Osteoporosis

Osteoporosis is a disease that causes brittle, porous bones. A diagnosis of osteoporosis can feel overwhelming. What now? How will this change your life? Because it's a disease that weakens the bones, seniors living with osteoporosis are at risk of further injury. In this guide, we'll cover common medication and treatments, injury prevention, long-term care options, home modifications, choosing the right doctors, and more.

Osteoporosis risk factors

While anyone can develop it, some people are at higher risk of osteoporosis. Postmenopausal women, especially those over the age of 50, are at high risk because of hormonal changes in the body. In general, women have less bone mass and tissue to lose than men, which is one of the reasons there are more women with osteoporosis than men. Other genetic factors include:

  • Body size: Small, thin people have smaller, less dense bones.
  • Ethnicity: Caucasian and Asian populations have more cases of osteoporosis than African American and Hispanic populations. Though, anyone, no matter their ethnicity, can develop this disease.
  • Family History: Osteoporosis shows hereditary signs, often running in families. If you have a close family member with the disease, you are at a higher risk of developing osteoporosis. However, you can develop the disease even if there is no family history.

Beyond genetics, behavioral factors and certain medical conditions can increase the risk of low bone density, such as:

  • Hormone Imbalance: Low estrogen or testosterone levels contribute to osteoporosis as well as amenorrhea, the absence of menstrual periods.
  • Anorexia Nervosa: Without proper nutrition, the body cannot supply the necessary calcium for good bone health. This eating disorder weakens the bones along with other health problems.
  • Low Calcium and Vitamin D: A poor diet low in calcium and vitamin D can leave the bones susceptible weakness. Calcium supplements can help.
  • Inactive Lifestyle: A sedentary lifestyle or prolonged bed rest weakens the muscles and bones.
  • Alcohol Consumption: Long-term excessive use of alcohol puts the bones at risk of undernourishment and low density.
  • Medications: Some medications prescribed for arthritis, Crohn’s disease, lupus, and epilepsy contribute to bone loss as well as some used for cancer treatment and thyroid issues. Patients or caregivers should consult with a physician about the side effects of medications before starting or stopping a prescribed drug.

While early detection and prevention are ideal, sometimes people may not realize their personal risk factors for osteoporosis and may not know they have osteoporosis until they’ve suffered osteoporotic fractures or been diagnosed.

Effects on patients and families

Whether or not an osteoporosis diagnosis comes as a surprise, it often requires a series of lifestyle changes for the safety of the individual with the disease. These changes surround a constant vigilance to prevent falls and similar injuries. Osteoporosis most often affects those over the age of 50 and, depending on age and mobility, the effects can increase with age as the bones continue to lose mass and mobility decreases.

Physical changes

People with lower than average bone density, but not enough bone loss to be diagnosed with osteoporosis, may have osteopenia. People with a small, thin frame may be diagnosed with this condition even though they don’t actually have any bone loss. Their small build gives them a lower than average bone density, putting them at high risk for developing osteoporosis.

Mild osteoporosis, the beginning stages of the disease, and those with osteopenia may not need or note many changes in their lifestyle because of the diagnosis. They continue with their daily routine but focus on a healthy diet to support strong bones. A daily calcium intake and vitamin D supplement along with a healthy, well-balanced diet contribute to keeping further bone loss at bay.

The changes at this stage also come in mental awareness of surroundings and the body. Proper posture when lifting heavy objects off the floor or twisting motions became something these individuals begin to notice. Small adjustments to lifestyle allow many people to avoid the effects of severe osteoporosis.

Regular resistance exercise can also help individuals in this stage. However, it must be carefully undertaken to prevent injury to the bone. A physician should be consulted to reduce the risk of too much strain or potential injury.

Modifications

As the disease progresses, modifications in daily life may be necessary. Changes in the amount of daily activity or the kinds of activity participated in becoming more frequent. Discomfort or pain during regular activities like gardening, household cleaning, and cooking cause many patients to seek help from family to accomplish daily tasks.

A family member or support person may need to take on the role of caregiver, which can be a difficult transition for both the person with osteoporosis and the person providing care. Admitting the need for help is difficult for many people, especially those who have enjoyed an active lifestyle. Caregivers may experience resistance to their efforts to help. Their role, first and foremost, is to provide a safe environment for the person with osteoporosis.  They’ll also need to encourage regular activity, a nutritious diet, and be sure the person takes all recommended supplements and medications.

With encouragement and sensitivity, a caretaker can help maintain independence while providing support and keeping an eye on safety. Support may come in encouragement to stay active and participating in activities with the osteoporosis patient. If the disease continues to progress, the home may need to be modified for safety reasons.  

Severe osteoporosis

For patients with severe osteoporosis, the changes to daily life become quite restricting. Body movement must be undertaken with great care as any sudden twisting or bending can compress the bones and cause small fractures. Heavy lifting should be avoided as it is a fracture risk to the vertebrae.

At this stage of the disease, fall prevention takes on the utmost importance. Patients may be elderly with impaired vision and/or balance, which makes safety more complicated but even more imperative. A cane or walker may need to be used when leaving the house and, in some cases, should also be used while at home. Caregivers can make sure patients regularly consult with their physician, take necessary medications, and maintain a nutritious diet.

Depression and anxiety may become an issue with patients at this stage. The isolation and loneliness many people experience as they get older can be compounded with a condition like osteoporosis. The posture of the patient may make it difficult for her to have regular eye contact and conversation. Family members and caregivers can help by making sure the patient participates in social activity frequently, as well as arrange visits and phone calls from loved ones to help her stay connected with others.

Short-term care needs

Osteoporosis is a disease that, in many cases, can be slowed or even reversed. While patients may be prescribed medications to fight progressive bone loss, modifications to diet and behavior can also promote healthy bones. Changes in diet can help no matter the stage of the disease and are the easiest changes to make.

Diet and exercise

  • Calcium: A lifetime of inadequate calcium can lead to low bone mass, bone loss, and increased risk of fractures. Dairy products like milk, yogurt, cheese, and even ice cream are good sources of calcium. Other natural sources include broccoli, collard greens, bok choy, spinach, sardines, salmon, tofu, and almonds. Orange juice, bread, and other foods fortified with calcium also increase calcium intake. Keep in mind that some medications may interfere with calcium absorption. A physician may recommend calcium supplements.
  • Vitamin D: Proper calcium absorption requires regular doses of vitamin D. The body naturally makes vitamin D from sunlight. However, the body decreases vitamin D production with age, and the elderly often find themselves homebound and less likely to get a good daily dose of sunlight. In that case, natural food sources of vitamin D like egg yolks, saltwater fish, and liver are a good choice. A physician may recommend a Vitamin D supplement.
  • Reduce Sodium: Sodium, found in table salt, increases the amount of calcium flushed out of the body with urine. Consuming high amounts of sodium thus increases the need for calcium. Those with a risk of osteoporosis should try to maintain a low-sodium diet to allow the maximum amount of calcium to remain in the body.
  • Regular Exercise: Exercise keeps the bones and muscles strong, and must be undertaken in a safe manner for those at risk of injury from falls. Osteoporosis patients should focus on:
    • Strength: Weight-bearing and resistance exercises make the bones stronger. Weight-bearing exercises use the bones and muscles against gravity. Good examples of weight-bearing exercises include walking, jogging, hiking, stair climbing, and tennis. Resistance exercises like weight lifting improve muscle mass and strengthen the bone.
    • Flexibility: Range of motion plays a critical role in fall prevention. Flexibility can be maintained and developed through exercises like swimming, yoga, and tai chi.
    • Balance: Balance involves the body’s ability to remain stable while moving or standing still. It tends to decline with age so becomes important for the elderly to maintain as a means of fall prevention.

Safety measures should be observed while exercising. Attention to posture should be maintained while walking, standing, or sitting to prevent extra pressure on the spine. Be careful of quick, sudden movements as they can put extra stress on the joints and bones. A physician should be consulted before starting any exercise regimen but especially one involves any kind of twisting of the spine or bending from the waist.

Environmental changes for increased safety

Fall prevention

Falls are a big concern for seniors with osteoporosis thanks to slowed reflexes, decreased strength, and other common conditions associated with aging (like diminished eyesight). Caregivers and family members can help make sure a safe environment is maintained both in and out of doors:

Indoors

  • Install nightlights throughout the house
  • Keep floors clear of clutter
  • Wear rubber-soled shoes in the house (socks, slippers, or bare feet lead to more falls)
  • Check walkways for electrical cords
  • Check banisters and handrails for stability
  • Stairs should have handrails on both sides
  • Place a rubber bath mat in the shower or bathtub
  • Keep a flashlight with fresh batteries on the nightstand
  • Room lights should be accessible at the entrance of the room

Outdoors

  • Wear shoes with rubber soles for added traction (winter and summer)
  • Be aware of changes in floor surfaces when entering buildings
  • Any bags or purses should leave the hands free to hold handrails
  • Consider using a cane or walker for added stability

Long-term care needs

Many short-term care changes and needs should be continued long-term to promote the growth and maintenance of strong bones. However, the continued health of the osteoporosis patient should include long-term measures for safety and quality of life. To support and improve bone density over time, physicians may prescribe medications that either slow the rate of bone loss or increase bone density.

Medications

Bisphosphonates

Bisphosphonates include alendronate (Fosamax), ibandronate (Boniva), risedronate (Actonel), and zoledronic acid (Reclast). These medications slow down the rate of bone reabsorption, blocking the body from breaking down the bone. Some, like ibandronate, are taken monthly while others need to be taken weekly. Instructions must be followed carefully because, if taken incorrectly, side effects can include ulcers of the esophagus.

Calcitonin

Calcitonin, also under the name Calcimar or Miacalcin, is a hormone that naturally occurs in the body to regulate calcium and build bone. It can also be prescribed as a pain reliever for spinal compression fractures.

Denosumab

Denosumab (Prolia) slows bone loss by preventing certain cells from breaking down the bone. It is used for women or men who are at high risk of bone fractures like postmenopausal women or men receiving prostate cancer treatments.

Teriparatide

Teriparatide (Forteo) is prescribed for those with more severe cases of osteoporosis. The medication has a natural hormone that helps to peak bone mass and strength to prevent fractures.

Raloxifene

Raloxifene (Evista) is most often used by post-menopausal women to reduce their risk of invasive breast cancer. It has an anti-estrogen effect that helps maintain bone density.

Consult the patient’s physician about possible side effects as many of these medications put patients at risk for other disorders. A thorough personal and family history can help physicians determine which medications would be the most effective. Family members and caregivers may need to monitor when medications have been taken. Elderly individuals may have trouble tracking medications, especially if they have some are taken on a monthly schedule and others weekly. A phone call reminder might be all some individuals need while others may benefit from a chart marked with when to take which medications.

Hormone therapy

Most physicians do not use hormone therapy to treat osteoporosis, but there are certain cases when it is the best option. For postmenopausal women who’ve had a hysterectomy, estrogen without progestin may be used. Because estrogen can increase chances of cancer of the uterus lining, only women who’ve had their uterus removed should take it.

Pain relievers

Even osteoporosis patients that take great care to prevent fractures may still get injured. Both over-the-counter and prescription pain medications are prescribed to relieve pain while the patient heals. Common medications for this kind of pain include:

  • Over-the-counter acetaminophen
  • Over-the-counter nonsteroidal anti-inflammatory drugs (NSAIDs) like ibuprofen or naproxen
  • Codeine or morphine for more severe pain
  • Calcitonin, which is also used to treat osteoporosis

Activity after injury

Many people are at risk or don’t know they have osteoporosis until they suffer a fracture from a minor fall. These individuals and elderly osteoporosis sufferers often find themselves bedridden with limited mobility. Though it can be hard to become active again after an injury, caregivers should continue to encourage these patients to start moving and exercising as soon as possible. Continued inactivity weakens the muscles and, consequently, the bones, which only contributes to further bone loss. The sooner the person can become active again the better.

Anxiety and depression

The psychological effects of osteoporosis may include anxiety and depression because of the added stress of the disease. Limited mobility can also make both patients and caregivers feel isolated and alone, contributing to psychological disorders. Osteoporosis-related anxiety may look like:

  • Increased worry about specific or generals aspects of life
  • Inattention to conversations
  • Increased feeling of irritability and/or anger
  • Difficulty sleeping because of repetitive negative thoughts
  • Feeling tense and restless
  • Increased fatigue and reduced energy

People who struggle with anxiety have thoughts that often get caught in a cycle with worries about osteoporosis like, “Will it get worse?” or “What if I fall?”. When these thoughts begin to take over, many patients find they cannot function as well in their daily lives.

Often seniors living with a chronic disease develop depression. This is true in the case of osteoporosis. Symptoms of depression to watch for include:

  • Poor self-esteem
  • Increased feelings of sadness, hopelessness, or worthlessness
  • Sudden weight loss or gain
  • Changes in sleep patterns, either too little or too much
  • Lost interest in hobbies or social activities
  • Less energy
  • Suicidal thoughts

People with osteoporosis often experience depression as grief and loss. The feel they’ve lost the ability to do activities they once enjoyed. Confidence and self-perception change, which can lead to confusion, shock, denial, and anger. Those with osteoporosis or their caregivers may want to consult a physician to see if the patient could benefit from a counselor, therapist, social worker, psychologist, or psychiatrist.

It’s also important to remember that caregivers may experience anxiety and depression as well. They, too, can become isolated as they offer round the clock care. Both the patient and caregiver should take steps to ensure proper diet and rest to assist their mental well being. Family and friends should be consulted to give caregivers a break and offer a change in company for the patient.

Patients or caregivers may benefit from a supportive group of people who are experiencing many of the same challenges. Local hospitals may have such groups already organized. Online support groups can be found on the National Osteoporosis Foundation or at 4BoneHealth.org.

Safety and physical changes

The immediate safety measures taken after diagnosis should be continued throughout the rest of the osteoporosis patient’s lifetime. Handles, handrails, and banisters need to be checked regularly to make sure they haven’t come loose. Clutter will need to be tidied daily. For added stability and mobility, patients may need to use a cane or walker both outside and inside the house. Dependence on these medical devices may increase with time.

With age, vision and hearing changes may make the elderly more susceptible to falls. Good vision not only helps one to see potential tripping hazards, the eyes also help orient the body in space. Thus, balance depends on good vision. That’s one reason keeping the home well lit at night is so important.

The middle ear helps control balance as well. Some medications or illnesses can cause vertigo or other balance issues that could lead to a fall. If the patient or caregiver suspects middle ear related balance problems, a physician should be consulted.

Caregivers may need to accompany the elderly to doctor’s appointment to make sure they understand all the side effects of medications. Not all medications will directly affect bone density, but some can cause problems with balance or vision that could affect the patient’s stability. Caregivers also need to maintain vigilance about taking medications at the proper times.

Long-term care options

If care of the person with osteoporosis becomes too difficult for a family caregiver, other long-term options are available.

Assisted living facilities provide extra care, meals, help cleaning, and access to healthcare but not 24-hour help. These facilities work well during the time before 24 hours assistance is necessary but living alone is no longer an option.

Elderly individuals who have lost the ability to safely live on their own may be safest in a nursing home where they have 24-hour access to medical staff. These facilities give access to doctors, make sure all medications are taken, and help with daily care needs. They have a smaller staff to patient ratio than an assisted living facility, providing more individualized care.

Financial considerations

An osteoporosis medical specialty does not exist. That means most patients should start their osteoporosis care through their regular physician, who can recommend whether further assessment should take place. An assessment may require a bone mineral density test, which some private medical insurances cover and Medicare may cover a bone density test under certain conditions for individuals over 65 years old or who have been shown to have possible osteoporosis.

Monthly medications make up a steady cost for many osteoporosis patients. Some medications cost as little as $10 per month while others go as high as $900 per month, depending on the severity of the osteoporosis, medical history of the patient, and the physician’s chosen course of treatment. Osteoporosis medications are considered medically necessary so most private insurances will cover at least some of the cost. Medicare covers medications under certain conditions based on age, gender, medical history, and type of treatment prescribed. Patients may also be encouraged to purchase over-the-counter vitamin supplements and pain relievers, and medical equipment.

Expenses rise when falls or accidents lead to fractures. The hospital stay and medical care needed to treat a fall injury, on average, costs $30,000 with some bills coming in much higher. The expense is made up of hospital and nursing home fees, physician and specialist services, rehabilitation, medical equipment, and insurance administrative costs. Those costs rise as the age of the patient goes up because as the body ages, it’s slower to heal, which means patients need more care for a longer period of time.

Not included in these direct costs are the long-term expenses of disability. Many people find their dependence on others increases with age. Some people may not be able to continue working and experience unemployment, which makes the unexpected costs of a fall more difficult to bear.  

Patients with medical insurance need to check their coverage carefully. Medications and covered services may change each year and some services like bone screenings may not be covered, but are essential to monitoring osteoporosis. Bone screenings are important for individuals over the age of 50, especially females as they are more likely to develop osteoporosis.

Choosing long-term care

Though there’s not a medical specialty devoted to osteoporosis, there are several specialties that treat it. A good place to start treatment is with the patient’s regular physician, who can then give a referral to any number of necessary specialists if necessary.  Referrals may include visits to:

  • Endocrinologists
  • Geriatricians
  • Gynecologists
  • Internists
  • Orthopedists
  • Physiatrists
  • Rheumatologist

Other medical professionals that may offer services for osteoporosis include:

University or community hospitals can help direct you to services if the patient doesn’t have a regular provider or if special services are needed. Hospitals may have different departments that see osteoporosis patients so it’s best to ask which department takes this type of patient.

When going for a visit, caregivers can help by preparing in advance. Write down any questions you or the patient has so you don’t forget to ask once you’re in the room. Be sure to know the full medical history of the patient, including any medications, herbal supplements, or vitamins being taken.

If you need further help to find long-term care, you can use the National Osteoporosis Foundation’s Partner Network to find a physician.

  • Physicians with experience in metabolic bone disease will be able to treat osteoporosis as it falls under this category.
  • Women may be able to find services through their regular gynecologists.
  • A regular or primary care physician with whom the patient already has an established relationship often can provide excellent care because they have knowledge of the patient’s history, lifestyle, and special needs.
  • Have a thorough patient history available at the first appointment with a new physician.

Osteoporosis support organizations

Support for patients, families, and caregivers can come from many avenues. International and national osteoporosis organizations exist to help those who suffer from osteoporosis and their families to not only get accurate information but find access to specialists and the latest research information.

National Osteoporosis Foundation

The National Osteoporosis Foundation is a national nonprofit organization that promotes osteoporosis research, advocacy, education, and prevent osteoporosis. They offer resources for physicians, patients, and their families, including help finding osteoporosis specialists in your area. On their site, information about everything from fracture prevention to diet and exercise tips as well as clinical trials and patient support through a nationwide volunteer network. They also offer an online community to support patients, families, and caregivers.

International Osteoporosis Foundation

The International Osteoporosis Foundation coordinates education and osteoporosis research efforts worldwide. They not only focus on osteoporosis but other musculoskeletal disorders. Stats, statistics, and information about preventative measures are readily available on their site.

International Society for Clinical Densitometry (ISCD)

The ISCD has a mission to “advance excellence in the assessment of skeletal health”, including densitometry or the measurement of bone density. Information about bone density testing is provided as well as a directory to find specialists certified in densitometry in your area.

OrthoInfo by the American Academy of Orthopaedic Surgeons (AAOS)

A patient-friendly site that provides information on many orthopedic conditions including osteoporosis. Current news and an education library are available.

Own the Bone by the American Orthopaedic Association

Own the Bone is a program that focuses on the treatment gap after an osteopenic fracture and the prevention of future injury. Institutions can become certified in the program. The website has information for patients and their families.

NIH Osteoporosis and Related Bone Diseases National Resource Center

The National Institutes of Health offers information about osteoporosis prevention, nutrition, and treatment. It also covers related diseases and conditions that may lead to other bone conditions. Resources on the site can help find treatment facilities and physicians with experience treating osteoporosis.

4BoneHealth.org

4BoneHealth promotes bone health education for people of all ages. They offer resources for families to educate themselves about the importance of lifelong bone health but also help direct people to support groups for those who are at high risk of developing or who already have osteoporosis.

Osteoporosis FAQs

1. If the patient has already had a fracture, is it too late to start osteoporosis treatment?

Osteoporosis can be slowed or even reversed in some cases. Treatment can start while the person is recovering from the fracture. An evaluation can take place during or after recovery to determine if osteoporosis contributed to the fracture.

2. What happens during an osteoporosis evaluation?

The evaluation will start with a thorough medical history and questions about lifestyle. For example, a history of smoking or of taking certain medications would put the person at higher risk for osteoporosis. The physician may also suggest blood and urine samples be taken as well as a bone mineral density test.

3. What is a bone mineral density test and how long does it take?

There are different types of bone mineral density tests but the most common is the dual-energy x-ray absorptiometry (DXA) test. The body is scanned from above while the patient lies on a table. It takes about 15 minutes and exposes the body to less radiation than a normal x-ray.

4. I’m concerned about falling. Would it be best if I remained inactive to prevent injury?

Inactivity can lead to a greater risk of falling as muscle and bone mass decreases. Balance, strength, and flexibility also decrease with inactivity. Try to remain active as long as possible. If you’re worried about falls, consult your physician, who can direct you on how to safely perform regular activities and suggest safe forms of exercise.