A Caregiver's Guide to Osteoporosis, Fractures and Senior Bone Health


Only those who have experienced a fracture can truly understand how painful and debilitating it can be. As a caregiver helping your parent recover is probably your first priority. However, your doctor will also want to determine whether this fracture is a symptom of osteoporosis.

People with osteoporosis are at greater risk for future fractures. For anyone over age 50, there is a very good chance the fracture is related to osteoporosis.

Many people are unaware of the link between a broken bone and osteoporosis. Osteoporosis, or "porous bone," is a disease characterized by low bone mass. It makes bones fragile and more prone to fractures, especially of the hip, spine, and wrist.

Osteoporosis is called a "silent disease" because bone loss occurs without symptoms. People typically do not know that they have osteoporosis until their bones become so weak that a sudden strain, twist, or fall results in a fracture. Osteoporosis is a major public health threat for an estimated 44 million Americans.

According to the National Institute of Arthritis and Musculoskeletal and Skin Diseases, in the United States today, approximately 10 million people already have the disease and almost 34 million more are believed to have low bone mass, leaving them at increased risk for osteoporosis. Of the 10 million Americans estimated to have osteoporosis, eight million are women and two million are men. One in two women will have an osteoporosis-related fracture in their lifetime. Although it is a condition that predominantly affects women, men can get osteoporosis too. One in four men will have an osteoporosis-related fracture in their lifetime. At least 90 percent of all hip and spine fractures among older white women can be attributed to underlying bone fragility. Moreover, women near or past menopause who have sustained a fracture in the past are twice as likely to experience another fracture. Yet, unfortunately, only 5 percent of patients with osteoporotic fractures are referred for an osteoporosis evaluation and medical treatment.

How Can You Tell If An Elder Has Osteoporosis?

Here are some common questions and answers that caregivers ask about osteoporosis and their aging parents:

My mom has already had a fracture. Is it too late to talk to my doctor about osteoporosis?

It is never too late. Ideally, you should talk to your doctor during your mother's recovery about whether she might be a candidate for an osteoporosis evaluation. But even if her fracture has healed, she can be evaluated and begin taking steps to protect her bones.

What kind of doctor should I see about getting an osteoporosis evaluation?

Many different kinds of doctors can evaluate and treat osteoporosis. Start with your primary care physician or the doctor treating your loved one's fracture. He or she will likely be able to conduct the evaluation and may then refer you to a specialist, such as an endocrinologist or rheumatologist, if you require treatment.

What does an osteoporosis evaluation involve?

One thing your doctor will do is ask about your paren'ts medical history and lifestyle to determine whether he/she has risk factors for osteoporosis. Some of the factors that increase the risk of developing osteoporosis include: personal or family history of fractures; low levels of the hormone estrogen or testosterone; and the use of certain medications, such as glucocorticoids or antiseizure medications, that may contribute to bone fragility. Your doctor also may want to test your elderly parent's blood or urine and may suggest that he/she have a bone mineral density (BMD) test.

What is a bone mineral density test? Is it painful?

A bone mineral density (BMD) test is the best way to determine bone health. BMD tests can identify osteoporosis, determine your elder's risk for fractures (broken bones), and measure response to osteoporosis treatment.

The most widely recognized bone mineral density test is called a dual-energy x-ray absorptiometry or DXA test. It is painless: a bit like having an x ray, but with much less exposure to radiation. It can measure bone density at the hip and spine. The test is safe and easy, taking only 15 minutes or less to complete. For a DXA test, your elderly parent will be asked to lie on a table while a machine above measures bone density. Some private insurance plans will cover BMD tests ordered by a doctor. Medicare also may pay for a BMD test under certain circumstances for women and men aged 65 or older. Your doctor and his or her office staff can help you determine if Medicare will cover a BMD test.

Should I consider medication for my elderly parent?

Yes. Several medications are available to prevent and treat osteoporosis. These products have been proven effective at minimizing additional bone loss and/or reducing fracture risk. Your doctor can help you understand the benefits and risks of each of the following medications and select one that is right for you:

  • Bisphosphonate drugs: Alendronate, alendronate plus vitamin D, risedronate, risedronate with calcium and ibandronate
  • Calcitonin
  • Faloxifene, a Selective Estrogen Receptor Modulator
  • Teriparatide, a form of the hormone known as PTH, which is secreted by the parathyroid glands
  • Estrogen therapy (also called hormone therapy when estrogen and another hormone, progestin, are combined). In men, reduced levels of testosterone may be linked to the development of osteoporosis. Men with abnormally low levels of testosterone may be prescribed testosterone replacement therapy to help prevent or slow bone loss.

What else can my parent do to her bones?

In addition to taking her medication, some of the most important things your elderly mom can do are to follow a diet rich in calcium and vitamin D, maintain an adequate daily intake of protein, monitor sodium intake, and get plenty of bone building exercise.

Proper nutrition is one of the best ways to preserve your bone density and prevent falls as you age.

Calcium is needed to maintain healthy, strong bones throughout your life. After age 50, both men and women need to increase their calcium intake from 1,000 mg to 1,200 mg per day. Unfortunately, most Americans do not get enough calcium from their diets. Dairy products like milk, cheese, and yogurt are an excellent source of calcium, and some nondairy foods like broccoli, almonds, and sardines, to name a few, can provide smaller amounts. In addition, many foods that your aging mother may already enjoy - juices, breads, cereals - can now be found fortified with calcium.

Although food is the best source of calcium because it also provides other essential nutrients, calcium supplements can fill the gap if you're not getting enough from your diet. Calcium supplements are available without a prescription in a wide range of preparations and strengths. Many people ask which calcium supplement they should take. The "best" supplement is the one that meets your needs based on tolerance, convenience, cost, and availability. In general, you should choose calcium supplements that are known brand names with proven reliability. Also, you will absorb calcium better if you take it several times a day in smaller amounts of 500 mg or less each time.

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How to Prevent Your Aging Parent from Falling

Vitamin D plays a significant role in helping the body absorb calcium. The relationship between calcium and vitamin D is similar to that of a locked door and a key. Vitamin D is the key that unlocks the door, allowing calcium to enter the bloodstream. As we age, our bodies become less able to absorb calcium, which makes getting enough vitamin D even more important. The recommended daily intake for vitamin D is 400 to 800 International Units (IU). Many people get this amount through natural exposure to sunlight, which our bodies use to make vitamin D, and by consuming vitamin D-fortified foods like milk. In addition, many calcium supplements are fortified with vitamin D.

Sodium is another nutrional "no-nos" for those who are seeking to avoid osteporosis. Sodium, a main component of table salt, affects our need for calcium by increasing the amount of it we excrete in urine. As a result, people with diets high in sodium, or table salt, appear to need more calcium than people with low-sodium diets in order to ensure that, on balance, they retain enough calcium for their bones. Protein in excess amounts also increases the amount of calcium we excrete in urine, but it provides benefits for bone health as well. For example, protein is needed for fracture healing. In addition, studies have shown that elderly people with a hip fracture who do not have enough protein in their diets are more likely to experience loss of independence, institutionalization, and even death after their fracture. The recommended daily intake for protein is 56 grams for men and 46 grams for women.

My mother's fracture happened after she tripped on a rug in my own home. How can I prevent another fall?

Falls are a major source of fractures. The likelihood that you will fall depends on both personal and environmental factors.

Personal factors: A fall may occur because your loved one's reflexes have slowed over time, making them less able to react quickly to a sudden shift in body position. Loss of muscle mass may occur as you age, which can diminish strength. Changes in vision and hearing can also affect balance, as can the use of alcohol and certain medications. People with chronic illnesses that affect their circulation, sensation, mobility, or mental alertness are more likely to fall. To reduce the risk of falling, keep this personal safety checklist in mind:

  • Stay active to maintain muscle strength, balance, and flexibility.
  • Have vision and hearing checked regularly and corrected as needed.
  • Discuss your loved one's medications with your doctor to see if one of them (or their combination) might lead to falls.

Environmental factors: At any age, people can make changes in their environment to reduce their risk of falling and breaking a bone. The following safety checklists for fall prevention in the home can provide a few tips that should help:

  • Use nightlights throughout your home
  • Keep all rooms free from clutter, especially the floors
  • Keep floor surfaces smooth but not slippery
  • Wear supportive, low-heeled shoes even at home.
  • Avoid walking around in socks, stockings, or floppy slippers
  • Check that all carpets and area rugs have skid-proof backing
  • Keep electrical cords and telephone lines out of walkways
  • Keep stairways are well lit, with handrails on both sides
  • Install grab bars on bathroom walls beside tubs, showers, and toilets
  • Use a rubber bath mat in the shower or tub.
  • Keep a flashlight with extra batteries beside the bed.
  • Use at least 100-watt bulbs
  • In winter, wear warm boots with rubber soles for added traction.
  • Look carefully at floor surfaces in public buildings, watching for highly polished marble or tile that can be slippery.
  • Stop at curbs to check height before stepping up or down.

If my mom is diagnosed with osteoporosis, what should I do next?

Your loved one may feel concerned or even frightened after being diagnosed with osteoporosis. However, the good news is that, armed with information and the support of your doctor, she/he can significantly improve bone health and reduce the risk of future fractures with a combination of medication, diet, exercise, and lifestyle modifications.

My dad has always been active, but doesn't want to risk breaking another bone. Should he spend more time "on the sidelines" from now on?

It is perfectly understandable that you want to avoid another fracture. No one who has broken a bone wants to revisit that pain and loss of independence. However, living your life "on the sidelines" is not an effective way to protect your bones. Remaining physically active reduces the risk of heart disease, colon cancer, and type 2 diabetes. It may also protect against prostate cancer and breast cancer, high blood pressure, obesity, and mood disorders such as depression and anxiety.

What is hip padding? Should I consider it?

Research has shown that hip protectors can decrease the risk of hip fracture among people who are at high risk for falls. Most hip protectors are washable undergarments that fit over the hips. On each side of the garment is a thin layer of lightweight foam plastic.

Hip protectors are typically worn by people who have an unstable stride or posture, and by people who tend to fall down (with the main impact near the hip) rather than the more typical fall forward (with the main impact on the hands or knees). However, studies have found that up to one third of people refused to wear hip protectors, or wore them for only limited periods.

Sources: 1. National Institute on Aging, https://www.nia.nih.gov/health/osteoporosis 2. The National Institute of Arthritis and Musculoskeletal and Skin Diseases (NIAMS), https://www.niams.nih.gov/

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