures.
  • Selective estrogen receptor modulator (SERM): They have estrogen-like effects and can be used in post-menopausal women to improve bone density in the spine.
  • Hormone replacement therapy: Oestrogen and testosterone replacement can be given in certain groups of women and men who are deficient in these hormones respectively.
  • RANK ligand inhibitor: This drug is an injection into the skin, which slows down bone loss and reduces fracture risk.
  • ​Parathyroid hormone analogues: They are injections used for a short duration of time which have good effectiveness in building bone.

Healthcare providers who treat osteoporosis include:

• Primary care physicians, e.g. General Practitioners and Polyclinic doctors
• Endocrinologists
• Geriatricians
• Rheumatologists
• Orthopaedic doctors
• Gynaecologists
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About Calcium Disorders

Calcium disorders ​​can include:
• High blood calcium (hypercalcaemia) which is more common.
• Low blood calcium (hypocalacemia) which is less common​.

Hypercalcaemia is a condition where calcium level in your blood is above normal. Hypercalcaemia is usually a result of overactive parathyroid gland(s), but can also be due to many other reasons. Other causes of hypercalcaemia include dehydration, immobility, certain infectious, cancer, some medications, overdose of calcium and vitamin D supplements and other medical conditions.

Hyperparathyroidism refers to overactive parathyroid glands, which is the most common cause of hypercalcaemia. Usually, this results from a small benign tumour or enlargement or one or more of the four parathyroid glands. The parathyroid glands are 4 small structures that sit at the front of your neck, next to and separate from the thyroid gland.

Mild hypercalcaemia may not result in symptoms. More severe cases may cause symptoms such as:

• Excessive thirst and frequent urination
• Stomach discomfort, nausea, vomiting, constipation
• Bone pain
• Confusion, depression and tiredness
• Palpitations
Besides the symptoms listed above, hypercalcaemia can affect multiple organ systems in your body. For example, if due to overactive parathyroid glands, this can result in:

• Osteoporosis: An excess of parathyroid hormone causes calcium to leach from your bones into the blood, leading to the development of osteoporosis (thin bones). This could result in bone fractures.
• Kidney stones: High calcium in the urine may lead to crystal formation in your kidneys and urinary tract, that can result in stones. Passing stones can be very painful, and increase risk of a kidney infection.
• Kidney failure: Severe hypercalcaemia can cause dehydration and damage your kidneys, limiting their ability to clear fluids and waste products.
• Nervous system problems: Confusion, dementia, coma, seizure
• Abnormal heart rhythm
Treatment of hypercalcaemia varies according to the underlying cause. If due to overactive parathyroid glands (hypercalcaemia), treatment depends on the age of the patient, severity of hypercalcaemia and the development of associated conditions. 

Treatment may involve surgical removal of the parathyroid gland(s), medications to lower calcium levels or to treat osteoporosis, or simply observation if mild. Your doctor will advise on the best treatment plan for you considering your overall medical condition and preferences.​


Contributed by Endocrinology
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