Many patients only come to me after suffering a fracture — a minor fall, yet it turns out their spine or hip has cracked. On investigation, their bone density had been very low for years without them ever feeling any sign. This is why I call osteoporosis the "silent thief."
How Do Bones Work?
Bone is not a dead structure — it is living tissue that is continuously renewed. There are two main types of cells:
- Osteoblasts: Cells that build new bone
- Osteoclasts: Cells that absorb and break down old bone
In youth (up to around age 30), osteoblasts are more active — bone density keeps increasing. After that, the balance shifts. In women, the most dramatic change occurs in the first 5–7 years after menopause, when bone density loss can reach 20% due to the drastic drop in oestrogen.
Osteoporosis Risk Factors
Factors that cannot be changed:
- Female sex (3× higher risk than men)
- Advanced age (over 50)
- Early menopause (<45 years, natural or due to surgical removal of the ovaries)
- Family history of osteoporosis or hip fracture
- Small, thin body frame (low BMI)
Modifiable factors:
- Vitamin D and calcium deficiency
- Lack of physical activity, especially weight-bearing exercise
- Smoking and excessive alcohol consumption
- Long-term corticosteroid use (more than 3 months)
- Certain medical conditions: hyperthyroidism, intestinal malabsorption, type 1 diabetes
The DXA Scan: Measuring Bone Density
The only definitive way to diagnose osteoporosis is with a Bone Mineral Density (BMD) test using a DXA scan (Dual-energy X-ray Absorptiometry). The test is quick, painless, and uses minimal radiation.
The result is expressed as a T-score:
| T-score | Interpretation |
|---|---|
| ≥ -1.0 | Normal |
| -1.0 to -2.5 | Osteopenia (low bone mass, at risk) |
| ≤ -2.5 | Osteoporosis |
| ≤ -2.5 + history of fracture | Severe osteoporosis |
I recommend a DXA scan for all women from age 50 (or younger if risk factors are present), and for men over 70.
Vitamin D Deficiency: The Hidden Epidemic
It may be surprising, but research in Indonesia shows that more than 70% of the adult population is vitamin D deficient — even though we live in a tropical country with abundant sunshine. The main causes: most people work indoors, use sunscreen, or their bodies do not produce vitamin D efficiently.
Vitamin D is not just for bones — it plays a role in:
- Calcium absorption from the intestines
- Immune system function
- Mood regulation (depression is more common with vitamin D deficiency)
- Reduced risk of several cancers, type 2 diabetes, and autoimmune diseases
Proper Vitamin D Supplementation
Needs that are often misunderstood by the public:
- Recommended daily dose: 1,500–2,000 IU/day for the general adult; it can be higher (3,000–5,000 IU/day) in severe deficiency, under a doctor's supervision
- Vitamin D3 (cholecalciferol) is absorbed far better than D2
- Take it with a meal containing fat — vitamin D is fat-soluble, and its absorption increases significantly when taken with food
- Monitor blood 25-OH Vitamin D levels before and 3 months after supplementation — never self-medicate with high doses without monitoring
Prevention Is Better Than Cure
Steps proven to maintain bone density:
- Weight-bearing exercise at least 3× a week — walking, jogging, dancing, or light weight lifting are all effective
- Adequate calcium intake: 1,000–1,200 mg/day from food (milk, cheese, anchovies, broccoli, tofu) or supplements
- Optimal vitamin D — confirm with a blood test, not just an estimate
- Avoid smoking and alcohol — both inhibit bone formation and accelerate resorption
- Hormone therapy for menopausal women who are suitable candidates — this decision requires an in-depth discussion with your doctor
"A hip fracture in old age carries a one-year mortality rate comparable to several types of cancer. This is serious. But most cases can be prevented if we start acting 10–20 years earlier."
— dr. Sebastianus Jobul, Sp.PD-KEMD, FINASIM