The silent thief – this is the nickname given to osteoporosis, a disease that lies low and shows no symptoms… until someone who has it falls and suffers a broken or fractured bone.

Osteoporosis causes weak and brittle bones, due to a loss of bone mineral density. For individuals with osteoporosis, a simple fall may prove to have serious consequences.

How does it happen?

During our youth, our bodies create new bone more rapidly than it can be broken down, allowing bone mass to increase until it peaks in one’s late teens and 20s.

However, as we age, the rate of bone loss outpaces new bone tissue creation.

Therefore, our likelihood of developing osteoporosis is partly affected by the amount of bone mass we are able to accumulate in our youth.

The greater one’s peak bone mass, the higher the bone reserve one has and the lower the chances of developing osteoporosis later on.

Who is at risk?

Risk factors for developing osteoporosis include:

• Increasing age

You reach your peak bone density in early adulthood, and after that point, your bone mass begins to decrease.


Individuals of Asian or Caucasian descent are at higher risk of developing osteoporosis.

•Body mass index (BMI)

Those classified as underweight, i.e. adults who possess a BMI of below 19, are at higher risk of developing osteoporosis.

Family history

You can identify a genetic predisposition towards osteoporosis by checking whether anyone in your family has been diagnosed with the disease, or broken a bone by falling down.

•Lifestyle choices

Smoking, excessive alcohol intake, sedentary lifestyle and a diet low in calcium can also influence the development of osteoporosis.


Women are at higher risk of developing osteoporosis, more so if they have low oestrogen levels.

•Other factors

Vitamin D deficiency, endocrine diseases and certain medications can also increase this risk.

Diet has a key role to play in building your bone strength and fending off the development of osteoporosis or curtailing its advancement once diagnosed.

Eating a well-balanced diet, including dairy, fish, fruits and vegetables, often provides more than enough calcium and vitamin D, which are vital for bone integrity.

Your doctor can help you identify risk factors and assess your risk of future osteoporotic fractures.

An osteoporosis assessment includes a physical examination, as well as possibly some lab tests and a bone density scan.

Because osteoporosis is preventable, it makes sense to see your doctor early for education on minimising risk factors.

This will also help you understand your rehabilitation needs to build your bone strength.


Because a simple fall can cause injury to them, it is critical for people suffering from osteoporosis to undergo rehabilitation that zeroes in on increasing muscular strength, bone strength and balance im-provement, such as the exercises below.

Please note that if you have already been diagnosed with osteoporosis, you should consult with your doctor before attempting any new exercise.

• Weight-bearing exercises

Weight-bearing exercises challenge you to move against the force of gravity, while maintaining an upright position. This involves your feet and legs working to support your body’s weight.

There are two types of weight-bearing exercises: low-impact, such as fast walking, low-impact aerobics and using a stair step machine; and high-impact, such as jumping rope, jogging or running, and dancing.

Individuals who have previously broken a bone due to osteoporosis should avoid doing any form of high-impact exercise.

In every exercise, and especially for individuals at higher risk for osteoporotic fractures, particular attention should be paid to improving balance. This is the most important element in fall prevention.

• Resistance exercises

Otherwise known as muscle-strengthening exercises, these are activities in which you work against the weight of another object, and not just to support the weight of your own body.

Water exercises, weight-lifting and resistance tubing are good resistance training activities for individuals with osteoporosis.

• Flexibility exercises

Regular stretches, yoga and tai chi are several good examples of flexibility exercises that can help prevent injury.

However, some yoga poses involve stretches at the waist that can be risky for people who already have osteoporosis.

Any exercises that involve bending or stretching at the waist are a potential risk if you have already been diagnosed with this condition.

Besides the three types of exercise outlined above, other forms of therapy include vibration platforms, based on the concept that non-invasive, short-duration, mechanical stimulation can have an impact on osteoporosis risk and reduce the risk of falling.

Proper prevention and management of osteoporosis is best provided by a multidisciplinary team.

This includes the physician who diagnoses the problem, and selects and coordinates care; the dietitian who assesses diet and nutritional status; and the therapists who provide an exercise regimen, fall prevention and home safety evaluation.

Dr Kavitha Ratnalingam is a consultant rehabilitation physician. For more information, email The information provided is for educational purposes only and should not be considered as medical advice. The Star does not give any warranty on accuracy, completeness, functionality, usefulness or other assurances as to the content appearing in this column. The Star disclaims all responsibility for any losses, damage to property or personal injury suffered directly or indirectly from reliance on such information.