The Skeletal Truth The basics of bone and joint diseases By Dawn Sin The skeleton refers to the collection of bones that holds the rest of our body up. It encases and protects our vital organs, gives us the general shape of our bodies and, with the help of our muscles, allows our bodies to move.    A bone to pick Bones are connective tissues that contain a hardened matrix of minerals like calcium, phosphate and carbonate materials, as well as collagen fibers. They have their own blood vessels and nerves, and the end of each bone is covered with a smooth protective substance known as hyaline cartilage. A joint is the juncture between two bones and it is held in place by strong ligaments. The bone ends are kept separate by a thin film of lubricant called synovial fluid.   Common disorders Although much attention has been paid to bone and joint diseases (a Bone and Joint Decade (BJD) 2000-2010 has even been established), musculoskeletal disorders continue to plague us. According to the BJD portal (www.boneandjointdecade.org), joint disorders account for half of all chronic conditions in persons aged 65 and above, back pain is the second leading cause of sick leave and 40% of all women over 50 will suffer from osteoporosis-related fractures. In Singapore, one in four women aged above 50 are estimated to be affected by osteoporosis.   The following are some common bone and joint diseases: Osteoporosis A bone disease where bone mass and strength decrease, and bones become thin and susceptible to fractures. Osteoporosis-related bone fractures typically occur in the hip, spine and wrist. Hip and spine fractures have particularly serious consequences. Statistics show that within a year of sustaining a hip fracture, one in five will die and one in three will become wheelchair-bound or bedridden. Spinal fractures can progress to chronic back pain and even deformity. In Singapore, hip fractures in both men and women aged 50 and above have increased substantially (500% for women and 150% for men) over the past three decades.   Arthritis A condition in which bone joints are adversely affected. Symptoms include pain in the joints, stiffness and inflammation. Such damage can lead to physical deformity, weakness, instability and impairment in carrying out normal daily activities like climbing the stairs and walking. There are different types of arthritis, such as rheumatoid arthritis (where the body’s immune system attacks the joints in what is known as an autoimmune response), osteoarthritis (also known as degenerative joint disease and is more common in the elderly) and septic arthritis (caused by joint infection). Risk factors for bone and joint diseases •   Thin, underweight or small-framed •   Aged 45 and above •   Obesity •   Gender (women are more susceptible) •   Caucasian or Asian ethnicity •   Smoking •   Family/previous history of fractures, infection, damage or diseases •   Malabsorption (nutrients are not properly absorbed from the gastrointestinal tract) •   Occupational hazard (certain physical activities involve repetitive motion in a particular joint) •   Loss of menstrual periods in women, known as amenorrhea. This can occur when women     undergo vigorous physical exercise or are anorexic. •   Vitamin D deficiency, which causes inadequate absorption of calcium •   The use of corticosteroids for more than three months. Other medications that can cause     osteoporosis through long-term use are heparin (a blood thinner) and phenobarbital (a     sedative and anti-convulsant).