Caregiving for Osteoporosis

Osteoporosis is a disease of the bones¹, and can happen when an individual loses too much bone, makes too little bone, or both. Osteoporosis affects both men and women. It causes bones to become weak, often resulting in a break from a minor fall, or in more serious cases, from simple actions like coughing, sneezing, or bumping into furniture. Fractures related to osteoporosis most commonly happen in the spine, wrist, or hip².

Weight-bearing exercises, eating a healthy diet, and certain medications may be able to prevent the loss of bone, or strengthen bones that are already weakened by osteoporosis.

As osteoporosis becomes more prevalent with increasing age, CNA’s and HHA’s will witness a high fracture risk in nursing facilities, long-term residential care facilities, or in a client’s home. Based on reports from nursing homes and hospitals, almost 14 billion is spent on osteoporosis-related fractures each year!⁴

Statistics:

Osteoporosis can strike at any age.

Nearly 44 million Americans are at risk of osteoporosis. Sixty-eight percent are women.

It is estimated that one out of every four men and one out of every two women will have a fracture related to osteoporosis in their lifetime.

Each year, almost 80,000 men have a hip fracture.

Osteoporosis is responsible for more than 1.5 fractures each year.

In the US alone, nearly 10 million people already have osteoporosis. 

Symptoms of Osteoporosis

Most people with osteoporosis have no symptoms⁵, especially when the disease is in its early stages.  Once the disease has already weakened the bones, there may be the following signs and symptoms:

• A suspicious bone fracture
• Exhibiting stooped-over posture
• Losing height over time
• Pain in the back from collapsed or fractured vertebrae

What Are the Causes of Osteoporosis ?

The bones of the body are constantly being broken down and built up.  New bone is always being made, and old bone is always being broken down⁶.  While a person is young, the body builds new bone faster than it can be broken down.  The bone mass then increases.  Most people have the greatest bone density in their early 20s.  As people get older, bone mass is lost  much faster than it can be made, and osteoporosis can happen.

A patient’s likelihood of developing osteoporosis depends in part on how much bone mass they achieved when they were younger.  The greater the peak bone mass in a person’s youth, the more bone that is stored as they age and the less likely it is that they will develop osteoporosis as they get older.

Without calcium, a person cannot rebuild new bone.  While that is true, people may think that a low calcium diet is a main culprit in osteoporosis, but that isn’t the only factor…

What Should I Know  About Risk Factors for Osteoporosis?

There are a variety of risk factors that will increase an individual’s chances of developing osteoporosis.  These include their race, age, lifestyle choices, and their current and past medical conditions.  The type of treatment your patient receives also contributes to the amount of osteoporosis they have.

And while you, as a CNA or HHA, cannot change many of the underlying reasons a patient may have osteoporosis, you can be on the lookout for risk factors.

Some risk factors, include:

• Family History
• Race
• Gender (Women are more likely to get osteoporosis)
• Thyroid problems
• Decreased levels of sex hormones.
• Other glandular problems
• Eating disorders
• Reduced calcium intake
• Stomach or Intestinal surgery
• Steroids and Related Medications
• Smoking
• Drinking too much alcohol
• Lack of exercise

What Are Common Complications, and How Can I Help?

The most serious complication from osteoporosis is bone fractures, particularly those of the hip or spine. Hip fractures can cause disability or even death from complications, especially in the elderly.  In some circumstances, fractures of the spine can occur even if a person hasn’t suffered from a fall.

You are in the perfect position to observe and document a patient’s change in posture, or if you see they are losing the ability to stand or walk for longer periods of time, have a diminished activity level, or if you witness a fall.  And, as between 50- and 75-percent of nursing home patients fall each year, you can take an active role in helping your patients take steps to improve, as well as maintain their bone health by encouraging proper nutrition and safe and appropriate exercise, by providing calcium supplements if necessary, and by reducing the risk of falling by removing rugs, clutter, and walkway obstacles.

Home health aides can also assess the amount of care a client needs who suffers from osteoporosis. As an HHA, you become your clients’ advocate by providing basic routine care, such as preparing nutritious meals, bathing, administering medicine, and helping with artificial limbs or walking aids. You may recommend physical therapy by a licensed PT, and encourage family and friends to help with exercise by taking their loved one for walks. HHA’s can suggest the use of hand and bed rails, canes or walkers, as well as assist with payment options.  And because you are with your client during the day, any change in behavior or activity level should be documented, as well as brought to the attention of the family.

What Are the Treatments for Osteoporosis

The types of treatment for osteoporosis⁷ are based on how likely it is that the individual will break one of their bones in the upcoming ten years. If the risk of fracture is not high, your patient might not need any medications but might instead be advised to exercise and increase their calcium intake to decrease the risk of fractures from osteoporosis.

Medications  – There are several types of medication⁸ used to prevent fractures in people with osteoporosis, and they all pose a risk of side effects.  Many can be found over-the-counter at a local drugstore, or a doctor will prescribe a medication.  As a CNA or HHA, you can make sure your patients are taking their medications to reduce their chance of further deterioration from osteoporosis.

Lifestyle Remedies

There are any number of things your patients can do to decrease the risk of injury caused by osteoporosis, including:

• Prevent falling. Encourage your patients to wear low-heeled shoes that have nonskid soles. Check the house, room, or apartment for area rugs, electrical cords, and slippery places that might result in a trip and fall incident.  Reinforce the need to keep your client’s and patient’s rooms well-lit, make sure your patients can get easily get in and out of bed, and ensure that residents use the grab bars usually installed inside and outside the shower or bath.
• Avoid excessive use of alcohol. Drinking more than two alcoholic beverages per day may decrease the formation of bone and lead to osteoporosis.  Being drunk or otherwise under the influence of alcohol can also raise your resident’s risk of sustaining a fall.
• Stop smoking. If you notice your patient heading outside for a smoking break, gently encourage them to stop, as smoking increases the rate of bone loss and and the chance of developing a fracture from osteoporosis.

How Can I Help My Patients Maintain Strong Bones?

There are three essential factors you and your patient need to keep in mind when maintaining strong bones, including.

• Getting enough calcium in the diet
• Getting enough vitamin D in the diet
• Getting regular exercise

Calcium

Calcium is vitally important in building new bone. Recommending your patients eat a diet rich in calcium can help build new bone and east the onset of osteoporosis. Excellent sources of calcium include the following:

• Calcium-fortified cereals
• Calcium-fortified orange juice
• Soy products, like tempeh and tofu
• Canned salmon or canned sardines with bones
• Dark green leafy vegetables
• Low-fat dairy products (200-300 milligrams per serving in most cases)
• Even Rolaids and Tums

Vitamin D

Vitamin D improves the ability of the body to absorb calcium.  Many people get enough vitamin D from sunshine, but this may not be possible if your patient lives in a northern state, if they regularly use sunscreen, if they avoid the sun entirely, or if they are housebound.  Take your patient for a walk in the sunshine whenever possible.  Or, recommend a lamp that emits ultraviolet rays and is often used as a substitute for sunlight.

Exercise

Exercise is probably the most helpful treatment for preventing osteoporosis at any age because it helps build strong bones and slows the loss of bone.  Exercising will allow your patients to maintain muscle strength, coordination, and balance, which helps prevent falls and related fractures.

It is recommended that your patients combine weight-bearing exercises with strength- training exercises. Strength-training exercises, such as lifting weights or using elastic bands, are helpful because they can strengthen the bones and muscles in the upper spine and back.  Weight-bearing exercises, like walking and stair climbing, can strengthen the bones in your patient’s legs, lower spine, and hips.

Swimming, using exercise machines and elliptical trainers can give your patients a good workout from a cardiovascular standpoint, but because these are activities that involve low impact, they aren’t as good at improving the health of the bones when compared to weight-bearing and strength-training exercises.

Caring for a Patient with Osteoporosis

Osteoporosis has been called the “silent disease” because there are few obvious signs of this progressive bone disease until significant damage has occurred.  By the time a fracture has occurred, the disease is already well-established. The biggest risk for patients with osteoporosis is falling and breaking a bone, which can lead to pain, suffering, depression, and social withdrawal.  You, as their CNA or HHA, can do a lot to help them by getting rid of clutter in the home, removing area rugs, and training them in the correct use of assistive devices.  Encouraging them to eat foods high in calcium and vitamin D, and to get regular weight-bearing exercise will strengthen their bones and boost their state of mind.  As always, safety is key. Prevention of fractures is essential to preserving their quality of life.

Encourage residents to walk tall and use good posture, and avoid activities that may cause injury, such as twisting or bending too quickly, or lifting heavy objects. Help residents to move slowly. Even sudden movements like sneezing and coughing can cause fractures in residents with osteoporosis.

As always, be aware of your patients’ care plans.  Work with the nurses on the floor and with family members at home; encourage communication and follow-up with any goals, such as increasing calcium in their diet or setting up an exercise program.  Develop a routine with your resident, and promote their self-care.  Maintaining a resident’s independence is important to their overall health. When an independent person becomes dependent, physical and mental problems may result.

References

1. What is Osteoporosis? National Osteoporosis Foundation
2. Osteoporosis; Definition; Mayo Clinic; Mayo Clinic Staff
3. Management of osteoporosis in the elderly; PubMed.gov; Oct. 25, 2009. Rizzoli, R.
4. An Overview of Osteoporosis; AgingCare.com; National Institutes of Health
5. Osteoporosis; Symptoms; Mayo Clinic; Mayo Clinic Staff
6. What Causes Osteoporosis? And Why?; WebMD; Rebecca Buffum Taylor
7. Diseases and Conditions: Osteoporosis; Treatments and drugs; by Mayo Clinic Staff, Dec., 2014.
8. Find the Best Medications for Osteoporosis; healthline; 2005-2016 

1. Definition.
   http://www.mayoclinic.org/diseases-conditions/osteoporosis/basics/definition/con-20019924. Accessed 3/21/16.
2. Symptoms.
   http://www.mayoclinic.org/diseases-conditions/osteoporosis/basics/symptoms/con-20019924. Accessed 3/21/16.
3. Causes.
   http://www.mayoclinic.org/diseases-conditions/osteoporosis/basics/causes/con-20019924. Accessed 3/21/16.
4. Risk factors.
   http://www.mayoclinic.org/diseases-conditions/osteoporosis/basics/risk-factors/con-20019924. Accessed 3/21/16.
5. Complications.
   http://www.mayoclinic.org/diseases-conditions/osteoporosis/basics/complications/con-20019924. Accessed 3/21/16.
6. Tests and Diagnosis.
   http://www.mayoclinic.org/diseases-conditions/osteoporosis/basics/tests-diagnosis/con-20019924. Accessed 3/21/16.
7. Treatment and drugs.
   http://www.mayoclinic.org/diseases-conditions/osteoporosis/basics/treatment/con-20019924. Accessed 3/21/16.
8. Lifestyle and Home Remedies.
   http://www.mayoclinic.org/diseases-conditions/osteoporosis/basics/lifestyle-home-remedies/con-20019924. Accessed 3/21/16.
9. Prevention.
   http://www.mayoclinic.org/diseases-conditions/osteoporosis/basics/prevention/con-20019924. Accessed 3/21/16.