The Silent Killer: Osteoporosis

Osteoporosis is the second most prevalent global disease, second only to cardiovascular disease. Due to its often asymptomatic nature, it is often referred to as a silent disease. Therefore, scenarios like the following are quite common in daily life: "Mr. Wang, aged 45, has a sedentary job, occasionally smokes, and rarely exercises. He has experienced mild lower back pain occasionally, attributing it to overwork and not paying much attention to it. One day, the lower back pain suddenly became so severe that he couldn't get out of bed, prompting him to seek urgent medical attention. After examination, it was discovered that he already had osteoporosis."

According to information from Taiwan’s National Development Council, Taiwan had already entered an aging society as early as 2018, with the proportion of people aged 65 and over reaching 17.5% in 2022. The population structure is rapidly aging, and the prevalence rates of osteoporosis among Taiwanese men and women over 50 are 23.9% and 38.3%, respectively. The crisis of osteoporosis is also reflected in the fracture rate, with Taiwan ranking first in Asia and seventh in the world for fracture incidence. This indicates that this disease is an issue that cannot be ignored. The World Health Organization (WHO) has designated October 20 as World Osteoporosis Day, and the International Osteoporosis Foundation (IOF) responds globally, urging people to take action to protect bone health.

What is Osteoporosis?

Osteoporosis is about the quality of the bone mass. Bones support the body (and thus give forms to humans), protect organs (such as the heart, liver, spleen, lungs, ovary, and uterus), facilitate movement, and participate in metabolism. The rate of bone loss depends on the balance between osteoblasts responsible for bone formation and osteoclasts responsible for bone resorption. Generally, the period when women experience the most rapid bone loss is within 5 years after menopause. During this time, spinal density decreases by an average of 3 to 6% per year, and over 50% of women will experience fractures after the age of 80. In contrast, the rate of bone loss in men is relatively stable, generally decreasing by about 0.5 to 2% per year. Thus, age affects bone mass. Due to bone loss, bones become more porous and less dense, leading to fragility and susceptibility to fracture. When excessive bone loss occurs, the formerly dense bones now form many pores, resulting in a hollow and porous appearance, known as osteoporosis. In essence, osteoporosis means "porous bones" in English, indicating a disease where bones become thin and brittle due to decreased bone density.

Osteoporosis is a systemic chronic disease of the bones, often asymptomatic, with most patients showing no obvious symptoms. Some older patients may only experience changes in appearance such as decreased height or kyphosis (forward curvature of the spine). These patients usually do not notice their condition and do not pay much attention to it. However, a minor fall or sudden excessive force, such as bending to lift objects, can lead to fractures. Fractures can cause severe pain, immobility, potential long-term disability, affecting quality of life, and even death.

Causes of Osteoporosis

•Menopause：After menopause, the secretion of estrogen (female hormone) decreases significantly, causing an increase in the activity of osteoclasts (cells that naturally break down bone tissue) in the bones. This makes the bones more susceptible to damage, thus increasing the risk of osteoporosis.

•Aging：As the body ages, the efficiency of bone-forming cells decreases, leading to a decrease in bone mass and an increased likelihood of osteoporosis.

•Smoking：moking reduces the concentration of vitamin D in the body and may cause menopause in women at an earlier age. When lacking estrogen protection, women are at a higher risk of developing osteoporosis.

•Alcohol abuse：Studies have shown that heavy drinkers are 2 to 3 times more likely to develop osteoporosis and fractures than non-drinkers. Alcohol may have a direct toxic effect on bones, reducing bone density and leading to osteoporosis.

•Inadequate calcium intake：After the age of 40, bone density decreases annually. Without timely calcium supplementation, osteoporosis is more likely to occur.

•Lack of exercise：Many modern people lack time for exercise due to work pressure and lack interest in exercise. However, exercise stimulates bone response and generates more bone mass compared to being sedentary, thus preventing osteoporosis.

•Other factors：Family history of fractures, being underweight, previous history of fractures, etc., all increase the risk of osteoporosis.

Save Your Bones as Early as Possible to Prevent Osteoporosis

The International Osteoporosis Foundation (IOF) states that increasing bone density by 10% during youth can delay the onset of osteoporosis by 13 years. To prevent osteoporosis and fractures, the IOF has set the theme "Step up for bone health", urging people of all ages to take five steps to strengthen bone health:

•Consume bone-healthy foods：Calcium is an essential component of bones. Adults should consume 1,000 milligrams of calcium per day to maintain bone health. Good sources include milk, cheese, tofu, dark green vegetables, black sesame, etc. High-quality protein is also crucial for bone formation, with a recommended intake of 1-1.2 grams of protein per kilogram of body weight. Vitamin D promotes calcium absorption, which can be obtained from eggs, salmon, mushrooms, and adequate sun exposure. It's recommended to expose yourself to sunlight for 10 to 20 minutes daily before 10 a.m. or after 2 p.m., without sunscreen, to allow for the conversion of vitamin D3 in the body, enhancing calcium absorption and preventing osteoporosis. It also helps reduce the risk of various chronic diseases.

•Exercise to strengthen bones and muscles：According to WHO reports, more than a quarter of adults worldwide do not get enough exercise. Exercising 3-4 times a week for at least 30-40 minutes each time is recommended. Weight-bearing exercises such as climbing stairs, jogging, jumping rope, and swinging rackets can increase bone density and muscle strength. Resistance training using body weight, dumbbells, resistance bands, etc., can provide resistance to the body for muscle training. Balance exercises like single-leg standing and Tai Chi can improve balance and further prevent falls.

•Maintain a healthy weight：Underweight, overweight, and obese individuals have a higher risk of osteoporosis. Excessive weight loss not only leads to malnutrition but also decreases estrogen secretion in women, accelerating bone loss. Overweight and obesity increase the burden on bone joints and increase the risk of fractures from falls. Maintaining a normal weight range and a healthy posture with a BMI between 18.5 and <24 is recommended.

•Quit smoking and avoid excessive alcohol consumption：Smoking reduces the activity of osteoblasts, leading to a loss of bone calcium and a 5-10% decrease in bone density. Alcohol inhibits osteoblasts and affects the absorption of calcium and magnesium, leading to bone loss. It's advisable to quit smoking and limit alcohol consumption to less than 20 grams of alcohol per day for men and less than 10 grams for women.

•Be aware of risk factors：Individuals with a family history of fractures, those taking corticosteroid medications, and those with diabetes have a higher risk of osteoporosis. In particular, women who have undergone menopause, ovarian removal, or have entered menopause before the age of 45 may experience accelerated bone loss due to a lack of estrogen.

In response to the aging population and modern lifestyle habits, CTCI’s Health Center has repeatedly emphasized bone health education during the monthly health management reminders to enhance colleagues' awareness of the disease and better understand their own health conditions.

The Taiwan National Health Agency's policy on the prevention and treatment of osteoporosis prioritizes health promotion and prevention, focusing on strengthening public education to establish correct prevention and treatment awareness. As long as individuals regularly monitor their bone density and understand their own physical condition, living a happy life should not be a problem. Even in cases where osteoporosis has already developed, with proper care, medication, exercise habits, and healthy eating habits, bone health can be improved, leading to a more relaxed and safer lifestyle, including travel and family activities.

Source: Department of Health Promotion, Ministry of Health and Welfare (Taiwan); Taipei City Health Bureau; Chang Gung i-Healthcare Network