Susan Low, 48, had always attributed her aches and pains to age. So when she started feeling pain in her hips, she tolerated the discomfort. "The throbbing pain comes on and off in my hipbone. When it's not painful, I can do most of the things I enjoy. When it's really bad, I can't walk, I can't get out of my chair. I can barely stand up straight. My body would be bent into an ‘S'."

In 2006, Susan went to see a doctor in a government hospital about an unrelated problem. During the consultation, Susan mentioned her bone problem and her doctor referred her to an orthopaedic surgeon. Her bone system was scanned and they found that she was suffering from ostopenia, a condition where the bone mass density is lower than normal but has not reached the level of osteoporosis. However, a follow-up scan a few weeks later showed that her hipbones had deteriorated sufficiently to be classified as osteoporosis.

Susan was put on medication, including calcium and vitamin D supplements, but after six months, showed no improvement. She sought a second opinion at a private hospital but received the same results. switch in medication, however, worked. After another six months, tests showed that her bone density levels had increased to almost normal levels.

"I'm glad that the treatment restored my bone strength. I never liked drinking milk even as a child, so maybe this is why I have this problem. I tell my children to drink more milk and take calcium and magnesium supplements to help them avoid this problem later in life."

Understanding the disease

At this point, you're probably thinking that osteoporosis affects women who are in their twilight years, so really what does this have to do with you? After all, calcium absorption only begins to decrease after the age of 60, as Professor Chan Siew Pheng, President of the Malaysian Osteoporosis Society (MOS), points out.

But you would have noticed that Susan is only in her late 40s. Clearly, osteoporosis doesn't have a set age group that it targets. Although this disease generally affects women who are above 65 years of age, it does tend to run in families, which means that those with a family history of this problem should begin taking care of their bones immediately.

As we age, our bones weaken and dissolve. It is reabsorbed by our system but is not sufficiently replaced with new bone matter. This process of dissolving and rebuilding is nature's way of allowing our bones to adjust its strength and repair fractured areas. Bones that carry more weight will become thicker and stronger, while under-utilised bones tend to become weaker. If the bones continue thinning for a long time, they can become so weak that they break with very little force. This process happens so stealthily that it often goes undetected until it is too late.

This means that exercise plays a vital role in maintaining the strength of not just our muscles but bones as well. Exercises that are most beneficial are weight-bearing ones - exercises where your feet and legs support all your weight - such as walking or jumping jacks.

"Swimming and cycling are good, but they are not as effective in strengthening the skeleton. patient who is sedentary or immobile is at bigger risk, as lack of movement causes us to lose bones at a faster rate. Other than strengthening the bones, exercise also strengthens muscles and keeps them supple. Strong muscles reduce the likelihood of unsteadiness which often causes bad falls and subsequently, fractures," Prof Chan explains.

"The best way to avoid problems arising from osteoporosis is to keep patients from falling," says Prof Chan. Falling is the major cause of hip and bone fractures. "Even fragile bones hardly ever break unless some force is exerted on it. So make sure your house doesn't have slippery floors and steps where patients can trip and fall. Also avoid medications that make them dizzy and prone to falling down," she adds.

Dr JK Lee, a Consultant Orthopaedic Surgeon, Vice President of MOS, says that although pain is not a common indicator of osteoporosis, weakened muscles and bones could lead to discomfort. Sometimes, osteoporosis patients feel pain due to tiny fractures in their bones, usually along their spine, resulting in chronic back pain. In many cases, people can literally grow shorter as their spinal bones break and collapse. In others, the back can become hunched or form a hump - also referred to as dowager's hump, as it often happens to older women.

In severe cases, the bones sometimes fracture if pressure is exerted on them. This can come from lifting heavy weights or merely coughing and sneezing. However, hip and arm bones do not usually break unless the patient
hits them hard.

Although bone loss does occur in men as well, their larger, stronger bones generally hold up better than women's, and they don't go through similar hormonal changes. As women age, calcium absorption from food becomes less efficient, thus weakening bones as calcium loss exceeds replacement. In some cases, the onset of osteoporosis could be due to kidney problems, or from the side effects of medication that disrupt calcium absorption or bone formation. The skin also becomes less capable of producing vitamin D from exposure to sunlight in later years. It is vitamin D that aids calcium absorption.

* Extracted from June's Her World magazine

D the way to fight it

The most crucial nutrients for optimal bone health are calcium and vitamin D. "Calcium is required by the bones, but bear in mind that it can't be absorbed without vitamin D to assist in the process.Therefore, there is not much use eating high-calcium foods unless there is sufficient vitamin D in your system.

You can get vitamin D from multivitamin supplements or from exposure to sunlight. It's not widely found in food unless it's vitamin D enriched. It is recommended to take 400-800 I.U of vitamin D and 500mg-1g of calcium supplements per day. That's about 2 glasses of high-calcium milk. Activated vitamin D can only be prescribed by doctors and has to be supervised, as it can cause high blood calcium. Too much calcium in the blood can cause health problems like kidney stones," warns Prof Chan.

To screen for osteoporosis, doctors use a chart to see if a person is at risk. The smaller sized a person is at an older age, the higher her risk of contracting the disease. The other method is to use an ultrasound to scan the heels. But the only test that can truly determine if a person has osteoporosis is a Bone Mineral Density test, which is done using either a special X-ray, computed tomography (CT) scan, or ultrasound. The unit of measurement is the T-score, which is a comparison of your bone density with that of standard healthy young women. The normal range for bone density is a T-score above -1. A score between -1 and -2.5 indicates osteopenia while a reading of less than -2.5 indicates osteoporosis.

Although this problem usually affects women in the later years, it is prudent to care for our bone health from  today. This isn't difficult at all. Just ensure that your diet is fortified with calcium and vitamin D, and that you get a decent amount of exercise. That's nothing at all compared to the hell you might have to go through should  your bones begin to dissolve into nothing.