Caring for Osteoporosis
Understanding Osteoporosis From a Caregivers Perspective
Osteoporosis is one of the most common problems associated with aging. Breaking a bone becomes more and more commonplace with advancing age. Although you may think of osteoporosis as a “women’s disease,” men are affected, too. In fact, men account for 29% of the 2 million fractures that occur each year in the U.S. Fractures of the wrist, spine, and hip are the classic osteoporotic fractures. However, breaking any skeletal site may indicate underlying osteoporosis.
Hip Fractures are Killers
Think about this statistic: Every 2 minutes someone in this US will suffer a hip fracture. That equates to nearly 300,000 a year. Men account for one in four hip fractures. The majority of hip fractures happen in men and women over the age of 75. More than 40% occur in those over the age of 85.
Major surgery and old age is a dangerous combination. Unfortunately, hip surgery has a high complication rate due to problems from anesthesia, pneumonia, heart failure, or kidney failure to name a few. In particular, men fare worse than the weaker sex. One in three men will die within a year of their hip fracture. Although women do better their death rate is also high with one in five women dying within a year of sustaining a hip fracture.
Also a high rate of disability is associated with hip fractures. Six months after surgery, the majority of survivors are unable to walk unaided across a room. Therefore, they are unable to return to their home without assistance or their residence is permanently changed to an assisted living or long-term care facility.
You will be taking care of these individuals in whatever setting you are providing your services.
Do Not Overlook Spine Fractures
On the other hand, fractures of the spine are typically silent and only 20 to 30% are associated with pain. Spine fractures may only be identified if someone has lost height or had some imaging of their spine that shows the fracture.
Why is it important to know about spine fractures? Once one spine fracture happens more are likely. The risk of death and disability increases with having a spine fracture. Individuals with spine fractures that are painful have a death rate similar to that of hip fractures.
The Problem
Too few seniors are diagnosed with osteoporosis before they break a bone. After a fracture happens, too few seniors are treated to prevent the next fracture. Seniors often have multiple medical problems that need to be juggled at one time. Usually whatever disease that is causing the most symptoms is at the top of the list to be addressed. Since osteoporosis is a “silent” disease, unless a fracture occurs, it is often overlooked as a problem that needs addressing.
You can help make a difference in the lives of people under your care by recognizing who is at risk, essential nutrients for bone support, preventing falls, and lowering the risk fractures.
Steps to Improving Care of Seniors with Osteoporosis
1. Recognition-Who is at Risk for Breaking a Bone?
If you are caring for seniors, the chances are high that they have osteoporosis.
Common risk factors that might help identify these individuals include:
- Advanced age
- White or Asian woman
- History of previous fracture
- Body weight less than 127 pounds
- History of mother or father with hip fracture
- More than 2 alcoholic beverages a day
- Smoker
- Certain chronic diseases
- Rheumatoid arthritis
- Diabetes, type 1 or 2
- Inflammatory Bowel Disease
- Celiac Disease
- Certain medicines
- Corticosteroids like prednisone
- Proton pump inhibitors
Diagnosis is made by history of previous fractures as an adult over the age of 50 or assessment of bone density at the hip or spine by a dual energy X-ray absorptiometry scan, called DXA for short.
2. Essential Nutrients for Bone
Bone is made up of collagen that is hardened through a process called mineralization. Bone is constantly being remodeled and requires essential nutrients for the process. These include
- Healthy diet- a protein source needed at every meal. The majority of seniors do not consume sufficient protein each day. If meals do not provide an adequate source then protein supplements may be helpful.
- Calcium- food and supplement sources together should total 1200 milligrams a day for men and women over the age of 70.
- Vitamin D supplement is needed to ensure adequate vitamin D status. The latest guidelines specify 800 IU per day for men and women over the age of 70; however, individuals may need more to maintain a vitamin D level over 30 nanograms per milliliter.
3. Fall Prevention
Ninety percent of hip fractures are a result of a fall. Regardless of one’s bone density, if one doesn’t fall breaking a hip, shoulder, or wrist is unlikely. Falls have multiple causes. Research studies have identified more than 400 risk factors, many of which may be modifiable. Here a few pointers to lessen risk of falls:
- Evaluate everyone for fall risk
- Create a safe environment
- Use appropriate assistive devices correctly
- Incorporate balance training
- Ensure adequate vitamin D because it helps with muscle strength
4. Lower Risk of Fractures
For high-risk individuals, the above steps may not be enough. A FDA-approved prescription medicine to lower fracture risk may be indicated to use in conjunction with the above bone-healthy measures. If a person under your care has had a fracture and is not taking an osteoporosis medicine, talk with their doctor or health care professional who is managing their care.
Remember to add “osteoporosis” to your evaluation of each person under your care. These simple measures will help lower the risk of breaking bones. Don’t let your patients become another statistic. It is never too late to make a difference!
Author Bio:
Diane L. Schneider, MD is a geriatrician and epidemiologist whose career has focused on prevention and treatment of osteoporosis. A former associate professor of clinical medicine at the University of California-San Diego, she is author of The Complete Book of Bone Health and co-founder of 4BoneHealth, a nonprofit focused on bone health awareness and education.