Osteoporosis And Associated Fractures
Dr Paul Thng Leong Keng 
MBBS (Singapore)
FRCS (Edin)
FRCS (Glas)
Osteoporosis is defined as “a systemic skeletal disease characterized by low bone mass and micro-architectural deterioration of bone tissue leading to enhanced bone fragility and a consequent increase in fracture risk.” (WHO 1994). The decrease in bone mass and tissue can be seen in the pictures below:
Why is Osteoporosis important?
Osteoporosis can affect the whole skeleton, and is often “silent”, that is the patient does not feel any pain or symptoms until a fracture occurs. It is also widespread among the population.
When a fracture occurs, however, the impact can be severe. It often will affect the patient’s quality of life with a corresponding socio-economic impact.
The most commonly affected sites are the spine, hip and wrist. The corresponding impacts of such fractures have been well studied and published in medical literature.
Despite the potential hazards of osteoporosis, a study done locally revealed that awareness of osteoporosis among Singaporeans is still low. In fact the more elderly you are (and hence the higher your risk) the less likely is the person aware of osteoporosis.
| Age (Years) | % heard of osteoporosis (n=797) | % who have not heard of osteoporosis (n=579) |
| 45-54 | 69% | 31% |
| 55-64 | 58% | 42% |
| ≥65 | 30% | 70% |
Saw SM et al. Awareness and health beliefs of women towards osteoporosis. Osteoporos Int 2003 (14): 595-601
Diagnosis of Osteoporosis
There are several ways in which bone quality can be measured. These include the following:
- Dual energy X-ray Absorptiometry (DXA)
- Ultrasound attenuation and velocity
- Morphometric X-ray absorptiometry
The dual energy Xray Absorptiometry (DXA) is currently the gold standard for bone mineral density (BMD). It measures the BMD on the spine, hip, forearm and heel. It provides a T and Z score.
| T score | Interpretation |
| -1 and above | Normal |
| -1 to -2.5 | Low bone mass |
| < -2.5 | Osteoporosis |
| < -2.5 and fracture | Established osteoporosis |
Treatment
The best method of managing osteoporosis is prevention, if possible. This should be started as early as young adults and can be achieved by a combination of appropriate diet, exercise and activity, and correction of any risk factors, the details of which go beyond the intended purpose of this summary write up. The primary aim is of course to prevent potentially debilitating fractures to occur. If fractures were unfortunate to occur, surgical intervention might often be needed early to minimize the duration of bed rest required in order to start rehabilitation as early as possible. Details are best discussed with your doctor.
Osteoporosis Treatment
Case examples:
Immediate Relief: Vertebroplasty for 71-Year-Old Lady's Chronic Pain with 2 Fractures
An example of a 71 year old lady with chronic pain for 4 months with 2 osteoporotic compression fractures treated with vertebroplasty, which immediately and nearly completely relieved her severe pain symptoms.
Swift Mobility: Hip Replacement Enables Immediate Weight Bearing for 70-Year-Old Female
An example of a 70 year old female who broke her hip and had a hip replacement which would allow her to weight bear immediately.
Dr Paul Thng Leong Keng
Senior Consultant Orthopaedics Surgeon / Spine Specialist
MBBS (Singapore) ∙ FRCS (Edin) ∙ FRCS (Glas)
Dr. Thng has been recognized for his work internationally and has been invited to demonstrate live spine surgical and operative skills in several countries.
- Senior Consultant and Medical Director, PTL Spine & Orthopaedics Clinic
- Visiting Senior Consultant Orthopaedic Surgeon, Changi General Hospital
- Adjunct Associate Professor, National University Hospital
- Trustee, AO Foundation
- Associate Editor, Global Spine Journal
- Scientific Reviewer, Singapore Medical Journal and Annuals of the Academy
Dr Paul Thng Leong Keng is a fellowship-trained orthopaedic surgeon subspecializing in spinal surgery. Based on hospital OTM records from 2003-2013, he performed over 3000 operations and over 1200 spine procedures, both open and minimally invasive. He has held various prestigious positions such as the Head of Spine service at Changi General Hospital, Chairman of AOSpine East Asia, and Executive Member of AOSpine International Board.
Dr. Thng has been recognized for his work internationally and has been invited to demonstrate live spine surgical and operative skills in several countries. He continues to contribute to the field through research and serves as an associate editor of the Global Spine Journal.
PTL Spine & Orthopaedics
Mount Elizabeth Novena Specialist Centre
38 Irrawaddy Road #07-34
Singapore 329563
+65 6734 5574 (Fax)
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