Osteoporosis in the Elderly - Causes, Symptoms and Prevention by Dr Sasikala Vemuri, Florida, USA

 

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Introduction - An oft-given cautionary note regarding the lifestyle of seniors is for us to avoid situations that can lead to a fall. Thus we are told not to stand on a stool, to wear our pants sitting down and not while standing, to hold the handrails of a staircase as we climb them, or to look down when walking in a new place.
 
One of the reasons is that seniors are in a more vulnerable stage of life when they are more prone to bone diseases like Osteoporosis.
 
Especially for this blog, Dr. Sashikala Vemuri from Florida, USA has written the below article on Osteoporosis, detailing why the disease occurs, what are the Risk Factors for developing the disease, the symptoms, testing & treatment for osteoporosis, and preventive steps that can be taken to keep it at bay.

What is Osteoporosis?
                                            
Osteoporosis is a disease of the bones where the bones are thinner and less dense than they should be. This increases the risk of fractures.
 
Bones are living tissue that are constantly being broken down and replaced.
 
When newborn formation cannot keep up with the loss of old bone osteoporosis occurs.

What are the Risk factors for osteoporosis?

Although any person can develop osteoporosis, certain risk factors could increase the chances of developing osteoporosis.

• Age over 50, 
• White and Asian race, 
• Female gender, 
• Family history, 
• Small-built people. 
• Smokers, those who drink alcohol in excess,
• People with a low calcium diet

•  Some medicines like corticosteroids, medicines used for epilepsy and certain water pills, certain hormones used to treat cancer, and some blood thinners. 

Commonly used medicines like pantoprazole and omeprazole can also decrease calcium absorption and thus increase the risk of developing osteoporosis.

Certain surgeries on the bowels including weight loss surgeries will also reduce the surface area available for absorption of the nutrients and may lead to osteoporosis.

People who are not active and spend a lot of time sitting are also at increased risk.

What are the Symptoms of osteoporosis?

Unfortunately, there may be no symptoms in the early stages of osteoporosis. 

As osteoporosis advances, it can cause a loss of height, stooped posture fractures, and back pain from the collapse of the bones in the spine. Hip fractures in older people are very dangerous and not only lead to loss of independence but also increase the risk of death. 

That is why it is important to focus on preventing the disease in the first place and trying to diagnose it early, especially in people with risk factors.

Testing & Diagnosis of Osteoporosis

Fortunately, there is a simple test to diagnose osteoporosis. This is called a bone density test and it is painless and similar to X-rays but with much less radiation. It is advisable for all seniors over the age of 65 and others with risk factors to get this test done periodically. 

This test would also help us diagnose osteopenia which is a stage before osteoporosis so that aggressive action can be taken to prevent the more dreaded osteoporosis.
 
How can you prevent Osteoporosis?

A healthy lifestyle is the key to preventing osteoporosis.
 
Getting the required amount of calcium and vitamin D early in life will help build strong bones. Everyone over the age of 50 should get at least 1200 to 1500 mg of calcium a day and 800 units of vitamin D.
 
Bone Healthy Diet - Good sources of calcium are dairy products like milk, paneer, curds and green leafy vegetables.
 
Supplements - Those who cannot tolerate milk or milk products may benefit from calcium supplements.. As all good things can also have bad effects, it is better not to exceed 2000 mg of calcium a day when you combine both the dietary sources and the supplements. Vitamin D helps in the absorption of calcium and daily exposure to the sun for a limited time helps and it’s also present in fatty fish and milk.
 
Surprisingly despite the sunny weather, a lot of Indians are deficient in vitamin D. It could be that many of them avoid the sun by staying indoors or they have trouble with absorption. If the vitamin D levels are low doctors will advise extra supplements.

Exercise: Exercise is another very important preventive measure. 

Weight-bearing exercises like walking and jogging will help build up bone strength. 

Using small weights while walking will also help.
 
As falls increase the risk of fracture as one ages, balance exercises like Tai chi and yoga are beneficial and offered in many Senior centers.

What are the available treatments for Osteoporosis?
 
Although prevention is always better than cure, some of us will develop osteoporosis as we get older.
 
The most important thing is to diagnose it early and get it treated. Besides the calcium and vitamin D supplements and exercise that we discussed, many new medications have been out over the past few decades. 

Some of these medications like Bisphosphonates and hormone replacement therapies(especially useful in those women who had complete hysterectomies well before 50 years) help prevent further bone loss.
 
There are other medications that also promote new bone growth and these are especially useful for people with severe osteoporosis. These include medications like teriparatide,denosumab,romosozumab.
 
Of course, all medications do come at a cost with side effects and the doctors and the patient can decide together what the best options are considering the risks and benefits.

To conclude, I would like again to emphasize a healthy lifestyle, adequate exercise, Calcium, and Vitamin D intake to prevent developing osteoporosis.