Caring For Your Bones

By June Ramli

Kuala Lumpur, Nov 19: Orthopaedic disease is often underreported, underestimated, and under treated as many tend to assume it’s a natural part of ageing, making it a neglected medical problem. The lack of priority on bone health has been more prevalent during COVID-19. Health assessments, bone density testing and sometimes treatment itself were upended by the pandemic with more than 90 per cent of elective orthopaedic cases in Malaysia had to be cancelled or postponed. In addition to the late diagnosis, lack of physical activity as well as an increasingly sedentary lifestyle resulting from the prolonged and repeated lockdown may have caused serious, long-term consequences for patients. Given these facts, there must be a stronger focus on prevention and more work must be done to educate and reorientate the way people think about bone health. Dr Sureshan Sivananthan (pictured above), Consultant Orthopaedic, Arthritis & Sports Surgeon from ALTY Orthopaedic Hospital who has over three decades of experience working in the field of orthopaedics shares his thoughts with us on the matter.

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What orthopaedic diseases came to the forefront during the pandemic?

COVID-19 has affected all aspects of healthcare, including musculoskeletal care. One of the orthopaedic diseases that came to the forefront during the pandemic is osteoporosis, which is often described as “a silent killer” – and this has never been more true. 
The number of patients coming for osteoporosis screening declined significantly, while rates of fragility fractures increased due to lack of screening. These declines are especially concerning considering the already very low rates of screening and treatment for osteoporosis in the country. Osteoporosis is a growing health problem in Malaysia with about 77 per cent of Malaysian women living with post-menopausal osteoporosis. The increase in the total number of hip fractures is also expected to be highest in Malaysia within the Asian region by 2050. Besides osteoporosis, other orthopaedic diseases such as arthritis are also often underreported, underestimated, and underrated even before the pandemic. People tend to think of these diseases as a natural part of ageing, which makes these conditions a neglected medical problem. However, everyone should be cautious about their bone health. Low bone density could lead to fragility fractures which is a major medical issue if it is not diagnosed or treated in good time.

What are the short and long-term consequences on bone health due to social isolation and the subsequent sedentary behaviors?

With the COVID-19 lockdown, almost everything was shut for more than a year. The work-from-home orders and safety concerns related to interacting with others have driven many indoors as well. 
At ALTY Orthopaedic Hospital we noticed that our patients began to experience low back pain and joint pains due to restricted physical activity. Prolonged sitting in a poor posture also puts stresses on the muscles, joints, and ligaments. This can cause pain and damage to the adjacent joints. Physical activity or weight bearing exercise is important to help maintain bone mass. As people are confined within their homes with reduced physical activity, there will be rapid bone resorption (loss) as the muscles and bones are not getting adequate stimulation. It may also contribute both to decreased bone mineral density related to immobilisation as well as increased frailty and fall risk in the long term. Similarly, having to stay confined at home also impacts bone metabolism. The lack of exposure to the sun for months on end during the pandemic has critically affected vitamin D levels in our body, especially in those who do not take daily supplements – raising the risk of vitamin D deficiency. Vitamin D deficiency causes a variety of bone diseases, including osteoporosis. Additionally, many people who had been maintaining a healthy weight before COVID-19 have gained weight due to a lack of exercise and a poor diet. This sudden weight gain puts pressure on the joints, making them more prone to degeneration.

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What are some of the ways to get your bone health back on track?

Now, with the ease of restrictions, it is time to get back on track and make bone health a priority. One of the things you should do is to contact your doctor for a bone health review, whether for the first time or to follow up on your treatment. Let your doctor know if you have any persistent pain in the bone, joints, or ligaments. Besides that, you should start practicing good habits, like eating a diet with adequate vitamin D and calcium, exercising, and sitting less. Calcium and vitamin D work hand-in-hand to protect your bones. Calcium helps with the formation and maintenance of bones, whereas vitamin D aids in the absorption of calcium. Besides that, regular sun exposure is the most natural way to get enough vitamin D. In Malaysia, the ideal time for sun exposure is before 10 am or after 6 pm. Furthermore, bones also become stronger with exercise. Strength-building and weight-bearing exercises are the best for healthy bones. Try walking, climbing stairs, lifting weights or even dancing, and make sure you do it for 30 minutes each day. Strength-building and weight-bearing exercises stimulate bone cells and increase our bone mineral density as well as bone size thus lowering the risk of osteoporosis. Lastly, avoid smoking and excessive alcohol consumption which can contribute to bone loss and weakened bones. These unhealthy habits reduce the blood supply to the bones, slow the production of bone-forming cells, and interfere with calcium absorption. By avoiding these habits, you can reduce the rate of bone loss and protect your bones from negative impacts.

Why should bone health start from an early age?

There has to be more emphasis on prevention and more work needs to be done to educate and reorientate the way people think about bone health. Most people don’t start thinking about their bone health until they are in their late 30s or early 40s. By then, it would have been too late to do very much to protect against serious bone loss and  fractures. Concern about the strength of your bones should start from childhood and continue through adolescence. The amount of bone mass a young adult obtains determines their skeletal health for the rest of their life. Therefore, developing a higher peak bone mass will also better protect against osteoporosis and related fractures later in life.

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