Osteoporosis and Calcium Disorders

Choosing the right specialist depends on whether you are treating a break or the bone quality itself. While an Orthopaedic Surgeon is the expert you need for repairing a fracture or performing surgery, an Endocrinologist is the specialist who manages the underlying metabolic and hormonal causes of bone loss.

• Root Cause Analysis: At LW Cho Endocrine Clinic, we focus on why your bones are thinning in the first place. This involves checking for hormonal imbalances, such as parathyroid issues or estrogen/testosterone deficiencies, which directly impact bone density.
• Metabolic Management: Dr. Cho Li Wei, a dedicated osteoporosis doctor in Singapore, specialises in the systemic medical management of bone health. We look at your body’s internal chemistry to prevent the next fracture, rather than just treating the current one.
• Long-term Prevention: If you have been diagnosed with low bone density but haven’t had a break yet, an Endocrinologist is the most appropriate specialist to help you strengthen your internal scaffolding through medical and lifestyle interventions.

A Dual-Energy X-ray Absorptiometry (DEXA or DXA) scan is a highly precise, low-dose X-ray that measures the mineral content of your bones, usually at the hip and the lower spine. It is considered the most dependable method for identifying bone loss, as it generates a T-score that measures your bone density against that of a healthy young adult. The radiation exposure is extremely low, typically less than a day’s worth of natural background radiation.

A T-score of -1.0 or higher is considered normal. A score between -1.0 and -2.5 indicates osteopenia (early bone loss), and -2.5 or lower confirms a diagnosis of osteoporosis.

Beyond diagnosis, we use DEXA scans to track how well your treatment is working. By repeating the scan every 1 to 2 years, Dr. Cho can see if your bone density is stabilising or improving, allowing us to adjust your medications with high accuracy.

We strive to make the diagnostic process as seamless as possible for our patients by coordinating closely with our partner radiology centres within the same medical building, such as at Gleneagles or Parkway East. This coordination typically allows you to get your scan done on the same day as your consultation, meaning you don’t have to make multiple trips to different locations. Once the scan is completed, the raw data is sent back to Dr. Cho, who personally interprets the images and the T-scores in the context of your overall medical history. This ensures that the final report isn’t just a set of numbers, but a meaningful part of your personalised care plan discussed during a one-stop review session.

Think of bone health as being on a sliding scale where both terms describe bones that are weaker than they should be, but represent different stages of severity.

Osteopenia is often considered pre-osteoporosis, where your bone density is lower than normal but not yet low enough to be classified as highly fragile. This is the critical warning zone where lifestyle changes and early intervention can have the biggest impact.

Osteoporosis is a more advanced stage where the internal structure of the bone has become significantly thinned and porous, much like a sponge with large holes. This makes the bones brittle and significantly increases the risk of a fragility fracture from a minor fall. While osteopenia might only need nutritional optimisation, osteoporosis typically requires specialised medical therapy to actively rebuild bone.

We use advanced risk-assessment tools like OSTA and FRAX to look beyond just your T-score and predict your actual risk of breaking a bone in the next ten years.

The OSTA (Osteoporosis Self-Assessment Tool for Asians) is a simple formula based on your age and body weight designed specifically for Asian populations to identify those who need a scan.

The FRAX (Fracture Risk Assessment Tool) is a more comprehensive digital tool that calculates your 10-year probability of a major fracture by taking into account your gender, smoking history, family history, and use of certain medications.

By combining your DEXA results with these scores, Dr. Cho can determine if your risk is high enough to warrant osteoporosis treatment in Singapore, even if your density hasn’t reached the official osteoporosis range yet.

Bisphosphonates are a very common class of medication used to prevent bone loss, but they must be taken correctly to avoid side effects. The most common issue for oral versions like Fosamax is irritation of the esophagus, which can feel like heartburn.

To prevent this, you must take the pill on an empty stomach with a full glass of plain water and remain upright for at least 30 to 60 minutes. For those who cannot tolerate the oral version, we offer intravenous options that are administered once a year, bypassing the stomach entirely. You may have heard of very rare concerns like jaw bone issues, but these occur in less than 1 in 10,000 patients treated for osteoporosis. Dr. Cho will thoroughly review your dental health and medical history to ensure these medications are safe for you.

A few decades ago, the goal was simply to stop things from getting worse, but today we can often do much better than that. We now have bone-building medications that actually stimulate the body to create new bone tissue rather than just stopping old bone from being broken down. Many patients at LW Cho Endocrine Clinic see a measurable increase in their bone mineral density on their follow-up DEXA scans after starting these treatments. While we might not always return your bones to the state of a 20-year-old, we can often move your T-score from the high-risk osteoporosis range back up into the osteopenia range, significantly reducing your risk of life-altering fractures and strengthening your overall skeletal structure.

Exercise is medicine for your bones, but the type of exercise matters immensely when your bones are thin.

• Weight-bearing aerobics like brisk walking or dancing force your bones to work against gravity, which signals them to stay strong.
• Resistance training with light weights or bands helps build muscle, which acts as a natural cushion and support system for your skeleton.
• We also highly recommend exercises like Tai Chi that improve balance, as preventing a fall is the most effective way to prevent a fracture.

We generally advise avoiding heavy forward-bending or high-impact jumping if your bone density is very low, as these can put excessive pressure on a fragile spine.

Calcium and Vitamin D are the bricks and mortar of your bones and work best when optimised together because your body cannot effectively absorb calcium without sufficient Vitamin D. This is why many supplements combine both into one tablet for synergy. Despite our sunny weather, we see a very high prevalence of vitamin D deficiency in Singapore because many people spend time in air-conditioned offices or use sun protection. We usually recommend getting as much calcium as possible from food sources like dairy or fortified plant milks and using supplements to fill the gap. Dr. Cho will check your blood levels to ensure you aren’t taking too much calcium while ensuring your Vitamin D levels are high enough to protect your skeleton.

Yes, men are also susceptible to bone loss as they age. While women are at higher risk due to the drop in estrogen during menopause, men’s bone health often develops more slowly and is diagnosed much later, frequently only after they have already suffered a painful hip or spine fracture.

In men, bone loss is often linked to low testosterone levels, heavy alcohol use, smoking, or the long-term use of steroid medications. At LW Cho Endocrine Clinic, we provide specialised bone health screening for men and believe that bone density should be a standard part of health check-ups for men over 65 to ensure they remain mobile and independent.