Osteoporosis & Fragility Fractures

Osteoporosis is a condition in Singapore characterised by reduced bone density and deterioration of bone structure. This weakens bones over time, increasing the likelihood of fractures, particularly in the:

• Spine
• Hip
• Wrist
• Shoulder

Because bone loss occurs gradually and without symptoms, many people are unaware they have osteoporosis until a fracture occurs.

What are fragility fractures?

A fragility fracture refers to a broken bone resulting from minimal trauma that would not normally cause injury to healthy bones.

Common examples include:

• Hip fractures after a simple fall
• Vertebral fractures causing back pain or height loss
• Wrist fractures from bracing during a fall

What causes osteoporosis?

The condition develops when the natural process of bone renewal becomes imbalanced. Healthy bones are constantly broken down and rebuilt, but certain biological changes can disrupt this cycle and weaken the skeleton over time.

• Reduced bone formation – as we age, the body becomes less efficient at producing new bone tissue, resulting in gradual thinning of bones.
• Increased bone resorption – specialised cells called osteoclasts may break down bone faster than it can be replaced, leading to loss of bone density.
• Hormonal influence on bone metabolism – oestrogen plays a key role in maintaining bone strength. A drop in oestrogen levels accelerates bone loss by increasing bone turnover.
• Impaired calcium and vitamin D utilisation – calcium is essential for bone structure, while vitamin D supports absorption. When either process is inefficient, bones become structurally weaker.
• Micro-architectural deterioration – over time, the internal structure of bone becomes more porous, reducing its ability to withstand stress even if the outer shape appears normal.

What are the common symptoms of osteoporosis and fragility fractures in Singapore?

Although osteoporosis itself does not cause pain, certain subtle signs may suggest reduced bone strength, especially as the condition progresses:

• Loss of height over time – gradual height reduction may occur due to compression of the spinal bones.
• Stooped or hunched posture – weakening of the vertebrae can lead to curvature of the spine.
• Back discomfort or stiffness – tiny compression changes in the spine may cause persistent or unexplained back pain.
• Fractures from low-impact events – breaking a bone after a minor fall, coughing or lifting something light may indicate fragile bones.

Fragility fractures occur when weakened bones break under forces that would not normally cause injury, such as a simple fall from standing height. The symptoms depend on the location of the fracture, but commonly include:

• Sudden, localised pain – pain often starts immediately after a minor injury or movement.
• Difficulty moving or bearing weight – fractures in the hip, leg or spine can severely limit mobility.
• Swelling or tenderness – affected areas may feel sore, bruised or swollen.
• Spinal fracture symptoms – vertebral fractures may cause sharp back pain, worsening posture or a noticeable loss of height.
• Reduced independence – hip and spinal fractures can impact daily activities and may require prolonged rehabilitation.

Who is at risk of osteoporosis and fragility fractures?

Certain factors can increase the likelihood of developing osteoporosis or sustaining fragility fractures, such as:

• Advancing age – bone density naturally declines with age, making fractures more likely in older adults.
• Female sex – women are more vulnerable, particularly after menopause, due to hormonal changes affecting bone strength.
• Family history – having a parent or sibling with osteoporosis or hip fractures increases inherited risk.
• Low body weight or small body frame – less bone reserve means lower tolerance for bone loss.
• Lifestyle factors – smoking and excessive alcohol intake interfere with bone health and repair.
• Chronic medical conditions – conditions such as thyroid disorders, inflammatory diseases or malabsorption syndromes can increase fracture risk.
• Long-term medication use – prolonged use of corticosteroids or certain anti-epileptic drugs can weaken bones over time.
• History of falls – balance issues or poor coordination increase the likelihood of fractures once bones are fragile.

How are osteoporosis and fragility fractures diagnosed in Singapore?

Identifying osteoporosis early is crucial in preventing fractures and preserving long-term mobility. A thorough evaluation helps determine bone strength, uncover contributing factors and guide a personalised management plan.

• Clinical assessment – our doctor will review your medical history, including any previous fractures, family history of bone disease, medication use and lifestyle factors, such as physical activity and nutrition. Fall risk, balance issues and symptoms suggestive of spinal fractures may also be assessed to understand your overall fracture risk.
• Bone density testing (DEXA scan) – this quick and non-invasive test measures bone mineral density, usually at the hip and spine and helps determine fracture risk before symptoms occur.
• Imaging studies – imaging may be recommended if a fracture is suspected or to assess structural changes in the bones.
  • X-rays – commonly used to detect fractures, spinal compression changes or bone deformities related to long-standing bone loss
  • Magnetic resonance imaging (MRI) – provides detailed images of the spine and surrounding tissues, helping identify recent or subtle fractures and distinguish them from older injuries
• Blood tests – these may be performed to look for underlying medical conditions that contribute to bone loss. They can assess calcium and vitamin D levels, hormone balance and markers of bone metabolism, ensuring secondary causes of osteoporosis are not overlooked.

How are osteoporosis and fragility fractures treated in Singapore?

Managing osteoporosis and fragility fractures requires a comprehensive approach that goes beyond symptom relief. It often consists of a combination of treatments, such as:

Conservative management

• Nutrition optimisation – adequate intake of calcium and vitamin D is essential for maintaining bone density and supporting bone remodelling. Our doctor may provide guidance on dietary sources or supplementation based on individual needs and blood test results.
• Weight-bearing and resistance exercise – regular physical activity helps stimulate bone formation and maintain muscle strength. Weight-bearing exercises, such as walking or stair climbing, combined with resistance training, support bone integrity and improve overall stability.
• Fall prevention strategies – reducing the risk of falls is a key component of fracture prevention. Balance training, vision assessment and home safety modifications, such as improved lighting or removal of trip hazards, help minimise injury risk.
• Lifestyle modifications – smoking cessation and moderation of alcohol intake are strongly encouraged, as both are known to accelerate bone loss and increase fracture risk. Maintaining a healthy body weight also supports skeletal health.

Medical management

• Anti-osteoporosis medications – these treatments work by reducing bone breakdown or stimulating new bone formation, helping to strengthen bones and lower fracture risk. The choice of medication depends on bone density results, fracture history and overall health profile.
• Calcium and vitamin D supplementation – supplementation may be recommended when dietary intake is insufficient or blood levels are low, ensuring optimal conditions for bone metabolism and medication effectiveness.
• Hormonal or targeted therapies – in selected individuals, hormone-based or targeted treatments may be considered to address specific risk factors contributing to bone loss, under careful medical supervision.
• Platelet-Rich Plasma (PRP) injections – in selected cases, PRP injections may be considered as an adjunct to support fracture healing or joint function, particularly when soft tissue recovery is involved.

Rehabilitation and physiotherapy

• Restoring mobility and strength – targeted exercises are used to rebuild muscle strength around affected areas, improve joint mobility and support safe movement patterns after periods of reduced activity or immobilisation.
• Improving balance and coordination – balance training helps reduce the risk of falls, which are a major cause of fragility fractures. Exercises are tailored to improve stability during standing, walking and transitions such as rising from a chair.
• Reducing fear of movement – after a fracture, many individuals develop anxiety around physical activity. Guided rehabilitation encourages gradual, controlled movement, helping patients regain confidence while avoiding unnecessary strain.
• Supporting a safe return to daily activities – physiotherapy focuses on functional movements needed for everyday life, such as walking, climbing stairs and lifting light objects, allowing patients to resume routines safely and independently.
• Ongoing injury prevention education – patients receive guidance on posture, safe movement techniques and activity modification to protect weakened bones and reduce the likelihood of future fractures.

Book an Appointment

If you are concerned about bone strength, have experienced a low-impact fracture or wish to reduce your future fracture risk, a medical assessment can provide clarity and reassurance.

Dr James Tan offers comprehensive evaluation and tailored management plans to support long-term bone health and safe recovery. Contact the clinic today to arrange an appointment and take a proactive step towards safeguarding your bone health.