Osteoporosis is often referred to as a “silent epidemic,” and for good reason. This skeletal disease, characterized by weak and brittle bones, typically shows no symptoms until a fracture occurs—by which time significant bone loss has already taken place. In the Philippines, osteoporosis has become a growing public health concern, affecting millions of Filipinos and placing a substantial burden on the healthcare system.
What is Osteoporosis?
Osteoporosis, literally meaning “porous bone,” is a condition where the creation of new bone cannot keep pace with the removal of old bone. This imbalance leads to decreased bone mineral density, making bones fragile and more susceptible to fractures, particularly in the hip, spine, and wrist.
Unlike many other diseases with clear symptoms, osteoporosis develops silently over years. Most people don’t realize they have it until they experience a fracture after a minor fall or bump—an event that wouldn’t typically cause a break in healthy bone.
The Growing Burden in the Philippines
The statistics on osteoporosis in the Philippines paint a concerning picture. According to estimates from the Osteoporosis Society of the Philippines Foundation Inc. (OSPFI):
- About one-third of Filipino adults aged 40 years and above are at medium to high risk for developing osteoporosis
- The number of Filipinos at risk for osteoporosis was projected to reach 4 million by 2020
- By 2050, this number could soar to 10.2 million Filipinos
More alarming is the widespread nutrient deficiency that contributes to poor bone health. The 2021 Expanded National Nutrition Survey (ENNS) by the Department of Science and Technology – Food and Nutrition Research Institute (DOST-FNRI) revealed that 97.2% of adults and 95.5% of elderly Filipinos suffer from calcium deficiency, a situation that has worsened since earlier surveys.
Who is at Risk?
While osteoporosis can affect anyone, certain factors significantly increase the risk:
Non-Modifiable Risk Factors
- Age: The risk increases substantially with age, particularly in those over 70 years. In a study of postmenopausal women in Davao, the prevalence increased dramatically with age: 3.7% in women in their 40s, 9.9% in their 50s, 13.8% in their 60s, 68.3% in their 70s, and reaching 100% in those in their 80s.
- Sex: Women are disproportionately affected, with Filipino women aged 40 and above showing a higher prevalence of medium to high risk (38.8%) compared to men (30.7%). Postmenopausal women are particularly vulnerable due to the rapid decline in estrogen, which plays a crucial role in maintaining bone density.
- Ethnicity: Being Asian is itself a risk factor, placing Filipino women at inherently higher risk compared to other ethnicities.
- Family History: Having a parent or sibling with osteoporosis increases the risk, suggesting a genetic component to the disease.
Modifiable Risk Factors
- Low Calcium and Vitamin D Intake: The staggeringly high calcium deficiency rates among Filipinos significantly contribute to poor bone health. Vitamin D, essential for calcium absorption, is also commonly deficient.
- Low Body Weight: Studies in the Philippines have identified lower body weight as an independent predictor of osteoporosis. Weight-bearing exercise, which is more significant for heavier individuals, may contribute to higher bone mineral density.
- Sedentary Lifestyle: Lack of appropriate physical activity contributes to bone loss. Interestingly, one study found that routine exercise (primarily moderate walking) did not show a protective effect, suggesting that more intensive weight-bearing exercises are necessary.
- Smoking and Alcohol Consumption: Smoking one pack of cigarettes daily throughout adult life can lead to a 5%-10% loss of bone mass. Excessive alcohol intake interferes with calcium absorption and bone health.
The Impact of Osteoporosis
The consequences of osteoporosis extend far beyond bone health:
- Fractures: Osteoporotic fractures almost always require hospitalization, causing pain, decreased quality of life, lost workdays, and disability.
- Mortality Risk: Hip fractures caused by osteoporosis may have a mortality rate of 50-70% within the first year post-injury.
- Quality of Life: Even before fractures occur, awareness of having osteoporosis can negatively impact quality of life, leading to anxiety, depression, and social isolation.
- Economic Burden: The cost of a hip fracture in the Philippines is estimated at over 2,200 USD (approximately 110,000 PHP), placing a significant financial burden on individuals and the healthcare system.
Diagnosis: Challenges and Solutions
The “gold standard” for diagnosing osteoporosis is Dual Energy X-ray Absorptiometry (DEXA), which measures bone mineral density (BMD) at central sites like the lumbar spine and hip. However, DEXA scans face significant accessibility challenges in the Philippines:
- They are not readily available at the community level
- The high cost of screening is prohibitive for many Filipinos
- Limited resources in developing areas restrict widespread use
As an alternative, Quantitative Ultrasonography (QUS) has become increasingly accepted as a screening tool. It’s more affordable and accessible, though it has limitations compared to DEXA. Studies using QUS in the Philippines have shown varying prevalence rates of osteoporosis, from 3% to 19.8% depending on the population studied.
The FRAX (Fracture Risk Assessment Tool) is another valuable resource, combining clinical risk factors with or without BMD measurements to estimate fracture risk. Recent research has established Philippines-specific FRAX intervention thresholds, making it more applicable to the local population.
Prevention and Management
The good news is that osteoporosis is largely preventable, and even when diagnosed, it can be effectively managed:
Lifestyle Modifications
- Calcium-Rich Diet: Incorporate foods like small fish eaten with bones, green leafy vegetables, cereals, shellfish, and dairy products. Food fortification programs beyond just milk products could serve as vehicles for calcium and vitamin D.
- Vitamin D: Ensure adequate vitamin D through sufficient sunlight exposure and supplementation when necessary.
- Regular Exercise: Engage in weight-bearing exercises like walking, jogging, and resistance training to strengthen bones and muscles, improve balance, and prevent falls.
- Avoid Smoking and Excessive Alcohol: Both contribute to bone loss and should be limited or eliminated.
Medical Interventions
For those diagnosed with osteoporosis, treatment options include:
- Anti-resorptive medications: These slow or block bone resorption, increasing bone strength and preventing fractures. Bisphosphonates like alendronate, risedronate, and zoledronic acid are commonly prescribed.
- Anabolic treatments: These speed up the formation of new bone and are an option for individuals with very high fracture risk or elderly individuals with multiple fractures.
- Calcium and Vitamin D supplementation: Essential components of any osteoporosis treatment plan.
- Hormone therapy: Estrogen therapy may be considered for some women after menopause to help prevent bone loss.
A Multidisciplinary Approach
The management of osteoporosis, particularly for elderly patients with fractures, benefits significantly from a multidisciplinary team approach. The UP-PGH Orthogeriatric Multidisciplinary Fracture Management Model and Fracture Liaison Service (FLS) is an excellent example of this approach in the Philippines.
This model has shown promising results, including:
- Decreased average time from admission to surgery (from 13 days to 5 days)
- Reduced average length of hospital stay (from 21 days to 13 days)
- High follow-up rates (96%) and good compliance with maintenance medication (72%)
Call to Action
As the projected number of Filipinos at risk reaches over 10 million by 2050, addressing osteoporosis becomes increasingly urgent. Here’s what needs to be done:
- Increase Awareness: Osteoporosis is often seen as part of natural aging and not considered a national health priority. Public education campaigns are essential to changing this perception.
- Improve Accessibility to Diagnosis: Local Government Units (LGUs) should establish diagnostic facilities like DEXA scans in their Health Centers for early detection.
- Preventive Programs: LGUs should implement sustained public awareness programs on bone health and initiate primary prevention programs focusing on nutrition and lifestyle.
- Food Fortification: Intensify food fortification programs to serve as vehicles for calcium and Vitamin D.
- Individual Action: Filipinos, especially those over 50, should prioritize bone health, get screened, and consult with healthcare providers about prevention and treatment options.
Osteoporosis may be silent, but its impact is profound. Through increased awareness, early detection, and appropriate intervention, we can work toward a future where fewer Filipinos suffer from this preventable condition. The time to act is now – before the silent epidemic grows louder through its devastating consequences.
Additional Resources
For more information on osteoporosis and bone health resources in the Philippines, please check out my previous post which contains helpful links to resources for prevention, diagnosis, and treatment.
Jasmin Vinculado
