How common is osteoporosis in Taiwan?

According to a survey by the Health Promotion Administration, about one in five men over the age of 50 has osteoporosis, and the rate in women is roughly twice that of men. There are often no obvious symptoms early on, and fractures later may lead to limited mobility or long-term bed rest.

How can I quickly self-assess my osteoporosis risk?

You can use the osteoporosis society's quick screening questions to check yourself, for example whether you or a parent has broken a bone from a minor bump or fall, whether you have taken corticosteroids for more than three months, or whether you have lost more than 3 cm in height compared with your younger years. If you answer yes to even one, you have some risk, and it is advisable to discuss with a physician whether further testing is needed.

What medication options are there for osteoporosis?

If osteoporosis is confirmed, treatment usually includes supplementing both vitamin D and calcium. Medications fall broadly into two groups, those that reduce bone loss (such as bisphosphonates, SERMs, and denosumab) and those that increase bone formation (such as parathyroid hormone analogues and romosozumab). Each drug differs in formulation, cost, and rare side effects, and studies show supporting data for bone density or fracture risk; the actual choice needs to be assessed by a physician based on individual circumstances.

Do I Need Treatment for Osteoporosis?

Q: Who is at higher risk of osteoporosis?

Common risk factors include older age, menopause in women, being underweight, a family history of osteoporosis, long-term corticosteroid use, little sun exposure, lack of weight-bearing exercise, and long-term insufficient calcium intake, as well as smoking and heavy drinking, rheumatoid arthritis, hyperthyroidism, and kidney disease.

Osteoporosis is one of the questions older patients most often ask in clinic. The osteoporosis society recently produced a very thorough patient education booklet that is well worth downloading and reading for those who need it.

The content below is excerpted in part from the osteoporosis society’s download-area education booklet.

Epidemiology

According to a survey by the Health Promotion Administration, among men over the age of 50 in Taiwan, one in five has osteoporosis, and the proportion in women is even higher, about twice that of men. Osteoporosis has no obvious symptoms in its early stages and is easily overlooked, but later, besides pain, fractures can cause problems such as reduced mobility and long-term bed rest. One year after a hip fracture, about 40% of people are unable to walk independently, around 30% have physical disability, and there is roughly a 20% chance of death.

Risk factors

These include older age, menopause in women, being underweight, a family history of osteoporosis, long-term corticosteroid use, little sun exposure, lack of weight-bearing exercise, long-term insufficient calcium intake, rheumatoid arthritis, hormone therapy for breast or prostate cancer, smoking and heavy drinking, hyperthyroidism, and kidney disease.

Quick screening

Have your parents ever broken a hip from a minor bump or fall?
Have you yourself ever broken a bone from a minor bump or fall?
Have you taken corticosteroids for more than three months?
Is your current age minus your weight greater than or equal to 20? (For example, age 60 with a body weight of 40 kg?)
Have you lost more than 3 cm in height compared with your younger years?
Do you drink three or more glasses of alcohol a day, or smoke more than 20 cigarettes a day?
Do you have diabetes, an enlarged thyroid, or malnutrition?
(Women only) Did you reach menopause at 45 or earlier?
(Women only) Aside from during pregnancy, have you ever stopped menstruating for more than 12 months?
(Men only) Have you experienced impotence, reduced libido, or other related symptoms due to low testosterone?

If you answer yes to even one question, you have some risk of osteoporosis, and it is advisable to discuss with a physician whether further testing is needed.

Medication treatment options

If osteoporosis is confirmed, it is generally advised to supplement 800-1000 units of vitamin D and 1200 mg of calcium at the same time. Medications can mainly be divided into the following groups.

Bisphosphonates

There are more than four products; they work by reducing bone loss. National Health Insurance covers oral and intravenous formulations (from weekly to yearly). If you do not meet the insurance criteria, the out-of-pocket cost is roughly NT$27-35 per day.
They can increase bone density in the spine and hip. Apart from ibandronate, the other drugs have research support for reducing the chance of spine and hip fractures.
People with hypocalcaemia and severe renal insufficiency should be cautious, and dialysis patients are not advised to use them, because there have been rare cases of osteonecrosis of the jaw and atypical femoral fracture.

Selective oestrogen receptor modulators (SERMs)

They work by reducing bone loss and require daily oral dosing. If you do not meet the insurance criteria, the out-of-pocket cost is about NT$40 per day.
They can increase bone density in the spine and hip, and there are research data for reducing spine fractures (but not for the hip).

RANKL monoclonal antibody (denosumab)

It works by reducing bone loss and is given as a subcutaneous injection every six months. If you do not meet the insurance criteria, the out-of-pocket cost is about NT$45 per day.
It can increase bone density in the spine and hip, and there is research support for reducing the chance of spine and hip fractures.
A small number of cases have involved hypocalcaemia, as well as rare osteonecrosis of the jaw and atypical femoral fracture.

Parathyroid hormone analogue (teriparatide)

Unlike the previous drugs, it works by increasing bone formation. Its drawbacks are the daily subcutaneous injection and the cost; if you do not meet the insurance criteria, the out-of-pocket cost is about NT$573 per day. Current research advises not using it for more than two years, after which you can switch to another type of medication.
It can increase bone density in the spine and hip, and there are data for reducing the chance of spine and hip fractures, with no notable rare cases reported so far.

Sclerostin-inhibiting monoclonal antibody (romosozumab)

This is the newest drug, working by increasing bone formation together with reducing bone loss, with a subcutaneous injection needed only once a month. Its drawback is the cost; if you do not meet the insurance criteria, the out-of-pocket cost is about NT$573 per day. Current research advises not using it for more than two years, after which you can switch to another type of medication.
It can increase bone density in the spine and hip, and there are data for reducing the chance of spine and hip fractures. There have been rare cases of osteonecrosis of the jaw, so for patients with poor dental health, assessment is advised before use.

Summary

Guarding against osteoporosis early can help avoid future regrets. Based on the quick screening, your assessed risk, and the values shared between doctor and patient, it is advisable to choose a treatment approach that offers the most benefit for the patient.

Epidemiology

Risk factors

Quick screening

Medication treatment options

Summary

Frequently asked questions