For the past 10 years, I have been in and out of Clinic H at the Singapore General Hospital. It’s the orthopaedic specialist clinic which takes care of my mother. (No, I am not the patient).
I used to chafe at the wait outside the doctor’s room, but in recent years, I have taken a greater and greater interest in the patients around me. In a wheelchair. With crutches. With a walking frame. They look like the walking wounded. Once, I had a nice chat with a gentleman who motored in on his PMD, asking him about the pros and cons of getting one.
It’s only when you get older that you start worrying about old(er) people’s ailments. Some, like long-sightedness, are inevitable. In my late 40s, I waited for my menstruation to end with bated breath, wondering if I would be subjected to hot flushes or would need hormone replacement therapy. (I sailed through that period of non-period).
What I didn’t realise was that the joy of having months with no bleeding had an impact on the bones. They don’t grow as fast and become more brittle because the female hormones haven’t been flowing in the usual quantity. Men (sniff) keep filling up on their testosterones. I keep wondering if I should have started pumping estrogen into myself but, then again, it could cause cancer. (Why is it that in trying to avoid a problem, you might just be opening the gates to another?)
That’s why you see more elderly women than men who are stooped and shrunken. They can be bent double and need a walking stick to help them stay on their feet. The bag of bones can be easily rattled. A fall in the bathroom can be fatal. They are suffering from osteoporosis.
I’ve never quite fathomed the difference between the various osteo-somethings. When my mother and I had a bone density test taken many years ago, I couldn’t believe my mom had the better results. I had confused osteoporosis with osteoarthritis. Osteoporosis means decreasing bone mass and strength.
Osteoarthritis, on the other hand, refers to the wear and tear of the joints, particularly hands, hips and knees, which is what my mother has. Both her knees had to be replaced.
So, she had strong bones but her joints weren’t clicking together as well as they should. Her latest test, however, wasn’t so hot; bones deteriorate pretty fast once it starts. She’s also getting shorter and has spinal compression problems. To put it technically or medically, her bones are breaking down faster, a process known as resorption, than they are building up.
We never think about our bones, unless we break them. We think of them as extra hard pieces inside the body, not as living tissue that is actually full of small holes – which get bigger as you age and therefore becoming more brittle. Osteoporosis actually means “porous bones’’.
Some, especially those in the older generation, probably never cared a hoot about what happens to their bones when they were younger. Building strong bones and teeth are for babies and children, not young, healthy adults. Then just when you are about to smell the retirement roses, your posture and gait changes and you can’t seem to get up from your chair without using your arms. You ignore them because you know that you’re ageing and that’s just “wear and tear’’.
Then you suffer a fall and fracture a hip bone. You end up in a wheelchair. Your doctor then asks about your calcium intake – and you go “what?’’
I know enough about aging bones to make sure that my mother gets an X-ray every time she falls. We’ve heard too many stories of her contemporaries dying after a fall. That’s why there’s a thriving business in non-slip flooring and grab bars. It’s to keep the elderly on their feet.
The figures are, no pun intended, shattering. In 2017, the estimated incidence of osteoporotic fracture in Singapore was 15,267 cases. Hip fractures, especially among women, and spine fractures, are the most common. Medical literature suggests that after a fracture, you are five times more likely to suffer a second one within just one year. Left untreated, osteoporosis can lead to multiple fractures over time.
Health-conscious people look at calories in their diet or the amount of protein and Vitamin C – not calcium and Vitamin D. Most times, we don’t need to start counting milligrams of calcium when we eat or drink, especially if we drink milk, take cheese or eat eggs. Or like broccoli, spinach and ladies’ fingers.
In our mid-20s, our bone mass is at the maximum level. We stand tall and strong. After that, we start to lose bone mass slowly as our body dissolves more bone than it rebuilds. It’s a process called resorption. That’s when we’ve got to start thinking about calcium intake to slow down the rate of resorption and kick-start bone-building. And get out in the sun more for that dose of Vitamin D. Why? Because it helps to absorb calcium through the intestines.
But.
I prefer beer to milk. And I am no longer a young person who likes frolicking by the beach or perspiring in the heat. An older person gets more and more sedentary over time, liking the cool of air-conditioning. Get some sun? It means slathering stuff on the face to ward off skin cancer. (As I said, why does avoiding a problem means risking another surfacing?)
My mother, who is the ultimate guardian of my health, has been pumping me with calcium supplements for decades. I swallow the pill three times a week unthinkingly, knowing that my mother wasn’t likely to poison me. Until I read that too much calcium can cause heart attacks. Women through age 50 should get 1,000 milligrams of calcium each day. Older women need 1200 milligrams a day. So read the label.
There is always exercise – preventive medicine for all ills.
Now, I don’t think people think about their bones when they work out. They think about the flesh and the flab. I have a near-daily regimen of yoga and pilates to keep the tummy tucked in. Medical literature says the exercise, though, has to be of the “weight-bearing type’’.
Bone-headed me had to look that up. They are just really aerobic exercises on your feet, with your bones supporting your weight. Examples include walking, dancing, low-impact aerobics, elliptical training machines, stair climbing and gardening. I imagine that those in landed property will probably have good bones, because they can tend the plants in the garden.
Every time I find myself hunched over or leaning forward when seated, I get a little rattled about the state of my bones.
I am less concerned for myself than for my mother – at least for now. The Covid-19 restrictions are making it difficult for the elderly to move about. I got her a Personal Mobility Device, because I want her out in the sun without worrying about stumbling.
She belongs to a generation that’s happy enough to be able to keep body and soul together, rather than start worrying about the skeleton within. It’s best that signs of osteoporosis get caught early because there are medications, whether oral or via injections, that can help slow down the process and build up bone. There’s even a name for early stage osteoporosis – osteopenia.
A bone density test which simply involves you lying on a table as a scanner passes over your hip and spine will tell your doctor if your bone needs more backing. It also acts as an alert signal – a fall could lead to fractures or even be fatal.
It doesn’t mean that you swear off exercise because your bones are brittle. On the contrary, you need exercises that challenge the areas where osteoporosis commonly affects, like the hip. My mother is too elderly to do squats but she can still stomp her feet!
After a certain age, go “break a leg’’ no longer sounds funny.
PS. Amgen, a pharmaceutical company, sponsored this piece. I agreed to write also because I belong to that age-group of women who need to know about the condition.