May is National Osteoporosis Awareness Month, an opportunity to bring more attention to a condition that impacts millions of Americans — 54 million, in fact, who either have osteoporosis or low bone mass that puts them at risk for the disease. Those affected might not be aware of their weakened bone health until a bone unexpectedly breaks, yet one in two women and up to one in four men over the age of 50 will break a bone in their lifetime due to osteoporosis, according to the National Osteoporosis Foundation.
During this Osteoporosis Awareness Month, help your patients identify if they are at a higher risk for weak bones. Your patients should be aware of any risk factors they may not be able to control, along with those they can. By making seniors aware of the factors they can change, you’ll empower them to take preventative steps for staving off osteoporosis or at least reducing its severity.
Uncontrollable Risk Factors
The National Institutes of Health (NIH) outlines a number of factors linked to the development of osteoporosis. Those factors over which patients have no control are family history, ethnicity, gender, age, and body size. Women make up 80 percent of those with osteoporosis; they generally have smaller, thinner bones than men, and they’re prone to lose bone density later in life as a result of the hormonal changes of menopause. Certain ethnicities also experience higher rates of osteoporosis in the US: 20 percent of Caucasian women and 20 percent of Asian American women over the age of 50. Asian American women are thought to be more susceptible because about 90 percent of this demographic is lactose-intolerant, which can make it difficult for them to get enough calcium to keep their bones strong over the course of their lives.
Heredity may account for 50 to 90 percent of a patient’s bone mass. That leaves the remaining 10 to 50 percent to environmental factors that a person can at least somewhat control.
Preventable Risk Factors
Patients should be aware that they can take action at any age to positively influence their bone health. When given the proper education and options, they have the opportunity to avoid potentially debilitating or deadly fractures later in life. The NIH has identified the following lifestyle factors that contribute to the likelihood of developing osteoporosis: low calcium and vitamin D intake, inactivity, certain medication use, smoking and excessive alcohol intake, anorexia nervosa, and low sex hormones (resulting from amenorrhea or menopause in women, or low testosterone in men). If your patient is in the latter situation and considering possible hormone therapies, be sure to discuss the risks and benefits with her.
To reduce these risk factors in your patients, encourage them to make lifestyle choices aimed at reaching optimal peak bone mass and at continuing to build new bone tissue as they age. In other words, they can improve their bone health by choosing to quit smoking or reducing their alcohol consumption, getting into a regular exercise routine, and increasing their calcium and vitamin D intake.
Exercise, Exercise, Exercise
Exercise is generally seen as one of the best ways to prevent osteoporosis as well as the associated risk for falling that can result in fractures and other injuries. A number of studies have shown that physical activity can increase bone mass, density, and strength. Individuals who perform regular exercise or physical activity starting a young age experience increased benefit to their bones. However, bone tissue also responds to exercise in older adulthood, although the benefit seems to be the preservation of bone density, rather than an increase of bone density.
Seniors should seek out exercises for improving endurance and strength. Flexibility and back- and abdomen-strengthening exercise are also important for maintaining good posture. Exercises should not be done to a point of pain, but your patients should understand that it’s normal to experience some muscle soreness for a day or two following a workout. If you’re concerned about a patient who already has very low bone density or a recent bone fracture, recommend that he consult a physical therapist to find a regimen that is supportive but not so aggressive that it might aggravate or cause further injury. Activities that involve bending forward from the waist or too much twisting of the spine are generally not recommended.
Calcium and Vitamin D Levels
Adequate lifelong calcium and vitamin D intake play an important role in preventing osteoporosis. However, the optimal intake level of calcium is not clear. The National Academy of Sciences recommends calcium intake levels of 1,200 milligrams per day for those over age 50, but recent studies suggest that ingesting high amounts of calcium doesn’t necessarily lower a person’s risk for osteoporosis. In fact, a 2007 meta-analysis of prospective cohort studies and randomized controlled trials notes that calcium intake is not significantly associated with hip fracture risk in women or men.
Because of unresolved concerns about dairy’s possible association with an increased risk for prostate and ovarian cancers, some patients may want to avoid higher amounts of calcium through these products. At least until further large-scale studies are performed, you can recommend that your patients obtain their calcium through a healthy diet that incorporates calcium-rich foods such as dark leafy greens, one glass of milk each day, and perhaps a calcium supplement.
Vitamin D also plays a part in calcium absorption and bone health, and it can be found in fatty fish such as salmon, cheese, egg yolks, and vitamin supplements. The skin produces vitamin D when it is exposed to sunlight, as well, though older adults may need to take a vitamin D supplement if they live above 40 degrees north latitude, where winter sunlight is not strong enough to promote vitamin D formation. They may also need to take a supplement if they are housebound and not getting enough time in the sun throughout the year. A vitamin D blood test provides current levels, enabling appropriate recommendations for supplementation.
Smoking, Alcohol, and Bones
You’re probably already recommending that your patients avoid smoking and alcohol for a number of reasons. They’re bad for bone health, too. Smoking can negatively affect bone loss, and women who smoke often produce decreased levels of estrogen and go through menopause earlier, which, as stated above, is correlated with lowered bone density. Smoking can also lessen the amount of calcium absorbed from dietary sources.
As for alcohol, regular consumption of even just three ounces a day may damage bone health, according to some studies, in both older and younger adults. Those who drink more heavily may have the related effects of poor nutrition and increased fall risk, which can make them more prone to bone loss and fractures.
Osteoporosis: Fall Risk Culprit
Osteoporosis Awareness Month also provides an opportunity to talk with your older patients and their families about fall risks and fall prevention steps, especially if a senior is prone to fractures due to lower bone density. If a bone breaks as a result of a fall, that person’s activities are generally limited while the bone heals. Surgery or a heavy cast may be required, and physical therapy might be a necessary step toward returning to a normal level of activity. These issues can often be more extreme for older adults, especially those with osteoporosis.
For adults over age 50, most fractures are related to osteoporosis. Hip fractures are particularly concerning, as they are associated with an increased risk of death within a year of the injury, and a significant percentage of seniors living without assistance before a hip fracture end up in long-term care institutions afterward, such as an assisted living or nursing facility. And more than 90 percent of the time, hip fractures occur as a result of a fall.
In addition to osteoporosis, you may want to discuss the following fall risk factors with your senior patients:
- Muscle weakness
- Increased unsteadiness when on the feet
- Certain medications
- Worn or improper use of walking aides
- Poor vision and balance
Understanding the factors that may lead to a fall is only the first step in prevention. When a fall cannot be avoided, seniors may be able to protect themselves from more serious injury by using their reflexes and changing their body position during the fall. A hip fracture is more likely to cause long-term disability compared to a broken arm or wrist, so encourage your patients to use their hands and arms to reach for something as they fall, or to simply use their hands to soften the fall and avoid a more serious injury. And getting immediate care is critical should a fall occur, whether the senior has weakened bones or another medical condition. Encouraging seniors to set up a medical alert system, either at home or for outside the home, helps ensure that they get the help they need as quickly as possible.
National Osteoporosis Awareness Month reminds not only the public but the medical community at large to focus on prevention of a disease that affects millions. Patients at any age can benefit from information about osteoporosis; prevention efforts can begin with regular exercise in youth, but these efforts should continue throughout adulthood. The National Osteoporosis Foundation provides a wealth of information that you can point your patients and their caregivers to, including printable guides and fact sheets. The foundation also offers BoneSource for healthcare practitioners, which includes educational materials, webinars, and training. In May and throughout the year, remind your patients to take the necessary steps to improve or maintain good bone health so that they can reduce their risk of osteoporosis and the associated risks for fractures and falling.