Osteoporosis is a loss of bone density among elderly that can cause painful fractures, disability and deformity. While heredity and bone size affect the development of osteoporosis, it is often possible to prevent, delay or reduce bone loss through healthy lifestyle. Though Osteoporosis affects both sexes but it is most frequent among women.
It is a natural process that bones are constantly being renewed. But are we grow old, this process becomes less efficient, and bone mineral density is lost. When bone mineral density is lower than normal, and not reached to the level where it can be is termed as osteoporosis, it is called osteopenia. Osteoporosis causes bones to become very thin and weak over time and increases the risk of fracture.
What is Osteoporosis?
Osteoporosis is an illness in which bones become fragile and brittle, leading to higher risk of breakage. This occurs when bones lose minerals such as calcium more quickly than the body can replace them. Commonly termed as a “silent disease”, osteoporosis generally has no symptoms and is rarely diagnosed until bones break or fracture. Osteoporosis is the disease and fractures are the outcome we are trying to prevent.
Bones though feel solid, but the inside of a bone is actually filled with holes like a honeycomb. Bone tissues are broken down and rebuilt all the time. While some cells build new bone tissue, others dissolve bone and release the minerals inside. As we age, the tiny holes within bones get bigger, and the solid outer layer becomes thinner. Hard bones turn spongy, and spongy bones turn spongier, further, leading to osteoporosis.
Bones weakened by osteoporosis are more likely to break. Broken bones can lead to serious problems for elderly. The hip is a common site for osteoporosis, and hip fractures can lead to a downward spiral of disability and loss of independence. Osteoporosis is also common in the wrist and the spine.
Osteoporosis is often considered to be a condition that the weak elderly develop. However, the damage from osteoporosis begins much earlier in life. Because peak bone density is reached at almost 25 years of age, it is important to build strong bones by that age, so that the bones will remain strong later in life. Adequate calcium intake is an essential part of building strong bones.
Experts suggest that women start getting screened for osteoporosis at age 65. Women younger than age 65 who are at high risk for fractures should also be screened. Men should discuss screening recommendations with their health experts.
Meet with your physician to assess your bone density and risk for developing osteoporosis. Screening is done with a bone mineral density test at the hip and spine. The most common test is known as DXA, for dual-energy X-ray absorptiometry. It’s painless, like having an X-ray. Your results are often reported as a T-score, which compares your bone density to that of a healthy young. A T-score of −2.5 or lower indicates osteoporosis. There is a lot one can do to lower your risk for osteoporosis. Getting plenty of calcium, vitamin D, and exercise can be a good start.
Causes of Osteoporosis in Elderly
Mostly, the loss of bone occurs over an extended period of years. Often, a person will have a fracture before becoming aware that any disease is present. By then, the disease may be in its advanced stages and damage may be serious.
Women, especially those older than 60 years of age, are frequently diagnosed with the osteoporosis. Menopause is accompanied by lower estrogen levels and increases a woman's risk for osteoporosis. Other factors that may contribute to bone loss in this age group include inadequate intake of calcium and vitamin D, lack of weight-bearing exercise, and other age-related changes in endocrine functions.
Other conditions that may lead to osteoporosis include overuse of corticosteroids, thyroid problems, lack of muscle use, bone cancer, certain genetic disorders, use of certain medications, and problems such as low calcium in the diet. Some of the factors for osteoporosis are:
- Women who are white or Asian, especially those with a family member with osteoporosis, have a greater risk of developing osteoporosis than other women.
- Cigarette smoking, eating disorders such as anorexia nervosa or bulimia, low amounts of calcium in the diet, heavy alcohol consumption, inactive lifestyle, and use of certain medications, such as corticosteroids and anticonvulsants, are also a cause of osteoporosis.
- Rheumatoid arthritis is a big risk factor for osteoporosis.
- Having a parent who has or had osteoporosis is a risk factor for the infant.
- Women are at a greater risk than men, especially women who are thin or have a small frame, as are those of advanced age
- Lack of physical activity
- Chronic kidney disease
- Chronic liver disease
- Poor nutrition or eating disorders
- Intestinal problems that make it more difficult for your body to absorb nutrients from the food you eat
- Glandular diseases such as diseases of the thyroid, parathyroid, or adrenal glands
- Certain diseases and conditions like Crohn’s disease, celiac disease, or stomach surgery
- History of hormone treatment for prostate cancer or breast cancer
- Low body weight or a small body frame
- Women having had an early menopause or surgical removal of ovaries
- Men having had prostate cancer treatments that lower testosterone levels
- Cancer like multiple myeloma, leukemia, lymphoma.
- Even when you eat a healthy diet, you may not absorb as many vitamins and minerals as you used to. This is a normal part of aging.
Symptoms of Osteoporosis in Elderly
Usually, there are no symptoms in the early stages of osteoporosis. But as the disease progresses, elderly may experience:
- Bone pain or tenderness
- Curvature of the spine
- A stooped posture called kyphosis; sometimes known as “dowager’s hump”
- Loss in height i.e. as much as six inches
- changes in posture and body shape
- Low back pain or neck pain or even both due to fractures of the bones of the spine.
Treatment of Osteoporosis in Elderly
The best approach for treating age-related bone loss is always prevention. The main goal is to decrease the chance of a fracture. You can help keep your bones strong by getting your BMD tested when your doctor recommends a scan. Exercise and diet are also important steps to take to decrease your risk of osteoporosis.
Exercises have proved to be best in osteoporosis. It should be moderate to vigorous exercise done at least three times a week. Exercise can increase bone mass and reduce fractures. It has been shown that, after menopause, women can strengthen hip bones and improve muscle and balance though weight-bearing exercises. These include walking, weight lifting, and other forms of strength and resistance training. Balance exercises can also reduce both falls and fractures.
Treatment with medications is appropriate for older adults who have:
- Already suffered a fracture of the hip or a bone of the spine
- A BMD T-score of less than -2.5
- A BMD T-score between -1 to -2.5, which is considered osteopenia. Treatment with medications is appropriate if this T-score is accompanied by a more than 3% probability of a hip fracture or a more than 20% risk of any fracture over the next 10 years.
Medications that are commonly prescribed
- Bisphosphonates - These medications slow bone breakdown, preserve bone mass, and even increase bone density in some cases. They include alendronate (Fosamax), risedronate (Actonel), ibandronate (Boniva) and zolendronic acid (Reclast).
- Selective Estrogen Receptor Modulators (SERMs) - SERMS such as raloxifene (Evista) act like estrogen but do not carry estrogen’s risks of uterine and breast cancer. SERMs are normally only recommended for women.
- Teriparatide - Teriparatide (Forteo) is a form of parathyroid hormone. It is used to treat men or women at high risk of fractures. Teriparatide is the only treatment that encourages new bone growth. It is injected under the skin daily for a maximum of two years.
- Calcitonin - Calcitonin (Miacalcin or Fortical) is a hormone naturally produced in your thyroid gland. It can slow down bone loss, reduce spine fractures, and may manage the pain of spinal fractures.
Preventive measures for Osteoporosis in Elderly
- As a preventative measure older adults should take small and important steps to avoid falls. These steps should include: getting eye exams to assess depth perception, exercising regularly to strengthen muscles and improve balance; using walkers and canes; if necessary to help with walking.
- Calcium is a mineral that helps bones stay strong. It can come from the foods you eat like milk and dairy products, dark green leafy vegetables like kale and collard greens or from dietary supplements. Women over age 50 need 1,200 mg of calcium a day. On other hand, men need 1,000 mg a day from ages 51 to 70 and 1,200 mg a day after that.
- Vitamin D helps your body absorb calcium. As you grow older, your body needs more vitamin D, which is made by your skin when you are in the sun. You can also get vitamin D from dietary supplements and from certain foods, such as milk, eggs, fatty fish, and fortified cereals. Talk with your health experts to make sure you are getting a healthy amount of vitamin D. Problems can also arise if you are getting too little or too much.
- All elderly should be encouraged to eat well and to be active every day by following the advice provided by health care experts to reduce their risk of chronic diseases such as osteoporosis.
- Bones become stronger with increased activity. Include regular weight-bearing exercise such as dancing, walking, hiking or tennis in your daily routine. Exercise that improves balance and coordination such as yoga and flexibility exercises will help reduce falls and prevent fractures. Try several activities until you find the one that is perfect for you and like.
- Smokers have faster rates of bone loss and a higher risk of fractures than non-smokers. Women who smoke also tend to enter menopause at an earlier age than non-smokers. This means more rapid bone loss takes place at an earlier age.
The best part is, even if you already have osteoporosis, it’s not too late to start taking care of your bones. You can still reduce the risk for osteoporosis. Since your bones are rebuilding themselves all the time, you can help maintain the balance towards more bone growth by providing them calcium, vitamin D and doing regular exercise.
Teaser content for “How does Osteoporosis affects the elderly”
Osteoporosis is a loss of bone density among elderly that can cause painful fractures, disability and deformity. No need to worry even if you already have osteoporosis as it’s not too late to start taking care of your bones. Since your bones are rebuilding themselves all the time, you can help maintain the balance towards more bone growth by providing them required things.