Did you know that as we age Osteoporosis (porous bone) becomes one of the conditions men and women should be regularly screened for by their family general practitioner?
Men as well as women are affected by osteoporosis, a disease that can be prevented and treated.
As a family caregiver, if you are caring for an elderly person, it’s possible that they could have Osteoporosis. In fact, if you are over 50, you may even be at risk for this condition yourself.
Facts about osteoporosis in Canada
According to Osteoporosis Canada:
- 1.4 million Canadians have Osteoporosis
- 1:8 ratio for Osteoporosis in men over 50
- 1:4 ratio for Osteoporosis in women over 50
- Osteoporosis costs Canadians $1.3 billion per year
- 70% of hip fractures are osteoporosis-related. Hip fractures result in death in up to 20% of cases, and disability in 50 percent of those who survive
Definition of Osteoporosis
According to the National Institute of Arthritis and Musculoskeletal and Skin Diseases, Osteoporosis is defined as, “A disease characterized by low bone mass and structural deterioration of bone tissue, leading to bone fragility and an increased risk of fractures of the hip, spine, and wrist. Men as well as women are affected by osteoporosis, a disease that can be prevented and treated.”
Risk of Osteoporosis - what happens when we age and why
Bone strength is developed in early teens and teenage years. Teens require adequate levels of calcium, Vitamin D and weight bearing exercise to build strong bones.
- After age 19 you cannot improve bone mass, you can only maintain what you have.
- Our bones are constantly changing—new cells are created and older cells are removed.
- After the age of 30 the balance between forming new bone (osteoblast cells) and destroying old bone (osteoclasts cells) is lost.
- In women this loss is accelerated by the reduction of estrogen after menopause.
- Some bone loss with aging is considered normal. Excessive loss of calcium results in a reduction of bone mass, which reduces the density of bone. This creates porous bones that are weak and easily fractured under stress or injury. Stress is mostly carried in our spine and when we fall our wrists and hips absorb the impact. Fractures occur mostly in the hips and wrists in persons with Osteoporosis.
Bone loss is another reason why preventing falls is important if you are a caregiver caring for an older adult who is at risk for a fall. There is a very real possibility of a serious fracture. See our Elizz article on how to Prevent Falls in 4 Easy Steps.
What are the risk factors for Osteoporosis?
There are many risk factors for Osteoporosis. Lets review some of them so you can see if you or someone you are caring for are at risk. Check off all that apply and then take them to you family doctor.
- Age 65 or older
- Vertebral compression fracture with minimal trauma (after age 40)
- Family history of Osteoporotic fracture (especially if your mother had a hip fracture)
- Long-term use of glucocorticoid therapy such as prednisone (continuously for more than 3 months)
- Medical conditions (such as Celiac disease, Crohn’s disease)
- Primary hyperparathyroidism (weakening of bones due to loss of calcium)
- Tendency to fall over
- Osteopenia apparent on x-ray (reduced bone mass)
- Hypogonadism (low testosterone in men, loss of menstrual periods in younger women)
- Early menopause (before age 45)
Warning signs of Osteoporosis
There are also a number of warning signs to watch out for that might indicate Osteoporosis, especially if you are over the age of 50.
- Loss of height (four or more cm since your teens or two or more cm in one year) Usually individuals can expect to loose 1-2 cm over a lifetime
- Kyphosis (excessive backward curvature of the spine resulting in either a hump or a more gradually rounded back)
- Recent fracture to the wrists, hip, or vertebrae, in which osteoporosis is suspected
Screening for Osteoporosis
Your family physician can screen someone you are caring for (or screen you) by ordering a bone scan to measure the bone mineral density of your bones (BMD):
- The results (called a T-score) are compared to the bones of an average young adult.
- The T-score is expressed in units referred to as “standard deviations” (SDs).
- The SD units show how you differ (or are different) from what is considered normal for a young adult.
- Normal bone density is no more than 1 SD below the young adult normal value (BMD test results).
- A score between –1 and –2.5 SDs indicates “Osteopenia” or low bone density (not as severe as Osteoporosis).
- A T-score below –2.5 SDs indicates Osteoporosis.
If you are a caregiver and you or the person you are caring for has a negative score, you are at risk for fractures and will require interventions and or treatments.
If you or the person you are caring for falls into any of the categories of Osteopenia or Osteoporosis, your physician will order the following Treatments.
These you can do without a prescription. They include diet changes and exercise changes:
- Adequate diet of Calcium and Vitamin D—Milk products, soya products, broccoli, almonds
- Calcium = 1200mg per day
- Vitamin D = 800 units for those over 50---natural source is sunshine! Soak it up!!!
- Weight bearing exercises only = walking, running, weight lifting, (swimming or riding a bike does not help – instead, go for walks, join a social club/exercise club/seniors centre)
- Reduce risk factors such as excessive caffeine, smoking, alcohol abuse
A registered dietician can help you choosing the right foods to obtain your calcium, especially if you and or the person you are caring for has any dairy restrictions or food restrictions.
If necessary, your family doctor may order some medications such as:
- Estrogen (HRT)
- Vitamin D tablets and Calcium supplements
- Calcitonin (stimulates calcium deposits on the bone)
- Biophosphonates (These help slow the production of bone destroying cells [osteoclasts] allowing osteoblast cells to deposit calcium and build bone mass)
Each of the biphosphates requires specific instructions. Most are required to be taken an hour before meals, with water, and to prevent reflux and damage to the esophageal wall, clients are not allowed to lie down. Calcium supplements are to be taken at least one hour after these medications. Additionally, a diet rich in calcium is recommended.
Osteoporosis can be controlled and managed through diet, exercise, and when needed, the addition of medication. If you are concerned about the person you are caring for or for yourself, speak to your family doctor about Osteoporosis.
Here are a few websites you can visit as well, to obtain more information about Osteoporosis.
National Institute of Arthritis and Musculoskeletal and Skin Diseases
Elizz is a Canadian not-for-profit organization powered by Saint Elizabeth Health Care. Eizz offers care support services to family caregivers as well as for those in your care and is the place for all things caregiving.
If you still have questions about Osteoporosis and wish to speak with a care professional, please contact a caregiver coach or call Elizz at 1-855-Ask-Eliz (275-3549).