As the country officially reached aged nation status in 2021, Malaysia now faces a projected 3.5-fold increase in hip fractures between 2018 and 2050 — the highest rise in Asia.
This alarming trend is expected to burden the health care system with costs exceeding RM530 million (US$125 million) by 2050, underscoring the urgent need for preventive measures and greater public awareness.
Among those most vulnerable to osteoporosis and its complications are Malaysian women, particularly post-menopausal women, who are often overlooked in the conversation about bone health.
They face a unique set of bone health challenges that often go unaddressed, significantly affecting their quality of life and overall wellbeing.
Why Post-Menopausal Women Are Vulnerable
The risk of osteoporosis is doubled in post-menopausal women as compared to men. By 2050, more than 50 per cent of the world’s hip fractures is projected to occur in Asia.
Unfortunately, local data reveals a 20 per cent mortality rate after a hip fracture, with more than 40 per cent of men and women always needing support or a walking frame for the rest of their lives.
Malaysian women were also found to underestimate menopause-related problems and there was a lack in seeking treatment.
Post-menopausal women are at the forefront of osteoporosis risk due to a sharp decline in estrogen, a hormone crucial for maintaining bone density.
This hormonal drop accelerates bone loss, increasing the likelihood of fractures, especially in the hip, spine, and wrist.
Post-menopausal women face an alarmingly higher likelihood of fragility fractures, yet many remain undiagnosed and untreated.
Prioritising this vulnerable population through targeted screening, education on lifestyle changes, and timely medical interventions can significantly reduce fracture rates and the associated long-term health care burden.
Other challenges include cultural stigma around aging, which may discourage women from discussing health issues openly, and inadequate access to resources like nutrition education or physical activity programmes tailored to their needs.
By prioritising this vulnerable population through targeted screenings, lifestyle education, and timely medical interventions, we can significantly reduce fracture rates and alleviate the associated long-term health care burden.
Lifestyle And Nutritional Challenges
Nutritional deficiencies, particularly in calcium and vitamin D, are prevalent among women in Malaysia.
Calcium is vital for building and maintaining bone tissue, while vitamin D helps in calcium absorption and bone mineralization. Inadequate intake of these nutrients can lead to weakened bones and an increased risk of fractures.
Although Malaysia is a tropical country with ample sunshine, cultural practices like modest dressing, especially among Muslim women, limit sun exposure and contribute to widespread vitamin D deficiency.
A study revealed that 82.7 per cent of Chinese post-menopausal women in urban Malaysia had serum vitamin D deficiency.
Another multi-ethnic study found vitamin D hypovitaminosis in 26.7 per cent of Malay women and a staggering 87.8 per cent of Chinese women aged 50 to 65 in Kuala Lumpur.
Notably, 71.3 per cent of Malay women and 12.2 per cent of Chinese women had vitamin D deficiency, reflecting disparities among ethnic groups.
Vitamin D deficiency remains alarmingly high among post-menopausal women, in both urban and even rural areas.
Despite ample sunshine, Malaysians do not expose themselves to sunshine and as ageing occurs, the skin’s ability to make Vitamin D also declines.
This underscores the urgent need for screening and tailored interventions, such as vitamin D supplementation and dietary education, to ensure post-menopausal women receive adequate levels of this essential bone and muscle nutrient.
The Importance Of Early Action
Osteoporosis is often called a “silent disease” because it progresses without noticeable symptoms until a fracture occurs.
For post-menopausal women, early screening is a critical intervention. The Bone Mineral Density (BMD) test, which uses dual-energy X-ray absorptiometry (DXA), remains the gold standard for diagnosing osteoporosis.
The guidelines emphasise that women aged 50 and above should undergo routine screening, especially those with risk factors such as family history, low body weight, or previous fractures.
Tools like the Fracture Risk Assessment Tool (FRAX) and the Osteoporosis Self-Assessment Tool for Asians (OSTA) can help identify women at high risk, prioritising them for further evaluation and intervention.
Early diagnosis through bone density scans is crucial in detecting the disease, preventing fractures and minimising long-term health care costs.
Malaysian health systems must prioritise access to affordable screening programmes, especially for high-risk groups like post-menopausal women.
Public awareness campaigns are equally vital to educate individuals on the importance of early screening in preventing severe bone deterioration.
There is an urgent need to call for action and to recognise osteoporosis is a non-communicable disease (NCD), equally morbid to diabetes or hypertension.
In addition, establishing a centralised patient registry and funding larger-scale osteoporosis studies will play an integral role in developing effective, integrated care pathways for bone health management.
Breaking The Cycle: The Role Of Fracture Liaison Services
The International Osteoporosis Foundation (IOF) also reports that 80 per cent of patients worldwide are still not diagnosed or treated for osteoporosis after a fracture.
In Malaysia, fewer than one in four patients regain full mobility within six months of a fracture, underscoring the need for post-fracture care coordination programmes such as Fracture Liaison Services (FLS).
To address the high rates of post-fracture neglect, Malaysia must prioritise the implementation of Fracture Liaison Services (FLS).
These programmes, proven effective globally, ensure that patients with fragility fractures receive coordinated post-fracture care, including osteoporosis diagnosis, treatment, and rehabilitation.
For Malaysian women, especially those balancing multiple roles, these services could mean the difference between prolonged disability and a return to active living.
Championing Bone Health In Malaysia
Since its inception in 2020, Bone Health Alliance Malaysia (BHAM) has advocated for proactive measures such as regular bone health screenings and consultations with health care professionals to improve osteoporosis diagnosis and treatment.
Consistent physical activity, beginning at an early age, is also essential for building and maintaining strong bones throughout life.
Despite its prevalence, osteoporosis remains under-diagnosed in Malaysia. Low awareness, misconceptions, and a lack of understanding about the disease have contributed to this.
According to a survey conducted by BHAM, 96 per cent of respondents were unaware of the risk factors associated with osteoporosis.
Furthermore, after sustaining a fragility fracture, 80 per cent of patients are still not diagnosed or treated for osteoporosis, leading to a high risk of subsequent fractures within the first two years after the initial fracture.
Assoc Prof Dr Jeyakantha Ratnasingam is a consultant endocrinologist at UM Specialist Centre (UMSC) and committee member of the Malaysian Osteoporosis Society.
- This is the personal opinion of the writer or publication and does not necessarily represent the views of Ova.
