Most late life diseases are largely ignored by the teenagers of today. They simply do not relate to what goes on in the lives of people over 50 years of age. Exams, shopping and the latest movies seem to absorb all of their time and thoughts. Yet almost all research shows that lifestyle choices made by young people today can affect their chances of developing osteoporosis later in life.

Osteoporosis is a skeletal disease in which the bones lose mass and density, the pores in the bones enlarge and they become fragile. Called the “silent disease”, osteoporosis is often not diagnosed until a fracture occurs, most commonly in the hip, wrist or spine. As people in many Asian countries live longer, the incidence of this disease has shown a dramatic rise over the past few decades. According to the Osteoporosis Society (Singapore), in 1962 approximately 6900 fractures a year attributable to osteoporosis were reported in Singapore. In 1991, the figure had risen to 800 while last year there were more than 1,000 fractures reported. Estimates of the incidence of hip fractures for 1990 through to 2050 predict that the highest incidence will occur in Asia.

There are a variety of reasons why osteoporosis has risen in Asia and will continue to rise. These include people living longer, genetic factors, diet and exercise habits.

Factors that increase the likelihood of developing osteoporosis include:

• Being female

• Being thin or having a small frame

• Advanced age

• A family history of osteoporosis

• Being post-menopausal

• Having an abnormal absence of menstrual periods (amenorrhea)

• Eating disorders such as anorexia or bulimia

• A low-calcium diet

• Use of certain medications such as corticosteroids and anti-convulsants

• Low testosterone levels (men)

• An inactive lifestyle

• Cigarette smoking Excessive alcohol use

More common in women

According to the National Osteoporosis Foundation of America, osteoporosis is four times more common in women than in men. Women’s bones are naturally thinner and less dense than men’s and compared to men, women start losing bone ass and density at an earlier age. Menopause accelerates bone loss in women and the disease begins to emerge around the ages of 50-60 years. Osteoporosis affects one in four post-menopausal women in the United States with the figure rising to one in two after 75 years. For men, as levels of the male hormone testosterone decrease, the risk of osteoporosis increases. It is estimated that osteoporosis affects one third of all men by age 75.

The role of genetics

Research in Australia, Great Britain and Switzerland has confirmed a major link between bone mass and variations in the gene for the vitamin D receptor (VDR). While these studies suggest that seven to ten percent of the difference in bone mass density may be attributable to genetic variations, the studies have enlargely been conducted in Caucasians. Several studies are now underway in Asia. For people with a family history may help to identify and individual’s risk and enable early intervention.

Osteoporosis can be prevented

Research indicates that much can be done early in life to prevent this debilitating disease. Pre-teens and teenagers make lifestyle choices which affect their risk o later disease including osteoporosis. Bone mass can be increased between the ages of seven and twelve years and this translates to a reduce risk of osteoporosis later in life. The most important factor is diet. “Calcium intake is crucial during childhood, adolescence and early adulthood to help build the densest bones possible,” said Ms. Inge Hager, President of the Singapore Nutrition and Dietetics Association. “Calcium is like your bank account. The more calcium you deposit now, the more that is available later in life.”

Calcium is vital to bone growth, 45 percent of which takes place during adolescence. What many people do not realize is that while bone length is established by around 20 years of age, bone density and strength can continue to be built all the way to 30. This means that up until age 30, both men and women can build a “bone bank” by depositing calcium for use later in life.

What is the right amount of calcium?

The recommended daily allowance in Singapore for adults for calcium is 500mg a day. Similar recommendations can be found in Malaysia, Indonesia, Thailand and Hong Kong, while in the Philippines and China it is 700mg and 800mg respectively. However, most people are not getting enough calcium. According to Ms Hager, many women find it challenging to choose the right type of foods which provide sufficient calcium. “One cup of low fat mil and large square of tofu will supply the calcium needed daily. And taking three Chinese dessert-spoons of ikan bilis (dried small fish with the bones) will provide additional calcium,” she said. A table listing the calcium content of various foods is shown.

Where’s the calcium? Calcium content of some common foods

Excellent source (more than 200mg calcium per serving)

• 1 cup of low-fat milk

• 1 cup of whole milk

• 1 tub of low-fat yoghurt

• 3 Chinese dessertspoons of ikan bilis (dried small fish with the bones)

• 1 cup cooked kai lan

• 1 large square of taw kwa (bean curd)

Good source (more than 50mg calcium per serving)

• 1 scoop of ice cream

• 1 slice cheese

• 1 sardine (eating with the bone)

• Yellow dahl, half a cup

• 1 cup cooked chye sim (choi sum)

Physical Activity

Numerous studies conclude that daily, moderate physical activity increases bone mass and density. Exercise is important at any age – it builds bone mass and density during the formative years, while in older adults it is important for balance and co-ordination to prevent bone-fracturing falls. Engaging in vigorous, weight-bearing exercise such as walking, jogging, aerobics or dancing for 30-60 minutes at a time, three to five days a week is recommended for optimal results.

Making the right lifestyle choice early in life can prevent a debilitating disease later in life. Early awareness is considered essential in curbing the incidence of osteoporosis in Asia.

“By addressing this need at an early age, we hope that the young generation will develop health-promoting behaviors they can carry throughout life,” said Ms Hager.