Integrated Women’s Health Programme

(Professor Yong Eu Leong, Professor Michael Kramer, Dr Susan Logan, Dr Win Pa Pa Thu, Angelica)

The Integrated Women Health Programme (IWHP) was initiated to identify and address in a comprehensive fashion, the health care needs of mid-life Singaporean women. The program initially focused on menopausal osteoporosis and hip fractures but has since branched out to address other holistic areas of health. This program has two thrusts: firstly, the IWHP cohort itself where women are finely phenotyped, and secondly, the entire Singapore population of mature women available through national healthcare databases.

The IWHP cohort completed recruitment of 1200 women in 2014. Analysis of this cohort has provided insights into unique epidemiology and health care needs of this critical but often ignored demographic ^{(1, 2)}. We have for the first time identified chronic joint pain and hand grip strength as previously unknown predictors of menopausal osteoporosis ⁽³⁾. Ethnicity, BMI, height and poor sleep were also key mediators of bone health ^{(4, 5)}. Unexpectedly urinary stress incontinence was more common in premenopausal women with children, whereas urge incontinence was more common after the menopause ⁽⁶⁾. Mental health issues such as depression and anxiety affected 16% of mid-life women, and risk factors were weak upper and lower body physical performances emphasizing the importance of exercise for Singaporean women ⁽⁷⁾. Centrality of exercise is reiterated by the finding that insulin resistance was independently associated with obesity, visceral adiposity, low physical performance, and high levels of the blood cardiometabolic marker TNF- α ⁽⁸⁾. The data generated from these studies identified insufficient exercise as a key deficiency in midlife Singaporean women.

Utilising national databases, risk factors for osteoporosis in mid-life women were correlated with hip fractures that occur 2 -3 decades later ⁽⁹⁾. Although the absolute number of fractures increased, steep drops in elderly Chinese women drove a reduction in overall age-adjusted hip fracture rates. Malay ethnicity, older age, pre-fracture comorbidity, and trochanteric fractures were independently associated with increased risk of death, identifying population groups that could be targeted for intervention strategies ⁽¹⁰⁾. Nationally, a rapidly aging population will lead to a rise in total number of hip fractures, requiring budgetary planning and new preventive strategies.

Current work on the IWHP cohort includes a second round of interviews, examinations, and laboratory tests. This will permit an analysis of baseline characteristics as potential risk factors for changes in health outcomes between the first and second round. In addition, we will attempt to develop a population-wide screening strategy for osteoporosis in mid-life Singaporean women based on the first round of data collection and validate the strategy based on the second (follow-up) visit.

Infographic

Sep 2021

The integrated women's helath programme (IWHP): Key Findings