Monday, May 31, 2021

Why Is Calcium Important For Osteoporosis?

Hi Everyone,

Ladies, we have all seen it, the elderly aunt, sister, or mum whose life takes a drastic turn when she suffers a hip fracture. They spend the rest of their years bedridden or wheelchair-bound, their once-active lives taken away and it all boils down to bone health and strength.

Osteoporosis is a growing health concern in Malaysia with an estimated 77 per cent of Malaysian women living with post-menopausal osteoporosis. It's a disease that remains underdiagnosed and undertreated, with very little data on its prevalence despite the huge impact it has on a woman's life.

It's a silent disease with no symptoms and often goes unnoticed until patients experience a fracture. Globally, osteoporosis causes more than 8.9 million fractures every single year. Thus, here are some questions on what is exactly osteoporosis in our ageing population and what we can still do to strengthen our bones in our golden years.

1. What is osteoporosis and what causes it?

Osteoporosis is a bone disease characterized by reduced bone density (bone mass) and disruption of microarchitecture. As bones become more porous and fragile, the risk of fracture is greatly increased. Osteoporosis is a silent disease and often there is no symptom until the first fracture occurs1.

Osteoporosis mainly occurs in postmenopausal women and elderly men.

Osteoporosis can be divided into primary osteoporosis, which includes postmenopausal osteoporosis (type I) and senile osteoporosis (type II), and secondary osteoporosis, which has a clearly definable aetiology such as malabsorption, medications such as glucocorticoids, and some diseases such as hyperparathyroidism.

2. Who is at most risk of osteoporosis?

Risk factors include increasing age, female sex, postmenopausal status, hypogonadism, low body mass index, ethnic background (white persons are at higher risk than black persons), rheumatoid arthritis (RA), low BMD, vitamin D deficiency, low calcium intake, hyperkyphosis, current smoking, alcohol abuse, immobilization, and long-term use of certain medications, such as glucocorticoids, anticoagulants, anticonvulsants and cancer drugs.

3. What parts of the body are affected by osteoporosis?

The most common fractures associated with osteoporosis occur at the hip, spine, and wrist.

4. Why is calcium an important component in preventing osteoporosis?

Calcium is the major building-block of our bone tissue, where 99% of our calcium storage is in the skeleton. From childhood to late 20s, bone mass continues to accumulate, and calcium is required to increase the bone mass. After that, our bone mass will slowly decrease with age. In women, the bone mass will further drastically decrease upon menopause.

5. What food are bad for osteoporosis?

High dietary intake of salt can deplete calcium storage and lead to bone loss. Therefore, it is important to reduce consumption of food with high salt content such as processed food, fast food, canned food, pickles, and sauce.

WHO has recommended to limit salt intake to 2000mg daily, which is less than a teaspoon in a day.

A few studies have suggested that caffeine decreases bone mineral density (BMD), increases the risk of hip fracture, and negatively influence calcium retention4. However, if you have a good calcium and vitamin D intake, there is little reason for concern about moderate caffeine intake on your bones

While beans contain calcium, magnesium, fiber and other nutrients, they are also high in phytates3. Phytates interfere with your body’s ability to absorb the calcium that is contained in beans. A simple remedy would be to soak the beans in water for a few hours before cooking it.

6. How can I prevent osteoporosis before it starts?

The primary goal of osteoporosis management is to reduce the risk of fracture.

Treatment and prevention strategies include fall avoidance by correcting decreased visual acuity, reducing consumption of medication that alters alertness and balance, reducing fall hazards in the home (slippery floors, obstacles, insufficient light), and adequate dietary intake of protein, calcium, and vitamin D.

Adequate intake of calcium and vitamin D is essential to bone and muscle health. Vitamin D aids calcium absorption in the intestines and ensures normal muscle contractions.

In women, the recommended daily allowance (RDA) for calcium is 1,000 mg/d for age range of 19 to 50 years and increases to 1,200 mg/d for older than 50 years.

In men, the RDA of calcium is 1,000 mg/d for age range of 19 to 70 years and increases to 1,200 mg/d for older than 70 years.

The RDA for vitamin D is 600 IU/d for men and women aged 19 to 70 years and increases to 800 IU/d for those older than 70 years. All postmenopausal women, regardless of their bone density or clinical risk factors for osteoporosis should observe these recommendations.

The Malaysian Osteoporosis Society has also recommended daily intake of vitamin D3 800IU, especially in elderly with poor diet or minimal outdoor activities7.

7. What other ways can we ensure good bone health well into our senior years?

A) Get active (Avoid a sedentary lifestyle).

One of the ways to strengthen bone and muscles is by exercising regularly. Weight bearing exercise such as walking and hiking, as well as resistance training such as weightlifting are the keys to healthy bone and muscles in senior years.

B) Eat healthy.

C) Avoid smoking.

D) Advisable to do a DEXA 

(Dual energy Xray absorptiometry) scan in post-menopausal women and elderly men. This scan is the a very accurate tool to diagnose osteopenia and osteoporosis.

For more info on Osteoporosis and other orthopaedic issues, kindly refer to Dr Jagdish Krishnan through this doctor's profile : 

Dr. Jagdish Krishnan is a Consultant Orthopaedic surgeon with special interest in shoulder / knee arthroscopy and knee preservation surgery. Gleneagles Hospital Penang



2. Chan et al. Determinants of Bone Health Status in a Multi-Ethnic Population in Klang Valley,

Malaysia. International journal of environmental research and public health. 2020 vol. 17,2 384.


4. Prema B Rapuri et al. Caffeine intake increases the rate of bone loss in elderly women and interacts with vitamin D receptor genotypes. The American Journal of Clinical Nutrition. 2001. Volume 74, Issue 5, Pages 694–700,


6. Bischoff-Ferrari HA et al. Fall prevention with supplemental and active forms of vitamin D: a meta-analysis of randomised controlled trials. Br Med J. 2009.339: b3692.

7. Malaysian Osteoporosis Society, Academy of Medicine Malaysia. Clinical practice guidelines of management of osteoporosis (Revised 2015) 8.

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