Osteoporosis

How common is Osteoporosis in Singapore?

In Singapore, osteoporosis is a growing health concern, especially with the ageing population. In fact, 1 in 3 women, and 1 in 5 men over the age of 50 are at risk of developing an osteoporotic fracture in their lifetime.

Hip fractures, in particular, have increased significantly in recent decades. What is even more concerning is that Singapore has one of the highest hip fracture rates in Asia, with projections indicating a continued rise unless preventive measures are taken.

What causes Osteoporosis?

As the bone is a living tissue, it constantly undergoes renewal. When the rate of the bone breakdown exceeds new bone formation, bone mass decreases. Over time, this imbalance leads to osteoporosis.

Be that as it may, some additional common causes, and contributing factors include:

• Ageing – natural bone loss accelerates with age.

• Hormonal changes – oestrogen deficiency in postmenopausal women, and low testosterone in men can accelerate in bone loss.

• Medical conditions – such as chronic kidney disease (CKD), thyroid disorders or rheumatoid arthritis.

• Medications – long-term use of corticosteroids, proton pump inhibitors or certain cancer treatments.

• Sedentary lifestyle – lack of weight-bearing exercise weakens the bones.

• Smoking and alcohol intake – these habits impair bone metabolism.

• Vitamin D or calcium deficiency – inadequate intake or absorption affects bone health.

What are the symptoms of Osteoporosis?

Osteoporosis is often asymptomatic in its early stages. As such, many individuals remain unaware of their condition until a fracture occurs.

However, as the disease progresses, symptoms may include:

• Loss of height over time – a gradual decrease in height may indicate compression fractures in the spine caused by weakened bones.

• Persistent back pain due to spinal fractures – chronic or recurring back pain can result from tiny fractures in the vertebrae, often caused by osteoporosis.

• Stooped or hunched posture (kyphosis) – a forward-curved spine, commonly seen in older adults with osteoporosis, caused by collapsed or weakened vertebrae.

• Sudden fractures from minor falls or routine activities – fragile bones can break easily during simple actions such as bending, lifting or minor slips, and trips.

Who is at risk of Osteoporosis in Singapore?

There are several risk factors that contribute to osteoporosis, many of which are prevalent in Singapore’s ageing, and urban population.

These risk factors include:

• Age – as we age, bone renewal slows down. After 50 years old, bone breakdown begins to outpace bone formation, making bones progressively thinner, and more fragile.

• Female – women are at greater risk due to lower bone mass, hormonal changes. After menopause, a sharp drop in oestrogen accelerates bone loss, increasing risk of osteoporosis, and fractures.

• Family history – genetics play a significant role. If an individual’s parents or siblings have osteoporosis or experienced hip or spine fractures, then they may inherit a tendency for low bone density.

• Lifestyle – physical activity, especially weight-bearing exercises like walking or resistance training, stimulates bone growth. Lack of movement leads to reduced bone strength, and faster bone loss.

• Medication – long-term use of steroids, anti-seizure drugs or certain cancer treatments can reduce bone density by disrupting calcium balance or affecting hormone levels.

• Nutrition deficiencies – calcium is a key building block or bone, and vitamin D helps the body absorb calcium effectively. Inadequate intake or poor absorption weakens bone structure over time.

• Previous fractures – a history of fragility fractures, even from minor accidents, suggests underlying bone weakness, and a higher risk of future breaks.

• Smoking and alcohol consumption – smoking interferes with bone-forming cells, and reduces oestrogen levels. Additionally, excessive alcohol disrupts calcium balance, and impairs vitamin D production, weakening the bones.

• Weight – low body weight means less bone mass. In addition, people with low body mass index (BMI) may have nutritional deficiencies, and less cushioning to protect bones during falls.

Can Osteoporosis be prevented?

Fortunately, osteoporosis is largely preventable through lifestyle changes, and early intervention. The key step is building strong bones during youth, and maintaining bone health throughout your life.

As such, some of the preventive strategies include:

• Adequate calcium and vitamin D intake – this can be achieved through diet, and, if necessary, supplements.

• Avoiding smoking and limiting alcohol intake – this will help to maintain bone metabolism.

• Bone health screening – routine screening ensures you regain autonomy over your bone health, especially for individuals with risk factors.

• Maintaining a healthy weight – to help reduce unnecessary stress, and pressure on the bones.

• Regular weight-bearing exercises – such as brisk walking, dancing or resistance training to help strengthen the bone.

How is Osteoporosis diagnosed?

Osteoporosis is diagnosed using a bone mineral density (BMD) scan, typically performed with a dual-energy X-ray absorptiometry (DEXA) scan. This test measures the density of bones, usually at the hip, and spine. The scan then generates a T-score, which compares your bone density to that of a healthy young adult of the same gender. It helps determine whether your bones are normal, weakened or osteoporotic.

Generally, the results are as follows:

T-SCORE	WHAT IT MEANS	EXPLANATION
≥ -1.0	Normal bone density.	Your bones are within the healthy range, with low risk of fracture.
Between -1.0 to -2.5	Low bone mass (osteopenia).	Bone density is below normal, and may lead to osteoporosis if not managed.
≤ -2.5	Osteoporosis.	Bone density is significantly reduced, increasing the risk of fractures.

Beyond the bone mineral density (BMD) scan, our endocrinologist may recommend further investigations to gain a more comprehensive understanding of your bone health, and the underlying cause of osteoporosis. These tests help rule out other medical conditions, identify risk factors, and guide treatment decisions.

Some of the additional tests may include:

TEST	PURPOSE	DESCRIPTION
Blood Test	To rule our secondary osteoporosis causes.	Certain health conditions, and deficiencies can lead to secondary osteoporosis, where bone loss is the result of another underlying disorder. Blood tests may be performed to check levels of:Calcium.Kidney and Liver function.Markers of bone turnover.Parathyroid Hormone (PTH).Phosphate.Thyroid Function.Vitamin D. These tests help identify treatable causes, such as hormonal imbalances, nutritional deficiencies or chronic illnesses.
FRAX Tool	To assess fracture risk.	The FRAX tool is a widely used online calculator developed by the World Health Organization (WHO). It estimates an individual’s 10-year risk of developing a major osteoporotic fracture, based on the following factors:Age.BMI.Gender.Family history of fractures.History of previous fractures.Smoking and alcohol consumption.Use of corticosteroids.
X-Rays	To detect spinal fractures.	X-rays of the spine may be taken if you have symptoms like persistent back pain, height loss or stooped pressure. These images help identify vertebral compression fractures, which are common in osteoporosis but may go undiagnosed due to their subtle symptoms.

How is Osteoporosis treated?

Treatment for osteoporosis focuses on reducing fracture risk, slowing bone loss, and strengthening existing bone. 

Lifestyle and Nutritional Support

• Diet rich in calcium and vitamin D – supports strong bones, and helps prevent further bone loss. Calcium is essential for bone structure, while vitamin D helps the body absorb calcium effectively.
• Safe, regular physical activity – weight-bearing, and resistance exercises help maintain bone density, and improve muscle strength, balance, and coordination, thereby reducing the risk of falls, and fractures.
• Smoking cessation and alcohol moderation – smoking, and excessive alcohol weaken bones, and interferes with calcium absorption. Stopping smoking, and limiting alcohol can help slow bone loss.

Medications

• Bisphosphonates – these medications slow down bone breakdown, helping to maintain or increase bone density, and reduce fracture risk.
• Biologic therapy – a monoclonal antibody given by injection every 6 months. It helps slow down bone loss, and is useful for people who cannot take oral bisphosphonates.
• Selective oestrogen receptor modulators (SERMs) – these drugs mimic oestrogen’s bone-protective effects, helping to reduce bone loss in postmenopausal women.
• Parathyroid hormone analogues – these stimulate the body to build new bone, and are often used in severe cases or when other treatments have not worked.
• Hormone replacement therapy (HRT) – for selected postmenopausal women, HRT can help maintain bone density by replacing declining oestrogen levels.

Monitoring and Follow-up

• Regular BMD scans – BMD scans are usually done every 1 to 2 years to track changes in bone density, and assess treatment effectiveness.
• Blood tests – blood tests are done to monitor calcium, vitamin D levels, and bone turnover markers to guide, and adjust treatment.
• Ongoing assessment – regular review of fall risk, lifestyle factors, and potential medication side effects helps optimise long-term bone health.

Summary

Osteoporosis is a serious but manageable condition. With early detection, and tailored treatment, it is possible to reduce fracture risk, and maintain an active, independent lifestyle. At The Metabolic Clinic, we offer specialised endocrine care for osteoporosis, using evidence-based strategies to protect and strengthen your bones.

If you are concerned about your bone health or have experienced fractures, schedule a consultation today for a detailed assessment and personalised care plan.

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