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Article Source: Sin Chew Daily
May 6, 2024

As age increases, the body functions of the elderly gradually decline, and their movements are no longer as flexible and agile as when they were younger, so they need to be extra careful. In daily life, if the elderly accidentally fall, they are prone to fractures and are accompanied by a series of complex complications. Therefore, they need comprehensive treatment and care from geriatric orthopedics.

As the body enters the aging stage, the bones will undergo major changes in quality and quantity, making the bones of the elderly more fragile.

Consultant Orthopaedic and Trauma Surgeon at Beacon Hospital Dato’ Dr Lee Joon Kiong pointed out that aging leads to gradual degeneration or strain of joints, which will lead to degenerative arthritis or bone spurs.

“It is common for clinical patients to suffer from knee arthritis, but degenerative arthritis not only occurs in the knees, but also includes cervical joints, lumbar joints, hip joints, fingers and other parts.”

Osteoporosis has no obvious warning signs

At the same time, reduced bone density or bone mass is also one of the biggest health problems faced by the elderly. He said that since osteoporosis itself has no obvious symptoms or warning signs, the elderly are surprised to be diagnosed with osteoporosis when they develop fragility fractures after falling from a standing height.

“Human bone mass increases with age after birth, reaches its peak around the age of 25, and gradually declines in old age. In particular, women experience hormonal changes during menopause, which can easily lead to osteoporosis and spinal compression. Fractures, such as hunchback, height loss and other non-emergency fractures.”

Awareness needs to be strengthened

Dato’ Dr Lee Joon Kiong pointed out that compared with European and American countries, our country’s bone health prevention measures and public awareness are relatively insufficient.

“Osteoporosis fails to make the list of the top ten diseases. People generally pay more attention to heart disease, diabetes and high blood pressure. They mistakenly believe that osteoporosis is part of the natural process of the human body and ignore the importance of bone diseases. “

Timely treatment can reduce the period of morbidity

Dato’ Dr Lee Joon Kiong revealed that hip fractures will cause serious harm to the elderly. 25% of elderly people die within 1 year due to hip fracture; another 50% of elderly people need to rely on crutches or wheelchairs for mobility, and the remaining 25% of elderly people can move freely without relying on crutches after recovery.

“After a hip fracture, if not treated in time, the patient will be forced to stay in bed for a long time. Many patients die due to complications caused by long-term bed rest, such as pneumonia, bacterial infection, urinary tract infection, venous thrombosis, etc. Therefore, after a fracture, you should perform surgical treatment as soon as possible and allow the patient to get out of bed as soon as possible to avoid various complications. “

Dato’ Dr Lee Joon Kiong also mentioned that the principle of treating hip fractures in the elderly is to complete the operation within 48 hours.

If the elderly have internal medical diseases, such as heart disease, high blood pressure or diabetes, surgery must be delayed. At this time, the patient needs to receive treatment from a physician for the relevant medical conditions first, and hip fracture surgery can only be arranged after the physical condition is stable.

“Many people think that fractures in the elderly only need to be handled by an orthopedic surgeon.

However, this type of surgery is best done by geriatric physicians and orthopedic surgeons working together to develop the most appropriate surgical treatment plan for the patient and minimize risks. “

Currently, only a few hospitals in our country have geriatric medicine departments, and Beacon Hospital is one of them.

The hospital established this clinical department in 2023, which consists of geriatric medicine, orthopedic surgeons, dietary therapists, anesthesiologists, and pharmacists to form a cross-departmental professional team. However, many hospitals in our country do not have geriatric departments and can only be managed by orthopedics and internal medicine doctors.

Need to increase bone density after surgery

“Subsequent fractures occur when an older person has fallen but is not aware that he or she has osteoporosis and is therefore likely to have this condition again within the next year, such as using the toilet at night without turning on the light or accidentally due to poor vision fall.”

“Therefore, after the patient completes surgical treatment, doctors need to assess the patient’s risk of falling again, and take measures to reduce and prevent the risk to the greatest extent possible from aspects such as residence and living environment and bone density.”

According to Dato’ Dr Lee Joon Kiong’s observation, many orthopedic surgeons ignore patients’ osteoporosis before and after surgery, so patients may suffer repeated falls. He believes that if patients have stronger bone density and stronger bones, they will be less susceptible to fractures if they fall again in the future.

“Even with artificial knee replacement to replace an injured or worn knee joint, most patients can use the implanted artificial joint normally for 20 years or more.”

If a patient has osteoporosis and the doctor does not increase the bone density after surgery, the risk of fractures may increase near the artificial joint. The bone may sag or collapse, making it unable to support the artificial joint, causing the patient to experience knee joint pain again.

Elderly individuals facing osteoporosis should focus on both treatment and lifestyle modifications.

Adequate daily dietary intake of calcium (1200 mg) and vitamin D (1200 international units), moderate sun exposure, and moderate exercise (brisk walking, Tai Chi, etc.) are all beneficial to bone density.

3 ways to strengthen bones

Dato’ Dr Lee Joon Kiong revealed that clinically, drugs used to treat osteoporosis can be divided into three major categories.

  1. The first category of drugs is to reduce bone loss. 
  2. The second category of drugs is to increase bone building function. 
  3. The third category of drug has dual functions, reducing bone loss and improving bone building function. 

Your doctor will choose the most appropriate medication to treat your osteoporosis based on your physical condition.

A few years ago, Dato’ Dr Lee Joon Kiong and several orthopedic surgeons established the MyBONe Society (MyBONe Malaysian Bone Health Optimization Network) to educate all orthopedic surgeons on the importance of treating osteoporosis and advocate the responsibility of assessing bone health.

“We hope that through the promotion of this concept, every orthopedic surgeon will be more proactive in paying attention to and treating osteoporosis, thereby increasing the treatment rate and reducing the occurrence of fractures and secondary fractures.”

He also reminded readers to start receiving bone density tests (DEXA/DXA) during menopause to detect bone loss in the body. If your loved ones have high risk factors such as fractures and osteoporosis, they need to check their bone density regularly.

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