Osteoporosis In Older Patients

Introduction:

Osteoporosis is identified symptomatically in many people only when they have fractures. In osteoporosis, bones become fragile, giving rise to fragility fractures that are generally seen in a population above the age group of 50 years. Along with decreased bone mineralization rate, incidents of falls in the elderly contribute to the fragility of fractures. An essential fracture risk assessment is an assessment of falls in the elderly population. Detection of osteoporosis happens only at a much later stage when the bone starts to break, causing severe debilitating pain, hence involving the elderly age group. This can affect their ability to walk, cause postural deformities, reduce their daily activities, and interfere with the patient’s quality of life.

Who Is at a Greater Risk of Developing Osteoporosis?

Women are four times more likely to develop osteoporosis as compared to men. They develop osteoporosis at a much-advanced age after they attain menopause. White and Asian women are more likely to develop osteoporosis compared to the black population. Women should take additional care of their bones as they might experience increased bone loss for ten years after menopause. Even though women are at a greater risk of developing this disease, men should also take care and avoid all the risk factors leading to osteoporosis, as they cannot be completely risk-free of this disease.

What Are the Causes and Risk Factors of Osteoporosis in the Elderly?

Unfortunately, no specific cause leads to osteoporosis, but many listed risk factors exist.

• Family History: A family history where a close family member had osteoporosis can put an individual at a higher risk of developing the disease.

• Bone Frame: Elderly patients with smaller bone frames compared to those who are fat with a broader bone frame are at much higher risk of osteoporotic fractures as they have an amount of bone that can quickly be resorbed.

• Medical Conditions: Certain underlying medical conditions like rheumatoid arthritis (joint disease), sickle cell anemia (blood disorder), thyroid disorders, human immunodeficiency virus (HIV), acquired immune deficiency syndrome (AIDS), celiac disease (digestive system issue on eating gluten), and stroke can make the patient more prone to developing osteoporosis.

• Medications: In addition, certain medications like steroids, anti-seizure medications, cancer chemotherapeutic drugs, and hormone treatments for certain cancers can increase a person’s risk of developing osteoporosis.

• Sedentary Lifestyle: Apart from the causes mentioned above, even a sedentary lifestyle with a lack of exercise can lead to weakened bones, causing osteoporosis. Smoking and drinking can be risk factors for developing this disease.

• Nutritional Deficiencies: Nutritional deficiencies like calcium and vitamin D can develop osteoporosis in old age.

How Does Osteoporosis Affect Elderly People?

Osteoporosis affects elderly people, causing physical, emotional, and social challenges. Due to more brittleness and less density, the bones in older people are more susceptible to fractures, even from minor falls. In addition, fear of falling can lead to reduced mobility, causing muscle weakness and loss of bone density. The person may experience chronic pain if the vertebral fractures cause spinal compression. Early diagnosis and prompt treatment may reduce the impact of osteoporosis and maintain a healthy life in older age.

What Are the Symptoms of Osteoporosis in Older Adults?

Osteoporosis does not cause alarming symptoms until the bones get brittle and fracture. A few symptoms that few patients might experience are:

• Shortness of breath.

• Reduced height.

• Changes in posture.

• Lower back pain.

How to Diagnose Osteoporosis in Elderly Patients?

Osteoporosis can be diagnosed using the bone density test in elderly patients above the age group of 50 years. Patients who have a history of fractured bone following a minor fall should undergo a bone density test to check for osteoporosis. A bone density test uses dual-energy X-ray absorptiometry (DXA) scans which are low-intensity X-rays used to determine the mineral content of the patient’s bone.

Who Should Take This Test?

• Both men and women have risk factors for developing osteoporosis.

• Post-menopausal women with high-risk factors.

• Women in their menopause period, and a bone density test of the hip and spine of women 65 years of age or older.

• Along with this test, a computed tomography(CT) scan and ultrasound can also be done as further investigations.

What Is the Treatment for Osteoporosis in Elderly Patients?

It is best to keep a check on the risk factors and consult a doctor as soon as possible. The treatment protocol depends on the bone density test scores; if the risk of breaking the bone in the next ten years is much higher, the doctor might not start with medications but try to modify the risk factors to reduce bone loss and falls.

1) Medicines:

In medications, Bisphosphonates (Alendronate, Risedronate, Ibandronate, and Zoledronic acid) are the most widely used drugs.

• Common side effects when these drugs are taken orally are nausea, heartburn, and abdominal pain. When they are given in intravenous (IV) form, they might cause fever, headache, and muscle aches.

• Very rarely do they cause a crack in the thigh bone and osteonecrosis of the jaw bone following dental extraction.

• Another prescribed drug is Denosumab, which produces similar results as Bisphosphonates.

• The mode of administration for Denosumab is delivering a shot under the skin every six months.

• They cause similar side effects like osteonecrosis of the jaw and rarely a crack in the thigh bone.

• Hormone-related therapy should be started. Estrogen should be given to post-menopausal women, which helps maintain bone density.

• In men, osteoporosis can be linked to a decline in testosterone levels with increasing age; therefore, testosterone therapy is recommended for men.

• In addition, doctors might prescribe a group of bone-building medications (like Teriparatide, Abaloparatide, and Romosozumab) to treat osteoporosis. These are used in certain severe cases along with other osteoporosis drugs.

2) Dietary Planning:

People diagnosed with osteoporosis are advised to take increased quantities of calcium and vitamin D in their diet, along with multivitamin supplements, which will help in getting a sufficient amount of these nutrients. It is recommended that adults, especially women aged 50 years and older, take 1,200 mg of calcium and 800 - 1,000 international units (IU) of vitamin D daily.

3) Lifestyle Changes:

Making lifestyle changes after being diagnosed with osteoporosis is very important. Give up on smoking, drinking, and other forms of tobacco; this will improve muscle strength and reduce bone loss. Include exercise in daily routine like jogging, walking, dancing, etc., to improve bone remodeling. It is advisable to consult a doctor to make an exercise routine.

What Are the Preventive Measures for Osteoporosis in Older People?

The preventive measures for osteoporosis in older age are as follows:

• Take adequate calcium through foods or calcium supplements.

• Take vitamin D-rich foods.

• Regular exercise, such as walking, dancing, and jogging.

• Avoid smoking.

• Limit alcohol consumption.

• Take a well-balanced diet.

• Regular health check-ups.

• Ensure good lighting and remove non-slip mats.

• Maintain a good posture.

• Stay hydrated.

Conclusion:

Once diagnosed with osteoporosis, be very careful to avoid any falls. Avoid clutter, spread non-slippery rugs across the house, provide sufficient lighting in the house, and hold on to some form of grip while taking a bath. Follow the treatment protocol given by the doctor strictly. Make necessary dietary and lifestyle changes.