Walking may be the best medicine to ensure strong bones, especially for seniors.
“Walking stimulates bone formation because it is a weight-bearing exercise,” explains Nahid J. Rianon, MBBS, DrPH, a specialist in geriatric medicine with UT Physicians and McGovern Medical School at The University of Texas Health Science Center at Houston (UTHealth).
The geriatric population includes those over age 65, a time when many suffer the consequences of poor bone health.
“For this age group, weak bones can be life-changing and even deadly, making prevention of bone loss/osteoporosis and fractures a critical factor to quality of life,” Rianon adds. “There are dangerous consequences of fractures for those in the geriatric population.”
According to the International Osteoporosis Foundation, approximately 20-24 percent of people with an osteoporotic hip fracture die within one year after a hip fracture, and the increased risk of dying continues for at least the next five years. Loss of function and independence among survivors is profound, with 40 percent unable to walk independently and 60 percent requiring assistance a year later.
Osteoporosis and bone density screening
“Bone disease, such as osteoporosis, can be a silent disease until it causes a fracture,” says Catherine G. Ambrose, PhD, an associate professor and director of research laboratories in the Department of Orthopedic Surgery at McGovern Medical School at UTHealth.
Osteoporosis is common among seniors and occurs when bone density decreases and the body stops producing as much bone as it did before.
“Bone loss affects women and men, but unfortunately, most people don’t realize they have a fragile bone until it breaks because there are no symptoms,” she says. “Osteoporotic bones can break easily, increasing the risk of fractures, especially in the hip, spine, and wrist.”
For women in their 20s, hormones help protect bones. At menopause, usually for women in their 50s, a woman’s hormone production drops.
“There are proven treatments to build bone strength and reduce the risk of osteoporotic fractures,” Ambrose explains. “The first line of treatment are bisphosphonates, such as Fosamax (alendronate) or Actonel (risedronic acid), or other drugs that slow bone resorption, such as Prolia (denosumab). Other options to boost bone mass are through medications such as Forteo (teriparatide) and a new medication, Tymlos (abaloparatide).”
Most women understand the need to screen for breast and endometrial cancer and many routinely monitor their blood pressure and cholesterol.
“But many women don’t screen for osteoporosis,” she adds. “Testing bone density is an important way to determine bone health, and women over age 65 should have a bone density test.”
In the United States, the most common bone density test is DXA, a type of X-ray, which measures how strong bones are. The test is painless and takes only a few minutes.
Keep your bones strong
“We treat patients from age 50 to over 90, and the most common fractures in this age group are hip, wrist, upper arm, spine, and pelvis,” says James Kellam, MD, with the Bone Health Clinic at UT Physicians. Kellam is a professor in the Department of Orthopedic Surgery at McGovern Medical School at UTHealth.
“Our message is to focus on bone health and fracture prevention,” he explains. “If a person does have one fracture, we want to prevent a second fracture.”
Kellam confirms he sees many patients with fractures that could have been prevented by taking precautions about falls and taking measures to strengthen their bones. “Strengthening your body helps prevent falls and preventing falls is key to avoiding a broken hip or wrist,” he says.
Tips for seniors to strengthen older bones and help prevent bone problems:
- Weight-bearing exercise, including walking (30 minutes a day, even in 10-minute increments)
- Balanced diet (dairy products, fish, leafy green vegetables)
- Supplements (Vitamin D and calcium)
- Avoid salty foods and caffeinated beverages
“Those in the geriatric population may have a reduced appetite or be less inclined to cook balanced meals, making bone-healthy nutrition a concern,” adds Christina Yazdani, PA, with the Bone Health Clinic at UT Physicians and the Department of Orthopedic Surgery at McGovern Medical School at UTHealth.
Treatment of broken bones
“Statistics show there are more fragility fracture admissions from falls each year to hospitals than cardiac, cancer, and diabetes combined,” Kellam says.
A fragility fracture is any fall from a standing height, or lower, that results in a fracture. Bones should be able to sustain a fall from this height without a fracture, unless there is an underlying cause that weakened the bones.
“The orthopedic management of a fragility fracture is individualized for each patient to provide the best solution,” Kellam explains.
“For many upper extremity fractures, the preferred option is a non-operative method that uses a cast to treat a fracture until it heals,” he says. “A surgical option is used for lower extremity fractures, especially around the hip and knee. Surgical treatment uses metal implants such as plates or joint replacements that allow the patient to remain mobile. Keeping elderly patients mobile is key to their independence, as this is an important part of their mental health.”
Another common issue among the aging population is a fracture that occurs around a total joint replacement, such as a shoulder or elbow, called a periprosthetic fracture.
“Older patents are often sent to us to have their bone optimized before surgery and to treat any underlying problem,” Yazdani says. “Often, this means ensuring the patient has the right amount of calcium and vitamin D.”
Kellam and his team are concerned when an elderly patient’s fracture is treated, the patient thinks the problem is solved, and doesn’t work to improve their bone health.
“When we discharge a patient after treatment for a fracture, only 20 percent do follow-up treatment for osteoporosis,” Kellam adds. “Unfortunately, they think that it was just a broken bone and now it is fixed. They should ask, ‘Why did I break a bone?’ and take precautions to prevent a second fracture.”
Kellam, Rianon, and Ambrose are conducting a new research study to determine if the Trabecular Bone Score (TBS) will be effective in assessing risk of osteoporosis-related fractures in diabetic patients and patients with other chronic diseases. The study, analyzing the effectiveness of TBS in this patient population, compared with bone mineral density tests, is showing promise. TBS has already been validated for the general population.
A different pilot study is underway to evaluate advantages of another new tool – Raman spectroscopy. “This method measures bone protein and minerals and is promising for patients who are among those who do not receive an accurate bone density test,” Ambrose says.
“Often, osteoporosis is not a stand-alone disease,” Rianon adds. “Other diseases, such as high blood pressure or diabetes, may co-exist with osteoporosis. I urge people to talk with their doctor to make sure medications are appropriate. Certain medications may affect a patient differently if they have osteoporosis. Or some medications may have side effects such as drowsiness, and this can lead to falls.”
Rianon manages the Geriatric Osteoporosis Clinic at UT Physicians Center for Healthy Aging, where she sees patients 50 years and older. Her main research area is osteoporosis, due to age-related bone loss, and fracture prevention. “We conduct cutting-edge research and our aim is to individualize treatment for osteoporosis, evaluating bone loss patterns using DXA and metabolic biomarkers.” It is one of the few clinics in the U.S. with this emphasis.
“We can’t change our age or our genetics,” she emphasizes. “But we can take simple precautions such as night lights to prevent a fall and fracture. Do not wait for a bone to break. Talk with your health care provider about prevention strategies and individualizing your treatment, and find out if any of your medications could be weakening your bones.”
With more than 1,500 clinicians certified in 80 medical specialties and subspecialties, UT Physicians provides care for the entire family. Call 888-4UT-DOCS to schedule your appointment.