Older adults are more likely to develop osteoporosis, a condition that makes bones thin and weak. In severe cases, bones can fracture with relatively little trauma, like falling from standing height or rolling over in bed. Sometimes a bone can break without the person even being aware of the damage. The most common sites for fracture are hip, wrist, shoulder and spine.
In an older adult, breaking a bone can have serious consequences. A fracture might mean a hospital stay, a surgery to fix the bone, a period of rehabilitation, chronic pain, less mobility and loss of independence. It puts you at higher risk of complications like blood clots, infections, and further falls. Returning home may or may not be possible. This will depend on many factors, such as whether you can care for yourself, do household chores like cooking, or have problems with stairs.
As you get older, reducing your risk of fracture is just as important as reducing that of heart attack or stroke. Many people become more aware of this risk as they get older. However, protecting bones can start as early as childhood and adolescence, by establishing good habits of eating well and exercising. Don’t be surprised if your doctor says that a bone density test is not required, even if you’ve had bone density tests every couple of years in the past.
How can you know whether osteoporosis affects you? While a bone density test can help, the guidelines have changed. New understanding of bone health suggests that risk of fracture involves more than just bone density. Measuring bone density is still important, but testing is not needed as often as was once believed.
Your risk of breaking a bone depends on several factors. These include:
Risk calculators that consider these factors can help determine your risk of breaking a bone in the next ten years. Your doctor can do this calculation with or without a bone density test. This calculation can also help determine whether you might benefit from medication that protects bone density. Next time you and your dictor discuss bone health, instead of asking ‘Do I need a bone density test?”, try asking “What is my fracture risk?”
Until recently, bone-protecting medications known as bisphosphonates were prescribed to otherwise healthy women in their 50s and 60s when reduced bone density was found.
In reality, many of these women were at a lower risk of suffering from a fracture due to fragile bones.
We now know that these medications are most effective in older people more likely to have a fracture. New evidence also suggests that they work best over a short period of time, such as five to ten years. Using them longer may not benefit the bone, and may even carry a small risk of harm.
When used appropriately, bisphosphonates have been shown to reduce the risk of fractures due to osteoporosis by 30 to 40 per cent. For instance, if your fracture risk is 20 per cent, taking a bisphosphonate for three years reduces that risk by 30 to 40 per cent. This brings your risk down to 12 to 14 per cent.
Some problems associated with these medications have received media attention. They include osteonecrosis of the jaw (bone death caused by poor blood supply), ‘atypical’ fractures of the femur (thigh bone), cancer of the esophagus (the tube from the throat to the stomach), and atrial fibrillation (where the heart does not beat in proper rhythm). However, the number of these negative events remains rare.
Today, people who have taken these medications for years may be advised to stop them. Other types of medications can also be used to protect bones. Hormone replacement therapy is one possibility. The decision to use medication is a very individual one that you and your doctor must weigh together.
The good news is that whether you are 34 or 84, there are plenty of ways to protect your bones without medication.
The medical understanding of osteoporosis, bone density testing, and bisphosphonate treatment is changing rapidly. The advice your doctor gave two years ago about osteoporosis testing and treatment may differ today. Protecting your bones with a healthy lifestyle of exercise, healthy eating, and avoiding smoking and excessive alcohol intake is advice that never changes.