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Osteoporosis is a long-term condition that causes bones to become thin, weak, and brittle. In healthy bones, there is a balance between bone formation and bone breakdown. However, as we age (especially after age 50) this balance is disrupted. Bone loss starts to occur faster than the body can rebuild it, leading to a decrease in bone density. This makes the bones more porous and prone to fractures, even from minor slips, bumps, or sudden movements.
Many people don’t realise they have osteoporosis until they suffer a fracture, especially in the hip, spine, or wrist. These fractures can lead to chronic pain, loss of independence, or even long-term disability. That’s why osteoporosis is often called a “silent disease.” Prevention, early detection, and proper management are key to protecting your bone health as you age.
How common is osteoporosis?
Osteoporosis is a global public health issue, particularly affecting older adults. According to the International Osteoporosis Foundation, more than 200 million people worldwide are living with osteoporosis. The risk increases significantly with age, especially among postmenopausal women due to the drop in estrogen levels, a hormone that protects bones.
In Singapore, studies show that one in three women and one in five men aged 50 and above will experience an osteoporosis-related fracture in their lifetime. These fractures are not only painful but are also associated with longer hospital stays, slower recovery, and increased mortality in older adults. The hip fracture rate in Singapore is among the highest in Asia, and with a rapidly ageing population, the numbers are expected to rise.
Osteoporosis doesn’t just affect your bones, it affects your quality of life. That’s why early prevention and appropriate treatment, including lifestyle changes and proper supplementation, are so important.
Common osteoporosis medications
There are several medical approaches to managing osteoporosis, ranging from prescription medications to over-the-counter supplements. Common classes of prescription drugs include:
Bisphosphonates (e.g., alendronate, risedronate) – slow down bone loss.
Denosumab – a biologic agent that reduces bone breakdown.
Teriparatide – a synthetic hormone that stimulates bone formation.
Selective Estrogen Receptor Modulators (SERMs) – help maintain bone density in postmenopausal women.
However, the most foundational and universally recommended approach is to ensure adequate calcium and vitamin D intake. These nutrients are essential for bone growth, maintenance, and repair. In fact, many prescription osteoporosis medications will not work effectively without a proper baseline of calcium and vitamin D in the body. They are often the first step in both prevention and early management of bone loss, especially for individuals who are not yet candidates for stronger medications.
Even if you’re not diagnosed with osteoporosis, your doctor may recommend these supplements if your bone density is low or if you’re at risk due to family history, menopause, poor diet, or lack of sunlight exposure.
How calcium and vitamin D work?
Calcium builds bones, and vitamin D helps the body absorb and use calcium effectively. Both are essential to maintain bone strength and prevent fractures in older adults.
Calcium:
Makes up 99% of the mineral content in bones.
Prevents bone loss and supports bone remodeling.
Typical daily intake recommended: 1000–1200 mg/day.
Vitamin D:
Enhances calcium absorption in the gut.
Helps regulate calcium and phosphate in the blood.
Supports muscle function to reduce fall risk.
Daily recommended dose: 800–1000 IU/day.
Supplement Guidelines:
Split calcium into two doses (e.g., 500 mg morning and night) for better absorption.
Choose calcium carbonate with food or calcium citrate with or without food.
Take vitamin D with meals containing healthy fats (e.g., eggs, milk, nuts).
Drug interactions and precautions
While calcium and vitamin D are beneficial, they may interact with other medications.
Watch out for drug interactions with:
Thyroid medications (e.g., levothyroxine)
– Take at least 4 hours apart from calcium.Antibiotics (e.g., tetracycline, ciprofloxacin)
– Take 2–4 hours apart to avoid reduced effectiveness.Diuretics (e.g., hydrochlorothiazide)
– May increase calcium levels, leading to hypercalcemia.Heart medications (e.g., digoxin)
– Risk of abnormal heart rhythms when calcium is too high.
Precautions if you have kidney disease and parathyroid or vitamin D metabolism disorders. Always inform your doctor or pharmacist about all medications and supplements you are taking.
Food and supplement compatibility
The way you take your supplements, and what you take them with, can affect how well they work.
Calcium:
Calcium carbonate – Take with meals (requires stomach acid).
Calcium citrate – Can be taken with or without food.
Avoid taking with high-fiber foods or oxalate-rich vegetables (like spinach), which can block absorption.
Vitamin D:
Take with a meal containing fat (e.g., avocado, olive oil, dairy) to boost absorption.
Fortified foods (e.g., cereals, milk) can help meet daily needs.
Avoid or limit:
Caffeine and salt – Increase calcium loss through urine.
Alcohol and tobacco – Negatively impact bone health and vitamin D metabolism.
Watch out for side effects and signs of incompatibility
Side effects are rare but can occur with overuse or improper combinations.
Common side effects:
Calcium:
Constipation or bloating (especially with calcium carbonate).
Kidney stones (when taken in excess or without adequate hydration).
Hypercalcemia (high calcium in blood) – symptoms include nausea, vomiting, confusion, and weakness.
Vitamin D:
Usually well-tolerated.
Toxicity occurs only with very high doses over time.
Signs of vitamin D toxicity: nausea, frequent urination, bone pain, or kidney problems.
Seek medical attention if you notice:
Persistent stomach upset or constipation.
Feeling very tired, confused, or weak.
Sudden changes in urination or kidney discomfort.
Conclusion
Calcium and vitamin D are simple, accessible, and essential tools in the fight against osteoporosis, but they are not one-size-fits-all. It’s important to remember that more is not always better. Over-consumption can lead to health risks like kidney stones or imbalances with other medications.
Older adults often take multiple medications for various chronic conditions, so it’s crucial to avoid polypharmacy, taking too many drugs at once without proper coordination. Always check with your doctor or pharmacist before starting any new supplement, and keep an updated list of all the medications and health products you use.
Incorporating calcium- and vitamin D-rich foods into your daily diet, getting safe sun exposure, engaging in weight-bearing exercises, and monitoring your bone health through regular check-ups will go a long way in protecting your mobility and independence.
Strong bones mean a stronger future. Stay informed, stay proactive, and take charge of your bone health today.