Bone is a living tissue that is constantly being renewed. In normal bone, the rate of the breakdown of old bone is equal to the rate of the manufacture of new bone. Peak bone mass and density are attained when a person is between 20 and 30 years’ old.

With ageing and after menopause, the rate at which bone breaks down is greater than the rate at which new bone is manufactured. The bones become thinner and weaker.

Most cases of osteoporosis reveal themselves after fracture occurs with minor trauma. Recently, more cases are diagnosed through a simple screening procedure - the bone mineral density measurement. The fractures occur commonly at the hip, spine and wrist.

Hip fractures are perhaps the worst of these, as they result in a loss of independence, need a long period of rehabilitation and are associated with the complications of being bedridden for a long time. Possible complications include pneumonia, urinary tract infection, bed sores and deep vein thrombosis. On many occasions, these complications are fatal. 30% of patients die within a year after a hip fracture and only 20% manage to walk unaided after surgery. It is therefore important to prevent osteoporosis.

People who are more likely to have osteoporosis include those with a family history of the condition, women who menopause early, thin and small-built people, Asians and Caucasians, women whose calcium intake is low, those who are inactive/sedentary, and those who smoke or take steroids.

Osteoporosis is a silent condition, only becoming obvious when a fracture occurs. So measuring bone density is essential in the post-menopausal years, to detect osteoporosis early and monitor its progress. The density of bones is measured by scanning the hips and the spine with X-rays, or scanning the heel with ultrasound. The test is safe as the dose of X-rays is low. The results are given in T scores. T scores greater than -1 means your bone is normal; -1 to -2.5 shows your bone mass is low; anything less than -2.5 indicates osteoporosis. If you have a score lower than -2.5 and a fracture, you have severe osteoporosis.

To prevent osteoporosis, you need 1.2g of calcium a day. The best source of calcium is from food, such as bean curd, egg and milk. However, those who consume a lot of canned and fast foods should take a supplement that combines calcium with vitamin D. Without vitamin D, calcium in the gut cannot be absorbed.

Regular exercise helps to strengthen bones, while exposure to sunlight allows the skin to manufacture natural vitamin D. Smokers should give up smoking as it affects secretion of oestrogen by lowering the level of this hormone in the blood. Oestrogen is the hormone that retains calcium in bones. So a lower oestrogen level accelerates osteoporosis.

To treat osteoporosis and osteopenia, medications that can strengthen bones include female sex hormones, biphosphonates (Actonel and Fosamax), selective oestrogen receptor modulators (Evista) and Calcitonin. The newer medications include Protos and Forteo.

Hormonal therapy is indicated in patients with postmenopausal symptoms. However, this requires careful monitoring to detect abnormalities in the breast and uterus that could arise from such treatment.

Biphosphonates are inhibitors of bone resorption. They inhibit osteoclasts, which are the bone cells that remove bone. As food and drink may interfere with the absorption of biphosphonates, biphosphonates have to be taken when the person wakes up, waits 30 minutes before breakfast, or lies down again. These drugs are either taken once a day, once a week, or once a month. For intra-venous infusion, it is administrated into a vein of the hand once a year.

Evista is a selective oestrogen receptor modulator. It has an oestrogen-like effect on bone turnover, thus improving bone strength. It is given only to postmenopausal women. However, it cannot be given to those with a history of deep vein thrombosis. Tests have shown that four years on the medication can reduce the incidence of breast cancer by 62% to 72%. On top of that, it contributes to heart health as it decreases a person’s total and LDL cholesterol (the bad cholesterol), and reduces the risk of a heart attack and stroke by 40%.

Calcitonin sprays, administered into the nostrils, are used in cases of acute fractures to decrease bone pain. They inhibit bone resorption.

Forteo is a man-made form of hormone that stimulates bone formation and can improve the quality and quantity of the bone. It is injected underneath the skin once a day, at night.

Protos improves bone quality by stimulating bone turnover and formation, and improves the quantity of bone by inhibiting bone resorption. It is taken orally once a day, at night.

Long-term management of osteoporosis requires regular follow-ups. These are to ensure that the person is maintaining a healthy diet with calcium supplements, doing proper exercises and taking his medication regularly. It is also important to educate the person on how he can prevent falls.

Treatment of fracture in a patient with osteoporosis follows the principle of fracture management. After the fracture is treated, the patient will be given one or a combination of the bone strengthening medications.

In general, undisplaced hip fracture is treated with fixations using screws. The screws can be inserted using minimal invasive technique. Displaced hip fracture is treated with replacement of the head with metal prosthesis.

Compression fracture of the vertebral body is treated with a minimally invasive procedure called vertebroplasty. Bone cement is injected into the fracture site to fix the fracture.