Osteoporosis and bone fractures: The double trouble

Even a simple fall can result in bone fractures in old age. Have you ever thought of the reasons and preventive strategies of fractures in old age

Osteoporosis or reduction in the bone mineral density decreases bone strength, making the elderly much more prone for broken bones.

It is more common in women especially with the loss of estrogen after menopause. However, it affects both sexes and prevalence is 50-60% above the age of 70.The commonest sites of osteoporotic fractures are wrist, vertebra and the hip. Vertebral compression fractures are a common cause of severe back pain. Multiple vertebral fractures slowly result in stooping of the posture, loss of height and persistent pain restricting daily activities.

Presence of osteoporosis can be confirmed with Dual Energy X-ray Absorptiometry (DEXA) Scan. DEXA is similar to X ray but with lower radiation. The scoring system will assess loss of bone density which could range from normal to osteopenia (mild loss) to osteoporosis (severe loss). If the fracture risk is high, subjects should receive appropriate treatment.

Common reasons for osteoporosis are deficiency of oestrogen (women) and testosterone (men), Asian ancestry, early menopause or surgical removal of uterus or thin build. Excessive alcohol intake, cigarette smoking are independent risk factors. Vitamin D deficiency if any should be corrected.

Three commonly used drugs — steroids, medications for epilepsy and hypothyroidism — may induce bone loss.

Treatment includes oral medications (Alendronate), Tereperatide injection etc.

Take home message: Fractures in the elderly are preventable.

(The author is a consultant in geriatrics and was instrumental in starting the geriatric unit in Trivandrum Medical College)