15/06/2025

ON SUNDAY JUNE 15, 2025 theSunday Special VII

“At the same time, there is another problem – adherence to these therapies LV RIWHQ D̆ HFWHG E\ D ODFN RI DZDUHQHVV of the importance of these medications to help prevent future fractures. Many of these medications are required for ORQJ WHUP IURP RQH WR ¿YH \HDUV RU PRUH and many patients do not realise this. “Changes in bone density are only seen after two to three years. In addition, some medications such as bisphospho nates may have become victims of bad SUHVV GXH WR H[DJJHUDWHG VLGH H̆ HFWV DQG patients may interpret this negatively. Some of these medications are also ex pensive and not readily reimbursed by our healthcare system. This too may lead to non-adherence.” In a rapidly ageing nation like Malay sia, where the number of individuals aged 60 and above is projected to rise from 1.4 million in 2000 to 3.3 million by 2050, ZH FDQ QR ORQJHU D̆ RUG WR GLVPLVV ERQH health as a niche concern. Jeyakantha stressed that healthcare providers also need to step up. “Screening should be opportunistic, especially when elderly patients present for other medical problems. Nationally, policymakers must recognise osteoporo sis as a non-communicable disease, just like diabetes or hypertension.” The bottom line Osteoporosis does not announce itself with drama. It waits. Silently. Until the day your body gives way beneath you. By then, recovery can be slow and costly, especially for older adults with limited mobility or existing health conditions, which is why prevention and early man agement are essential. The real challenge lies in shifting mindsets, moving from reactive care to proactive planning. Just as we routinely check our blood pressure or blood sugar, we need to begin asking: How are our bones doing? Waiting for a fracture be fore taking action is like waiting for a tyre to burst before checking its pressure – the damage, by then, may already be done. Strong bones do not come from luck or youth alone. They are built day by day, through deliberate but straightforward choices – such as eating nourishing meals, being active and forming mindful habits. Every walk taken, every glass of milk or leafy salad consumed and every session spent lifting weights is a small investment towards a more independent and resilient future. It’s easy to take our bones for granted when they work quietly in the back ground, holding us upright, cushioning our falls and carrying us through the busyness of life. But the truth is, strong bones are not just about avoiding frac tures. They are about preserving freedom – the ability to reach for the top shelf, climb a few steps to visit a friend, travel without fear of falling or simply live each day without hesitation. Whether you are 50, 60 or 70, it is never too late to give your bones what they need: nourishment, movement, vigilance and a little bit of care. What we build today will be the strength we stand on tomorrow. After all, the skeleton is not just our framework. It is the foundation of ev erything we do. Like any foundation, it deserves more than just an afterthought – it deserves our attention, now.

Weight-bearing exercises, such as walking, jogging, stair climbing, yoga and tai chi, help stimulate bone growth and density.

bone density. On the other hand, staying active, avoiding overly restrictive diets and maintaining a healthy body weight (neither too low nor too high) are key to

Nutrition to the fore One of the most important pillars of bone health is nutrition. Calcium and vitamin D are the dynamic duo when it comes to building and maintaining strong bones. For adults over 50, the Clinical Practice Guidelines recommend a daily intake of 1,000 to 1,200 mg of calcium and 800 to 1,000 IU of vitamin D. Despite Malaysia’s sunny climate, vita PLQ ' GH¿FLHQF\ UHPDLQV KLJKO\ SUHYDOHQW particularly among older individuals, those with darker skin tones and those who dress conservatively. “It is important for those at risk to check their vitamin D levels with a simple blood test and seek medical advice if they are low,” he said. Calcium can be found in dairy products like milk, yoghurt and cheese, as well as in tofu, leafy greens like spinach and kale, almonds and fortified beverages like soy milk and orange juice. Vitamin D, meanwhile, comes mainly from sun exposure and, to a lesser extent, foods OLNH HJJ \RONV DQG RLO\ ¿VK 0DQ\ ROGHU Malaysians, especially those who avoid the sun, may require supplements to meet their daily requirement. Beyond nutrients, movement matters. Bones, like muscles, need resistance and impact to stay strong. Weight-bearing exercises, such as walking, jogging, stair climbing, yoga and tai chi, help stimu late bone growth and density. Strength training, such as lifting weights or using UHVLVWDQFH EDQGV LV SDUWLFXODUO\ EHQH¿FLDO especially for the hips and spine. Even short, regular sessions a few times a week FDQ PDNH D GL̆ HUHQFH “Weight-bearing activities like brisk walking, cycling and line dancing can improve bone health and reduce muscle loss.” He also recommended yoga and qigong to improve balance and prevent falls, an important aspect in reducing fracture risks. In Malaysia’s humid climate, where outdoor exercise can feel unbearable by noon, early morning or indoor routines are the most practical option. Lifestyle habits also play a role. Smok ing and excessive alcohol intake are known bone enemies, accelerating the loss of

long-term skeletal support. Fall prevention is vital

Bone loss doesn’t happen overnight. It begins silently in your 30s and picks up speed by the time you hit 50.”

As bones weaken, the consequences of a simple slip can be life-altering. Installing grab bars in bathrooms, ensuring good lighting at home, removing trip hazards like rugs or wires and wearing proper footwear can all help reduce fall risks. Regular vision and hearing checks, as well as balance training exercises, are also worth incorporating into a “bone health” routine. If you are wondering whether you or someone you love might be at risk, the answer lies in a simple test. Dual-energy X-ray absorptiometry (DXA or DEXA) is the gold standard for measuring bone mineral density. According to Jeyakantha, screening programmes in Malaysia are still sporadic. “The Clinical Practice Guideline 2023 recommends that all women above the age of 50 be screened with a DXA scan. 5LVN VWUDWL¿FDWLRQ WRROV OLNH WKH 0DOD\VLDQ Osteoporosis Screening Tool and Osteo porosis Self-Assessment Tool for Asians are also available, but uptake remains low,” he said. Accessibility is another hurdle. “One major limiting factor is the avail ability of DXA scanners to measure bone density. These machines are confined to major tertiary centres in most states; hence, many patients in the outskirts may not be able to have this important test done. The scanners are also concentrated at private centres and the cost of the test may hinder the public from getting readily tested.” For those who have already been diag nosed with osteoporosis, treatment can help slow bone loss and strengthen exist ing bones. Medications such as bisphos phonates, denosumab and anabolic agents like teriparatide are available. “Different treatments are selected depending on the patient’s age, severity and site of fracture,” he said.

Women, especially after menopause, experi ence accelerated bone loss due to declining oestrogen levels.