OSTEOPOROSIS IN MALAYSIAOSTEOPOROSIS IN MALAYSIA

Wan Dalila Binti Wan Ishak

Siti Ijtima’yah Binti Kahalit

::introduction::::introduction:: Osteoporosis is a disease in which bones become fragile and

more likely to break. If not prevented or if left untreated, osteoporosis can progress painlessly until a bone breaks.

These broken bones, also known as fractures, occur typically in the hip, spine, and wrist.

Any bone can be affected, but of special concern are fractures of the hip and spine. A hip fracture almost always requires hospitalization and major surgery.

It can impair a person's ability to walk unassisted

may cause prolonged or permanent disability or even death.

Spinal or vertebral fractures also have serious consequences, including loss of height, severe back pain, and deformity

HIP

HIPS

SPINE

WRIST

Osteoporosis makes your bones weak and more likely to break.

Anyone can develop osteoporosis, but it is common in older women.

As many as half of all women and a quarter of men older

than 50 will break a bone due to osteoporosis

::what causes osteoporosis at the 1st place::

Bones are living tissues that must be constantly rebuilt via a two part process, by which both of osteoblast and osteclast function normally.

Osteoclasts and osteoblasts are activated by parathyroid hormone (PTH) which signals osteoclasts to pull calcium from the bones. Calcitonin is the hormone that stimulates osteoblasts to deposit calcium into the bones. The problems begin when the delicate balance between PTH and Calcitonin is disrupted.

::Who is at RisK ??::::Who is at RisK ??::

Risk factors you cannot change include:

Gender. Women get osteoporosis more often than men.

Age. The older you are, the greater your risk of osteoporosis.

Body size. Small, thin women are at greater risk.

Ethnicity. White and Asian women are at highest risk. Black and Hispanic women have a lower risk.

Family history. Osteoporosis tends to run in families. If a family member has osteoporosis or breaks a bone, there is a greater chance that you will too.

Other risk factors are: Sex hormones. Low estrogen levels due to missing menstrual periods or to

menopause can cause osteoporosis in women. Low testosterone levels can bring on osteoporosis in men. [During menopouse,bone loss can range from 4 to 8%]

Calcium and vitamin D intake. A diet low in calcium and vitamin D makes you more prone to bone loss. [In Malaysia most people hate drinking milk and hence increase their probability towards osteoporosis]

Medication use. Some medicines increase the risk of osteoporosis.

Too Much acidity in Food. As the blood must be a neutral pH, your body pulls calcium from the bones to neutralize the acidity. This is often the major factor in the development of osteoporosis

Activity level. Lack of exercise or long-term bed rest can cause weak bones.

Smoking. Cigarettes are bad for bones, heart, and lungs. Drinking alcohol. Too much alcohol can cause bone loss and

broken bones. Lack of magnesium may be the cause of osteoporosis.

Calcitonin relies on magnesium to function properly. When we lack magnesium, the balance between PTH and calcitonin tilts too far toward PTH. This results in excessive stimulation of osteoclasts, which causes net bone loss. Magnesium suppresses the hormone that tells your body to pull calcium from the bones, and stimulates the hormone

that tells the body to put calcium in your bones.

In Malaysia, it is estimated that over 1 million people

are at risk from osteoporosis, out of which

20% are men.  Reported by Arthritis Foundation ,Malaysia

::SyMPTOmpS::::SyMPTOmpS::

Osteoporosis is called the

"silent disease“ because bone is lost with no signs.

You may not know that you have osteoporosis until a strain, bump, or

fall causes a bone to break.

::DiagnosE::::DiagnosE::

A bone mineral density test (called a DXA) is the best way to check your bone health. This test can:

Diagnose osteoporosis

Check bone strength

See if treatments are making the bones stronger.

Bone densitometry

Bone Mass measurement

Spine X-ray

PREVENTIONPREVENTION1. Enough calcium intake daily; 800-1000 mg,

also other important nutrients; proteins, zinc, mg & vitamin D for healthy and strong bone

Vitamin D is important in absorption of Ca from food and incorporate it into bones

1 glass of high Ca milk = 500 mg Ca

2. Bone examination – free during World Osteoporosis Day – access risk of loss of mass of bone

3. Exercises but not excessive!!! (3-4 times a week) Exercise alters hormonal balances, favoring the

hormones that protects bone So, walk rather than ride, climb the stairs rather than using lift, stand rather than sit when appropriate :P

4. Campaign to increase awareness among the civilians regarding osteoporosis.

4. Importance of good posture Proper way to sit - Support your lower back

with a pillow or by a straight high-backed chair. When driving or reading, avoid bending the neck forward. When rising from a chair, do it slowly.

Proper way to walk and stand - Keep your head high, look forward with the chin in. Pull your shoulders back, pull your stomach in to maintain the natural arch of the lower back, and tighten your buttocks.

Wear low-heeled shoes with rubber soles

Proper way to lift - You must bend your knees when lifting heavy objects to avoid backstrain

and further compression fractures. Use your Leg muscles rather than your back!

5. Avoid taking too much coffee, tea or chocolate, because they help in loss of Ca.

6. High protein will reduce the ability of Ca resorption.

7. Alcohol destroys cells forming bone.

8. Smoking reduces estrogen It is important to remember that we

cannot avoid hormonal and genetic factor thus, we control the environment and diet factor, so that we can overcome the osteoporosis problem.

TREATMENTTREATMENT1. Calcium and vitamin D intake – reduce fractures

by maintaining BMD (bone mineral density) Vitamin D is necessary for our body to absorb

calcium optimum intake combination of dietary Ca

source and Ca in pills form

2. Physical activity – essential for bone growth and maintenance - improves muscle strength and

balance, thus, decrease the risk of fracture and falls

3. Bisphosphontes - a type of medication known as antiresporptive medications, taken orally or in injectable form - prevent bone loss by inhibiting

the normal function of cells called osteoclasts. These are the cells responsible for removing old bone.

- Side effects of bisphosphonates include muscle and joint pain, nausea, and heartburn

- common bisphosphontes ; fosamax, reclast, boniva

4. Calcitonin - is naturally made in your body

when blood calcium levels are high. Thus, retains calcium within the skeleton, rather than replenish the calcium in the bloodstream.

- administered by a nasal spray. - Side effects - runny nose, headaches and

nose bleeds.

5. Estrogen Treatment (ET) or Hormone Treatment (HT)

- effective treatments for preventing bone loss and reducing risk of fracture.

- Unfortunately, ET increased the risk of uterine cancer, therefore used in patients with prior hysterectomy (remove uterus)

- Concerns about increased risk of breast cancer, stroke, and blood clots have surrounded the use of these medications for osteoporosis. Therefore, the FDA recommends the use of ET/HT only if other medications cannot be used and there is a significant risk of osteoporosis.

STATISTICSSTATISTICS

Osteoporosis-related fractures have been recognized as a major health problem, particularly in the elderly. In 1997, the

incidence of hip fracture in Malaysia among individuals above 50 years of age was 90 per 100 000. Hip fractures are associated with a

high morbidity and mortality rate of up to 20% in the first year.

 The majority who survive are disabled and only 25% will resume normal activities. The direct hospitalization cost for hip fracture in 1997 is

estimated conservatively at RM 22 million.

ACKNOWLEDGEMENTACKNOWLEDGEMENT

1. http://www.cancersupportivecare.com/osteotherapy.html#exercise

2. http://drpakar.blogspot.com/2008/11/keperluan-kalsium-wanita.html

3. http://www.geocities.com/uitm_ot/osteoporosis.htm

4. http://www.msd-malaysia.com/content/corporate/disease/osteoporosis.html

5. http://orthopedics.about.com/od/osteoporosistreatment/p/medications.htm