The purpose of this article includes understanding osteoporosis and its prevalence in the geriatric population to promote prevention and highlight treatment options.
The geriatric population is also commonly referred to as the elderly population and is characterized by a group of individuals who are 60 years and older. This population is rapidly increasing and has been predicted to reach approximately 2 billion by 2050.
Osteoporosis is a condition characterised by low bone mineral density and changes in bone microstructure, leading to weakened and brittle bones. This increases the risk of low-impact fractures, commonly affecting the hip, wrist, and spine. Bone tissue continuously undergoes breakdown and regeneration, and osteoporosis arises when there is an imbalance between these processes.
Symptoms of bone loss include:
- Lower back pain because of a broken or collapsed bone in the spine
- Decrease in height over time
- Slouched posture
- Fragility fracture
Bones are in a constant state of renewal. At a younger age, the body regenerates new bone at a faster rate than it is being broken down, and thus bone mass increases. This process begins to slow down after the early 20’s, with most people reaching their peak bone mass by age 30. As ageing continues, bone mass reduces faster than it is being formed.
The risk of developing osteoporosis is partly determined by the peak bone mass, which is influenced by genetics and ethnicity. A higher peak bone mass provides greater reserves, lowering your risk as you age.
Osteoporosis affects over 200 million people globally, with the incidence increasing with age. More than 70% of individuals over 80 years are impacted; it is more common in females than males and amongst the Caucasian and Asian ethnicities.
Diagnosis
A bone density test (DEXA scan) uses x-rays to measure calcium and bone mineral content in specific areas, typically the spine, hip joints, and sometimes the forearms. This test helps confirm a diagnosis of osteoporosis, monitor treatment effectiveness, and assess fracture risk. It may be recommended for various reasons, including evaluating bone health:
- Lost of overall height: oosteoporosis is a leading cause of compression fractures in the spine, often observed in individuals who have lost 1.5 inches in height.
- Fractured bone: Fragility fractures occur when bones break more easily than anticipated due to increased fragility. A strong sneeze or cough may result in a fragility fracture.
- Use of certain drugs: Long-term use of steroidal medications, such as Prednisone, interferes with the bone-rebuilding process, which can in turn lead to osteoporosis.
- Decrease in hormone levels: This occurrence weakens bones. There is a natural decrease in hormone levels after menopause and reduction during certain cancer treatments.
The results of the bone density test are recorded as T–scores and Z-scores. The T-score compares your bone density with the average of a healthy young adult of your sex. A confirmation of the diagnosis occurs when your T-score is -2.5 and below.
A CT scan or Diagnostic Ultrasound may also be performed to diagnose or rule out osteoporosis.
Medical Management
To effectively treat osteoporosis, a DEXA scan estimates fracture risk over the next ten years. If the risk is low, treatment may focus on conservative management and addressing factors that contribute to bone loss and falls. However, if there is a high risk, then treatment might include medications such as:
- Bisphosphonates are most the commonly prescribed for men and women.
- Denosumab is administered via an injection under the skin every six months.
- Hormone-Related Therapy, which includes oestrogen for women and testosterone for men.
- Romosozumab and Teriparatide are prescribed to stimulate bone growth if the osteoporosis is severe, or the standard medications are ineffective.
Modifications of risk factors include:
- Smoking cessation
- Engaging in a physically active lifestyle
- Limit alcohol consumption, as there can be a decrease in bone formation when consuming more than two alcoholic drinks a day and being under the influence of alcohol can also increase the risk of falling.
- Fall prevention: safety measures include wearing low-heeled shoes with nonslip soles, removing any loose electrical cords or low height floor objects, eliminating slippery surfaces, and installing grab bars in and outside the shower.
Physiotherapy Management
Physiotherapy aims to improve quality of life and minimize the impact of osteoporosis. This includes:
- Education on diet and lifestyle modifications, safe environments, and body biomechanics.
- Enhancing strength with weight-bearing exercises to improve overall muscle strength to support bone health and reduce risk of fractures.
- Improving balance and coordination to prevent falls.
- Increasing flexibility to improve postural control, mobility, and functional ability
- Fall prevention by developing tailored fall prevention strategies.
- Pain management through appropriate exercises and modalities.
- Promoting independence by assisting individuals in preserving or restoring their independence in daily activities.
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