Key Note Address By Mr Heng Chee How Minister Of State Prime Minister's Office At The World Osteoporosis Day 2009 Public Forum On 24 Oct 2009 1.00pm At KK Women's And Children's Hospital Singapore

A/Prof Tang Ching Lau, President of the Osteoporosis Society (Singapore)
Mr Lam Pin Woon, CEO of HPB
Prof Ivy Ng, CEO of KKH
A/Prof Kenneth Kwek

Distinguished Guests,
Ladies and gentlemen,

Introduction

Good afternoon. I am delighted to join you on World Osteoporosis Day 2009. I commend Osteoporosis Society (OSS), Health Promotion Board (HPB) and KK Children & Women s Hospital(KKH) for your joint efforts in increasing public s awareness of osteoporosis in Singapore.

The Burden of Osteoporosis, Falls and Fractures

Osteoporosis, which means porous bones, is a condition where bones become weak and brittle, and fracture more easily than normal bones. Even a minor bump or fall can cause a serious fracture.

Osteoporosis affects some 75 million people in Europe, USA and Japan. Osteoporosis becomes more common as one gets older. Falls are also common as one gets older. Osteoporosis + falls = fractures. It is estimated that there are more than 2.3 million osteoporosis related fractures worldwide annually 1.

Between 1990 and 2000, hip fractures worldwide went up 25% 2. By 2050, the worldwide incidence of hip fracture is projected to increase by 310% in men and 240% in women 3.

Hip fracture should not be dismissed lightly. 1 in 3 persons with hip fractures suffers considerable loss of function and often becomes dependent on others for his or her routine daily needs. 1 in 5 people die within a year of sustaining a hip fracture 4. 

This paints a sombre picture for Singapore with our rapidly ageing population. In 2005, one in 12 residents was 65 years or older. In 2030, one in five residents will be 65 years or older 5.Osteoporosis, falls and fractures will become an increasingly important public health concern for us 6, 7.  Already, the local incidence of hip fracture has increased 1.5 times in men and 5 times in women over the last 40 years 8, 9.

Interventions to combat Osteoporosis, falls and fractures- A holistic approach

The upstream prevention of fractures and fracture-related disability and death requires a concerted effort to address osteoporosis and falls. For osteoporosis, key ways to improve bone health are the 3Ds: Diet, Discipline (exercise) and Drugs

Diet means adequate calcium and Vitamin D. I am told that just 15 minutes of being in the sun is sufficient to get us our daily requirement of Vitamin D. We should also eat foods with the right nutrients to supply our bodies needs.

By Discipline, I mean regular exercises. Physical activity helps prevent and delay chronic diseases and disability, has therapeutic effects and promotes social and mental wellness. The rise in health expenditure can be moderated if more seniors are healthy and strive to keep active as they age.

A 2005 survey conducted by the Singapore Sports Council 10 showed that 61% of seniors aged 55 years and above were sedentary in the three months preceding the survey. There is much to be gained by becoming more active.

The Seniors for Physical Activity (SPA) initiative was set up in 2008 to promote physical activity as a form of active ageing. It has very recently launched a national brisk walking programme as one way to encourage seniors (and indeed people of all ages) to exercise regularly. Brisk walking is not expensive and has mass outreach. It is scalable. It has demonstrated fitness and health benefits when done right and regularly. It is done in groups which means seniors get to exercise and make friends at the same time!

Moving forward, SPA is working on the Tai Chi and Qigong exercise platform. These exercises have been scientifically proven to improve strength as well as aid balance and flexibility. More platforms will be added in time to come.

A recent study conducted by HPB showed that 7 in 10 Singaporeans know the seriousness of osteoporosis 11. Yet, 80% of Singaporeans do not know that regular exercise could help prevent osteoporosis12. Other ways include moderating alcohol consumption, not smoking and maintaining an ideal body weight.

We must do more to inform the public about the benefits of the 3D approach in tackling this disease.

Partnership to raise awareness, prevent and manage osteoporosis, falls and fractures.

Starting young is important. Many may think that osteoporosis only affects older people. They forget that a person s bone mass is actually built up in the early years. Bone mass peaks when a person is around 30 years old. Therefore, HPB believes in targeting its osteoporosis prevention education efforts over a wide age band. It has implemented various programmes to increase awareness of osteoporosis. These includes guidelines to encourage adequate consumption of milk at childcare centres, competitions in schools to create high-calcium snack recipes, strength training workshops for the elderly, osteoporosis prevention talks and workshops for employees, supermarket tours and healthier high-calcium cooking classes for the community. I am told that these programmes are well received.

Partnership is key to the prevention and management of many diseases. I would like especially to commend OSS as a volunteer driven organization for taking the leadership in this effort.

I understand that the Society has strengthened its public awareness programmes significantly since 1996. It started with public forums and has since taken its programmes to the heartlands. At community health screenings, high risk individuals are issued with vouchers for a diagnostic scan. They are then advised to follow up with their own doctors with the results of the scan.

The Society also has a welfare scheme that subsidizes medication, transport, motorized beds and wheelchairs for needy patients.

I am happy to know that the Society has recently formed a support group of volunteers to visit osteoporosis patients to give emotional support.

INTERNAL PARTNERSHIPS

KK Women s and Children s Hospital also sees the importance of identifying those who may be at risk of having osteoporosis early, so as to start them on appropriate management before a fracture occurs. It has roped in doctors, nurses, therapists, exercise physiologists and pharmacists to work together on this.

EXTERNAL PARTNERSHIPS

Besides screening inpatients at the hospital, KKH has also brought its care beyond hospital grounds into the community. KKH partners OSS and various grassroots and social organizations to raise awareness in the community on the 3Ds. I am told that to date, they have reached out to more than 500 seniors in the community. I also understand that attendance at the KKH group exercise and balance-enhancement programme has been good.

CONCLUSION

While each entity can do well in its field, they can do even more together. The partners have done so in this case. I commend you for the good that you are doing. Thank you. 

1 EFFO and NOF (1997) Who are candidates for prevention and treatment for osteoporosis? Osteoporos Int 7:1.

2 Johnell O and Kanis JA (2006) An estimate of the worldwide prevalence and disability associated with osteoporotic fractures. Osteoporos Int 17:1726

3 Gullberg B, Johnell O and Kanis JA (1997) World-wide projections for hip fracture. Osteoporos Int 7:407

4 Magaziner J, Simonsick EM, Kashner TM, et al. (1990) Predictors of functional recovery one year following hospital discharge for hip fracture: a prospective study. J Gerontol 45:M101

5 Committee on Ageing Issues: Report on Aging Population. 2006.

6  Lau EM. Epidemiology of osteoporosis. Best Pract Res Clin Rheumatol. 2001 Jul;15(3):335-44.

7  Leong KH. Osteoporosis--the need for a paradigm shift. Ann Acad Med Singapore. 1998 Jan;27(1):100-4.

8  Koh LK, Saw SM, Lee JJ, Leong KH, Lee J. Hip fracture incidence rates in Singapore 1991-1998. Osteoporos Int. 2001;12(4):311-8.

9 Wong PC. Fracture epidemiology in a mixed southeastern Asian community (Singapore). Clin Orthop Relat Res. 1966 Mar-Apr;45:55-61.

10 Senior Citizens Sports Participation Survey 2005

11 Omnibus Survey 2005. Health Promotion Board, 2005

12 Omnibus Survey 2008. Health Promotion Board, 2008