Understanding Osteoporosis: Causes, Risk Factors, and Treatment Options

Understanding Osteoporosis: Causes, Risk Factors, and Treatment Options

Understanding Osteoporosis: Causes, Risk Factors, and Treatment Options

02 June 2023  | Article is written by Dr Gregory Low Jia Hao (Medical Officer, BP Healthcare Johor)

(Image credit: Jcomp/Freepik)

What Is Osteoporosis

Osteoporosis is a condition characterized by weakened bones and reduced bone density, leading to an increased risk of fractures. Bone density is defined as bone mass composition, whereas bone quality consists of architecture, turnover, degree of damage and mineralisation rate.

As the population increases and life expectancy rises, this silent threat to bone health is becoming a growing public health concern in Malaysia. Malaysia has a growing number of elderly individuals. Osteoporosis-related fractures is a major health problem among the elderly.

In 1997, the incidence of hip fracture among Malaysians aged 50 years and above was 90 per 100,000, and the number is growing annually. Morbidity and mortality rate of up to 20% within the first year among those who suffered a hip fracture. Osteoporosis leads to increased risk of fractures, hence increased morbidity and mortality rates, leading to reduced life expectancy and quality of life. Not taking into account cost of hospitalisation, rehabilitation and long-term nursing care.

Incidence by age group (per 100,000)
Age Group Male Female Overall
50-54 10 10 10
55-59 20 30 20
60-64 40 50 40
65-69 60 100 80
70-74 100 230 170
75 320 640 510

Osteoporosis classified into 2 types:

1) Primary osteoporosis
This type of osteoporosis occurs among women after menopause due to decreasing estrogen level. Estrogen is important in maintaining bone level density with its reduction leading to bone loss.

This type of osteoporosis occurs among women after menopause due to decreasing estrogen level. Estrogen is important in maintaining bone level density with its reduction leading to bone loss.

This type is common among elderly men and women. Advanced age leads to bone mass reduction, increasing the risk of fracture and other types of bone injury.

2) Secondary osteoporosis
Secondary osteoporosis is a type of osteoporosis that is caused by an underlying medical condition, medication, or lifestyle factor. It is not primarily caused by the aging process.

  • Cushing’s Syndrome
  • Hypogonadism
  • Thyrotoxicosis
  • Primary hyperthyroidism
  • Type 2 diabetes mellitus
  • Glucocorticoids
  • Heparin
  • Anticonvulsants
  • Immunosuppresants
  • Thiazolidinediones
  • Treatment in oncology
Chronic diseases
  • Chronic kidney disease
  • Chronic liver disease
  • Chronic inflammatory polyarthropathies (rheumatoid artritis, systemic lupus erythematosus)
  • Neurological diseases (stroke, Parkinson’s disease)
  • Nutritional deficiency
  • Malabsorption syndrome
  • Inflammatory bowel disease
  • Post-gastrectomy/gastric bypass surgical procedures
  • Multiple myeloma and malignancy
  • Osteogenesis imperfecta
Risk Factors

Osteoporosis is influenced by a combination of modifiable and non-modifiable risk factors. The non modifiable risk factors are those that cannot be changed while modifiable risk factors are those that can be changed or controlled. Here is an overview of both types of risk factors:

Non modifiable Modifiable
  • Advanced age
  • Ethnicity (Oriental and Caucasian)
  • Female gender
  • Premature menopause ( less than 45 years) including surgical menopause
  • Family history of osteoporotic hip fracture among immediate families
  • Personal history of fractures as an adult
  • Low calcium and/or vitamin D intake
  • Sedentary lifestyle
  • Cigarette smoking
  • Excessive alcohol intake (>3 units/day)
  • Excessive caffeine intake (>3 drinks/day)
  • Low body weight (body mass index <19 kg/m2)
  • Estrogen deficiency

Diagnosis and Screening of Osteoporosis

Osteoporosis can be diagnosed by measuring bone mineral density (BMD). The most common diagnostic tools and devices for measuring BMD includes:

1) Dual Energy X-ray Absorptiometry (DEXA)

This non-invasive technique measures bone mineral density (BMD) at specific sites, usually the hip and spine. DEXA scan is simple, quick, emits low radiation levels and is affordable.

2) Quantitative Ultrasound Calcaneum

This technique uses sound waves to measure bone density at peripheral skeletal sites, such as the heel or shin. This scan does not involve any radiation, portable, simple to use and low cost.

What To Do If I Have Osteoporosis?

Seek consultation and continued care from medical doctors. There are various treatment choices available, including bisphosphonates, denosumab, teriparatide, activated vitamin D, and raloxifene.

Non pharmaceutical ways of reversing osteoporosis

1)  Dietary and supplementation: Ensure a balanced diet that includes sufficient calcium and vitamin D, which are essential for bone health

2) Exercise

How Calcium and Vitamin D Help Improve Bone Health

Calcium is the major component of the bone and provides the skeleton strength and structure. Sufficient calcium intake throughout life is crucial for optimizing bone density and reducing the risk of osteoporosis.

The principal function of vitamin D is to increase calcium absorption from the intestine. It is also produced in the skin when exposed to sunlight.

Both calcium and vitamin D work synergistically to support bone health. Adequate intake of both nutrients through diet, sunlight exposure, and supplementation if needed, helps maintain strong and healthy bones throughout life.

How Can BP Healthcare Help You In Preventing Osteoporosis?

BP Healthcare has a diverse team of healthcare professionals, including physicians, pharmacists, and physiotherapists, who collaborate to support the screening, diagnosis, and preventive efforts related to osteoporosis.

Our health screening packages provide a multitude of tests which include blood tests (to screen for risk factors such as kidney, liver and thyroid disease, as well as for nutrient deficiencies such as Vitamin D levels).

Our centers also provide the screening tools to assess BMD such as DEXA scan and QUS scans in which the test results will be interpreted and explained by our team of doctors. Moreover, the doctors will also provide consultation on how to maintain bone health.

Specialist Head2Toe Health Screening

Assessment and risks of disease progression will be done by doctors who will then recommend the best course of management for each patient. Our supplement lines also consist of Calciluv as well as Vitamin D supplements which come in two types (2000iu/capsule and 25000iu/capsule) which will be recommended according to individual vitamin D levels.

BP Healthcare’s team of physiotherapists are also well-qualified to provide physical assessment and to recommend a suitable individualised training program.