Bone Alliance Featured in the Singapore Straits Times

ACCESS Health Southeast Asia has been working closely with partners in Singapore to drive a new bone health initiative, Bone Alliance Singapore, to improve awareness and to build new partnerships, ecosystems, and communities of practice for better bone health. The Bone Alliance was recently featured in the Singaporean newspaper the Straits Times. The article below originally appeared in a December 2019 issue of the paper and is available online here.

Fighting against fractures

A new group, Bone Alliance Singapore, aims to raise awareness of the potentially serious consequences of osteoporosis

By Timothy Goh

Fractures due to osteoporosis have an incidence rate eight times higher than that of breast cancer here and often result in high treatment costs and serious consequences – in some cases, even death.

But although there are medicines that can reduce fracture risks by 30 to 70 per cent, many patients and doctors here are not aware of the threat that osteoporosis poses, said Dr. Chionh Siok Bee, president of Osteoperosis Society Singapore. Osteoporosis, which means “porous bone”, is a bone condition characterised by low bone mass or decreased bone strength.

Calling the current general sentiment towards osteoporosis “laid-back”, Dr Chionh said: “It’s like the attitude towards diabetes 10 to 15 years ago, that it affects only old people who aren’t working. Then, people realised diabetes was occurring in younger and younger people be- fore we finally had a war on diabetes.

“We don’t want an epidemic of fractures before we start doing more for public awareness and prevention of fractures.” Citing a local study which found that 27 per cent of those with hip fractures died within a year, she said: “If they’re fit for an operation, they may have to undergo general anaesthesia to get their hip fixed and may suffer a heart attack or stroke as they’re usually older people.
“If they’re not fit for operation and remain lying in bed or a wheel- chair, the chances of them getting pneumonia, bed sores, or clots in the veins are very high.”

A 2012 study found that Singapore had the highest hip fracture incidence rate among independent Asian countries. Although this has declined in recent years, the absolute number of patients with such injuries is likely to increase, given the republic’s ageing population, said Dr Chionh.

Warning Signs

There are two ways to diagnose osteoporosis in a person. The first is if he gets a fracture during an activity that would not normally injure young and healthy bones, such as a fall from a standing height or less. Fractures in smaller bones such as the fingers, neck and toes are typically not considered for such a diagnosis, said Dr Chionh. Second, a bone mineral density test, called DXA, can be carried out using a special machine.

There are also two screening methods to tell whether one should go for a bone mineral density test or if one is at higher risk of fractures.

Asian women who have reached menopause can assess their risk of osteoporosis using their age and weight.
“If your age in years minus your weight in kilograms is more than 20, the chance of you having osteoporosis and it being detected by a bone density test is quite high. You should go for bone density screening,” said Dr Chionh.

People can also assess their risk of getting a fracture using an online tool known as Frax.

Some people may be more genetically predisposed to the condition, but there are other risk factors as well, said Dr Chionh.
These include smoking and drink- ing, as the chemicals in cigarettes and alcohol act negatively on bone formation cells in the body.
“If we break a bone, these cells will start to put new bone in. If you disrupt this process, you’re going to get into trouble,” she said.
She highlighted that the Health Promotion Board has recommended that men consume no more than two alcoholic drinks a day and for women, no more than one.

Certain diseases, including rheumatoid arthritis and diabetes, also put one at a higher risk of developing osteoporosis, as does having a low muscle mass.

In particular, those with diabetes are thought to be more susceptible because their condition affects the blood supply to their bones and the strength of their bones.

Anyone who has a height loss of 3 to 4cm from their peak adult height taken in one’s 20s is also highly likely to have osteoporosis.
Dr Chionh said that it is good to spot osteoporosis early as the cost and risks associated with treatment rise as one ages.
However, misconceptions about treatment are prevalent.

“Some patients say ‘I’m so old already, why should I take medicine? I can die any time’, but within one year of treatment, the risk is already greatly reduced,” said Dr Chionh.

Some patients are also reluctant to take their medication after get- ting their broken bones fixed as they no longer feel pain.
“They don’t realise that the chance of them breaking another bone is very high,” she said.

Reducing One’s Risk

Dr Chionh said that a person’s bone mass typically reaches its peak between his mid-20s and early 30s. If one’s peak bone mass is low, one could break a bone at an earlier age compared with one’s peers. In order to reach their maximum potential peak bone mass, people should engage in physical activity, get judicious exposure to sunlight in order to obtain vitamin D necessary for calcium absorption and bone crystal formation, and consume more calcium-rich foods. Such measures are most effective before one hits his peak bone mass, but it is important to continue them throughout one’s life, said Dr Chionh.

“Even after you hit peak bone mass, if you keep active, your rate of decline will be less steep.” However, she noted: “A lot of children are not going out to play in the sun, they’re not drinking milk any- more, they’re drinking sodas. Hopefully this will change.”

Alliance Fights Back

Helping raise awareness and dispel myths surrounding osteoporosis here is a new group, known as the Bone Alliance Singapore.
The Alliance, formed in May, consists of six organisations: Osteoporosis Society Singapore, the Lee Kuan Yew School of Public Policy, AMKFSC Community Services, Society for Wings, AccessHealth Inter- national Southeast Asia and Amgen Biotechnology Singapore.

Its official members include three doctors: consultant orthopaedic and hand surgeon at Mount Elizabeth Hospital Kanwaljit Soin, consultant rheumatologist in the Division of Rheumatology at the University Medicine Cluster of the National University Hospital Lau Tang Ching, and director of the Osteoporosis and Bone Metabolism Unit at Singapore General Hospital’s Department of Endocrinology Manju Chandran.

The Alliance intends to train 300 to 400 ambassadors to help spread the awareness of osteoporosis in the community and apply for Skills- Future funding to train doctors and nurses to engage patients and assess them for fall risks.

It will also conduct a study in partnership with the Lee Kuan Yew School of Public Policy to find out the attitude of the public towards osteoporosis and why many do not place importance on the condition.

Dr Chionh said: “We want to preserve their bone health and mobility throughout life. We don’t want people to break bones and go into a downward spiral.”