Opinion: Don’t Neglect Bone Health

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Half of women, and up to 25 percent of men, age 50 and older will experience a fracture in their lifetimes – but most relegate bone health to the bottom of age-related wellness concerns.

Sarah Berry is a Jamaica Plain resident and academic geriatrician in musculoskeletal health at Hebrew Rehabilitation Center.

May is Osteoporosis Awareness and Prevention Month, and it's important to know that older adults are likely to focus on what they can do to prevent conditions like cancer, Alzheimer’s Disease, or heart disease, believing those represent the greatest risks to quality of life and longevity with age. But that may be a mistake.

Broken bones are a leading cause of hospitalizations among women aged 55 years or older, ahead of heart attacks, stroke, and breast cancer. Fractures significantly impact quality of life, causing pain, restricting mobility, and leaving many patients feeling depressed. Effects can be long-lasting, resulting in increased use of health care services, a greater likelihood of hospitalization and nursing home placement, and increased mortality risk for up to 10 years post fracture.

Yet nearly all patients who survive heart attacks receive a treatment plan to prevent a second attack. By comparison, just 10-15 percent of hip fracture patients receive follow-up treatment plans although many experience a subsequent fracture. Roughly 25 percent of patients with a hip fracture will die within a year of fracture as the result of infection or other complications. That is another reason it is important to take preventive measures before a fall. 

It is important to understand that osteoporosis is a skeletal disorder characterized by compromised bone strength, a condition that is generally under-diagnosed. All too often the assumption is that a break from a fall or accident is due to the blunt force of the impact instead of being the result of underlying bone weakness.

But it’s important to note that osteoporosis is not inevitable with age, and is something to discuss with your doctor, even if you’ve never broken a bone.

Here are four steps you can take to protect your bones throughout life. 

  • Get a Bone Density Test

Ask about getting a bone density test, a low-dose x-ray test also known as a DXA scan, as part of your yearly wellness checkup to measure the density of minerals in your bones. The measurement helps show the mass and density of your bones. This test is important to determining how advanced the osteoporosis is, and to inform appropriate clinical treatment.

It's also important to find out if certain conditions may be contributing to your osteoporosis such as medications that can cause bones to weaken. Your primary care provider may refer you to specialists to help understand the full range of conditions that might be causing your osteoporosis including diabetes, kidney or liver disease, Celiac disease, and autoimmune disorders.

Food choices can make a difference, but you also may need medication, too.

  • Consume a higher level of dietary protein 

A study has shown seniors who do this are less likely to suffer hip fractures than seniors whose daily dietary protein intake is less. Researchers recommend older women consume at least 46 grams of protein per day and that older men consume at least 56 grams of protein daily. This can come from both animal sources (meat, poultry, fish, eggs, milk, cheese, and yogurt) and plants (legumes, grains, nuts, seeds, and vegetables).

Vitamin D intake is also extremely important because it is essential for absorption of calcium. It is synthesized in skin upon exposure to direct sunlight or ingested in foods such as egg yolks, fish, liver or in supplements. As with calcium, sunlight and diet are the best sources for vitamin D intake. However, Vitamin D supplementation should be advised for patients unable to have sun exposure without sunscreen use and is especially important for older individuals who live in northern latitudes or who are housebound.

It's also important to eliminate smoking and excessive alcohol consumption.

  • Exercise and balance training

Check with your primary care provider before starting an exercise program because, among other things, improving your fitness and balance is vital. Your doctor can also refer you to a physical and/or occupational therapists for evaluation and interventions to improve impairments in mobility, gait, and balance.

A recent study conducted by the Hinda and Arthur Marcus Institute for Aging Research, part of Hebrew SeniorLife, showed that Tai Chi for nine months improved bone mineral density and tended to slow down the turnover of bone, not to mention Tai Chi’s benefits on fall reduction. Exercise also improves muscle strength, and is important for the prevention of falls, fractures, and hospitalizations.

  • Eliminate Things that Can Cause Falls

Your PCP should regularly evaluate your risk. But here are some common sense ways to reduce the likelihood of falling in your home:

  • Keep rooms and floors free of clutter
  • Keep floor surfaces clean but not slippery
  • Place skid-proof backing on carpets and scatter rugs
  • Keep rooms well-lit
  • Use a rubber mat in shower/tub
  • Use handrails on stairs, in bathroom
  • Keep a flashlight at bedside
  • Use a portable phone and keep phone and electrical wires out of walkways
  • Wear supportive, low-heeled shoes
  • Do not walk in socks or floppy slippers
  • Arrange for daily contact with a family member or neighbor

A number of different medications are associated with falls and injury, including sedatives, antidepressants, anti-anxiety medications, and antihypertensives. Talk with your doctor about your medications and falls – when risky medications are needed, use the lowest dose possible. The good news is that treatment and intervention can help improve bone strength and balance but that requires taking osteoporosis seriously.

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Sarah Berry, M.D. is a Jamaica Plain resident and academic geriatrician in musculoskeletal health at Hebrew Rehabilitation Center in Boston. She is also a clinical researcher at Hebrew SeniorLife's Hinda and Arthur Marcus Institute for Aging Research where she advances the study of osteoporosis and falls. She completed her medical internship and residency programs at the University of Utah Health Sciences Center, and fellowship at Beth Israel Deaconess Medical Center as part of the Harvard Medical School Multi-Campus Geriatric Medicine Fellowship Program.