Speech by Dr. Amy Khor, Senior Minister of State for Health at the Opening Ceremony of the International Osteoporosis Foundation Asia Pacific Regionals Conference

Professor John Kanis and Dr Lee Joon Kiong, Meeting Co-Chairs

Professor Serge Ferrari and Dr Manju Chandran, Co-Chairs of the Scientific Programme Committee

Dr Chionh Siok Bee, Chair of the Local Organising Committee

Distinguished Guests,

Ladies and Gentlemen,

Good evening.

       It is my pleasure to be here today with you at the International Osteoporosis Foundation (IOF) Regionals 6th Asia-Pacific Osteoporosis Meeting.

Osteoporosis as a growing health concern

2.     In Singapore, osteoporosis has been a growing health concern, as the rate of people over age 50 suffering from hip fractures has increased five-fold in women and one-and-a-half fold in men from the late 1960’s to the late 90’s.^[1] With our aging population, it is likely that these figures will continue to increase. By 2030, the number of seniors over 65 years of age will more than double, from 430,000 today to over 900,000. At that time, one in five of us will be in that age range, an increase from one in nine at present.

3.     People with osteoporosis are more prone to fractures, with hip fractures the most severe among them. The rise in osteoporosis is therefore worrying, as hip fractures can have significant impact on the health and well-being of our patients.

4.     Internationally, up to half of patients who sustain hip fractures are unable to regain their ability to live independently, and as many as one in four hip fracture patients die within one year of sustaining the fracture.^[2] A study done in Singapore saw similar trends. The study found that about one-quarter of patients who sustained osteoporotic hip fractures died within one year.^[3] Of survivors, two in five required walking aids, and one in three were either wheelchair or bed bound one year after the fracture. These are very sobering statistics.

5.     Given the high cost and potentially severe impact of osteoporosis and hip fractures, it is crucial that every effort be made to prevent, detect and treat osteoporosis.

Osteoporosis prevention

6.     There are many preventable risk factors for osteoporosis. These include a poor diet, lack of physical activity, smoking and excessive alcohol consumption. While we cannot stop ourselves from getting older, we can avoid some of these risk factors by not smoking, moderating our alcohol, leading a more active lifestyle and having a healthy diet. Diet is especially important in osteoporosis prevention. However, the National Nutrition Survey conducted by the Health Promotion Board in 2010 found that three-quarters of adults between the ages of 50 and 70 do not have an adequate daily intake of calcium.

7.     To address this gap, HPB launched a nutrition campaign in May this year to help adults aged 50 years and above to understand the importance of good nutrition and encourage them to take sufficient calcium every day.

Osteoporosis detection and treatment

8.     To promote awareness of osteoporosis and better identify women at risk of osteoporosis, the Osteoporosis Self-assessment Tool for Asians, or OSTA, is a quick and easily self-administered chart that helps women discover their risk of osteoporosis based on their age and weight.^[4] Women who are high risk as indicated on the OSTA can then see their doctor for advice on whether to follow up with a bone mineral density scan for diagnosis.

9.     We understand the financial strain that osteoporosis can bring to a patient and his family. In June last year, osteoporosis was added to the list of conditions under the Chronic Diseases Management Programme, which allows patients to use their Medisave savings to offset management costs of osteoporosis, such as medication and doctor’s fees when patients seek medical treatment in the polyclinics or their family doctors.

10.     To further enhance accessibility to treatment, the Ministry of Health has also increased government subsidy for alendronic acid, one of the most commonly used medications for osteoporosis. Since April last year, means testing is no longer required to receive a subsidy for alendronic acid, making the drug more affordable to subsidised patients. Together, these changes will make osteoporosis treatment much more accessible to those who need it.

Public education

11.      These strides taken in prevention, detection and treatment of osteoporosis need to be coupled with public education. Many patients still think that osteoporosis is unimportant and regular follow up is time consuming. They also fear the possible side effects of treatment. We should empower healthy individuals with knowledge of how to prevent osteoporosis. We should also instil confidence in those with osteoporosis to be proactive and take control of their health for the best health outcomes.

12.     In view of this, the Women’s Health Committee will construct a two year roadmap to promote good bone health and osteoporosis prevention. This roadmap will incorporate OSTA in community health screenings, publicise regular reminders regarding the importance of calcium intake for bone health, and promote fall prevention awareness as part of the National Senior’s Health Programme and support the Action Plan for Successful Ageing.

Conclusion

13.      Improvements in prevention, early detection and adherence to optimal treatment are needed to address this growing issue. Events such as the IOF Conference will serve to inform us as to the best way forward with our ageing population.

14.      I wish you all a wonderful and enriching conference. Thank you.

^[1] Hip Fracture Incidence Rates in Singaporeans 1991-1998. Koh LKH et al, Osteoporosis International, 2001; 12:311–318

^[2] Johnell & Kanis, Epidemiology of osteoporotic fractures, Osteoporosis Int (2005) 16:S3-S7 & Schnell et al, The 1-Year Mortality of Patients Treated in a Hip Fracture Program for Elders, Geri Orth Surg & Rehab, 2010, 1(1), 6-14

^[3] Wong et al, Osteoporotic hip fractures in Singapore – Costs and Patient’s Outcome, Ann Acad Med Singapore 2002; 31:3-7

^[4] The OSTA is a chart which indicates the risk group (low risk, at-risk, high risk) which a woman falls into based on her age and weight