IN 2020 , Malaysian women and men were found to have a life expectancy at birth of 78.5 years and 74.4 years , respectively . Yes , we live longer , thanks to improved healthcare and higher living standards . In fact , according to the World Bank , we are already an ageing society , with seven per cent of our population aged 65 years and over since 2020 ! This group is projected to triple from two million in 2022 to over six million by 2040 . As more Malaysians grow older and live longer , many will likely suffer age-related non-communicable diseases , such as osteoporosis .
BURDEN OF OSTEOPOROSIS
Osteoporosis occurs when bone density is severely reduced . This disease results in bone fracture , commonly affecting the spine , hip or wrist . These are more common than often thought .
A 2021 study showed that 11.4 per cent of approximately 1-in-10 people over 45 in an urban population had asymptomatic vertebral fractures , a possible precursor to osteoporosis . A 1997 study revealed that 90 people out of 100,000 over had suffered a hip fracture . For most of them , the outcome would be bleak .
A study in 2020 found that , upon discharge from the hospital , all needed walking aids . Six months later , only 24 per cent or one in four regained mobility and independence . Sadly , another 26 per cent or one in four died within one year after the fracture !
All osteoporotic fractures are associated with disability and premature death . This is especially so , with hip fractures projected to increase from 5,880 in 2018 to 20,893 in 2050 , a 3.6-fold increase .
CLINICAL PRACTICE GUIDELINES
Osteoporosis is a serious disease that requires early detection , intervention and management even at later stages . Thus , I congratulate the Malaysian Osteoporosis Society for supporting these needs by developing its 2022 Clinical Practice Guidelines ( or CPG ) for the Management of Osteoporosis .
As osteoporosis can present to different medical specialties , I applaud the Society for assembling a diverse panel of authors including primary care physicians and endocrinologists , to geriatricians and surgeons . Together , these experts have provided the latest evidence-based options for osteoporosis assessment , diagnosis and treatment .
Investing in primary healthcare systems has demonstrated overall improvements in the healthcare delivery across the globe . Thus , it is commendable that the CPG recommends how one ’ s risk level can be assessed at government health clinics , and general practitioners ’ clinics .
If patients are at risk , the CPG provides further assessment , diagnosis , intervention , and information . If osteoporosis is present , there is guidance
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on the course of action to be taken , including when to initiate treatment ; what medications are available in Malaysia ; and which medications to prescribe under different situations .
These are encouraged to prevent even the first fracture ! This is crucial because once you have had one fragility fracture , you will likely experience another .
For these reasons , I urge healthcare professionals to utilise the CPG to make crucial , and timely clinical decisions . Initiating best practices will improve the lives of their ageing patients and help reduce the burden of osteoporosis that is expected to rise in the not-too-distant future !
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ALIGNED WITH THE HEALTH WHITE PAPER
Recently , the government introduced the Health White Paper , which looks forward to the future of healthcare in Malaysia . The ultimate goal should be to ensure that all Malaysians can live long and healthy lives no matter who they are or how old they are . Hence , maintaining strong bones and reducing fractures is crucial in making healthy ageing a reality .
As such , in addition to the comprehensive guidance and treatment of osteoporosis , I am pleased to note that the CPG has sections on the prevention of osteoporosis . In particular , the CPG contains relevant vital sections including ;
• First , prevention of osteoporosis / bone loss
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BY TAN SRI DR NOOR HISHAM ABDULLAH |
• Second , assessment of fall risk , as many fractures would not occur if the older patient does not fall
• Third , calcium and vitamin D
• Fourth , exercise and
• Lastly , avoid smoking and alcohol to help prevent bone loss and falls . These are practical and important everyday considerations that warrant repeating . As bone is constantly being broken down and rebuilt , older persons must ensure adequate calcium intake from their diet or supplementation .
Vitamin D , mainly made by the skin when exposed to sunlight , is crucial for calcium absorption . Despite living in a tropical country , many Malaysians do not have adequate vitamin D levels , even with sunlight exposure , and may require vitamin D supplementation .
Weight-bearing exercises , such as climbing stairs , walking , jogging , tai chi , dancing and sports , are encouraged to improve bone density .
One of the critical initiatives of the Ministry of Health ( MoH ) Malaysia is to stop smoking altogether . Tobacco smoking is bad for your heart and lungs and your bones . Compared to non-smokers , current smokers have a 25 per cent increased risk of fracture and a 60 per cent higher risk of hip fracture even after adjusting for other risk factors . Therefore , stopping smoking will also improve bone health !
PLANNING AND INVESTING FOR THE FUTURE
When looking at the distribution between gender , women tend to lose bone mass faster than it forms when menopause sets in . Whereas , men tend to lose bone mass at a slower rate . However , by age 65 or 70 , both men and women will lose bone mass at the same rate .
So regardless of gender , osteoporosis may become a threat to us all as we age . We must adopt preventive lifestyle practices , assess our risk and comply with the treatment to overcome the disease and attain our aspiration of ageing healthily .
Once again , I congratulate the Malaysian Osteoporosis Society and am pleased to launch the Third Clinical Practice Guidelines for the Management of Osteoporosis . – The Health
Tan Sri Dr Noor Hisham Abdullah is the Director-General of Health .
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