February 28, 2011
What comes to your mind when someone mentions “osteoporosis”? We all know what that word conjures. Thanks to advertising, the image of an old lady hunched with a walking stick is the one that we always associate with whenever that word crops up. However, that is the least of the problems associated with osteoporosis. Osteoporosis, on its own, does not pose much of a problem. Indeed, osteoporosis, like hypertension, often has no symptoms. It is only once the patient gets a fracture from a minor fall that the problem presents; and it is this complication of osteoporosis that can give a headache to the treating doctor.
Let me illustrate this with an example. Early this week, I was called to the ER. The history: An 85 year old lady had a minor fall at one of the hypermarkets here. It was, in medical lingo, a low velocity trauma, one that if it were to happen to a young lady, would most probably leave her with no more than a sore buttock and probably some bruised ego as well. In an elderly lady, someone with weakened bone due to osteoporosis, a trivial fall like that would highly likely lead to a fracture. Coming back to this lady, she was unable to walk after the fall and complained of severe pain over the right hip. After a short chat and examination, I shifted my attention to her x-rays. The films confirmed my suspicions: the patient sustained a fracture of the right hip.
Patients with osteoporosis typically sustain a fracture in three common places; the wrist, spine (back) and the hip. Now a hip fracture could be quite a debilitating thing to get. Beside the pain, one is usually bedridden unless surgery is done to correct the situation. (You can still be up and about if you sustain a wrist fracture) And depending on the severity and displacement of the fracture, the surgical options range from putting a metal plate and screw to a hip replacement.
Advancing age not only increases the risk of osteoporosis, but it also increases the risk of a fall. Well, the elderly are more susceptible to falls due to various reasons:
They might be on medications causing drowsiness, and some high blood pressure pills can cause a transient drop in blood pressure as they get up from bed, leading to dizziness and risk of fall.
Failing eyesight might cause them to trip over obstacles or steps, especially in poorly lit areas at night.
Muscle tone decrease with advancing age, and can lead to poor balance. Also reflexes become slower, therefore making it difficult for the elderly to correct any imbalance quickly.
Can we do something about this, you might ask. If you were to pose the question to me, I would say that beside the obvious, which is prevention and treatment of osteoporosis; (you can discuss this with your regular GP or your nearest friendly neighborhood orthopedic surgeon *wink*) the prevention of fall in an osteoporotic individual is an equally important fact that is often overlooked (simply because, they wouldn’t have a fracture unless they fall would they?).
Here are a few tips to prevent falls in the elderly
- Regular exercise program: This increases increase balance, coordination, muscle strength. Tai-Chi and Yoga are excellent exercises as they offer controlled slow movements and non-impact exercises. The worst thing that you could do is starting a high impact exercise program as they have a detrimental effect on the joints and also increases the risk of a fracture.
- Review the medication with your regular GP: some medications can cause drowsiness or have different effect on the elderly. Also be wary of anti-hypertensive medications as some may cause a transient drop in blood pressure on getting up.
- Test the vision and hearing regularly: as mentioned earlier, failing eyesight makes one more prone to falls and tripping over
If you have an elderly staying in your house here are a few tips to consider:
Let them stay on the ground floor. It is difficult, not to mention dangerous for the elderly to stay on the upper floor of a two-storey house as the danger of a mis-step or tripping over the steps are great. Talking about stairs, ensure that your house has handrails or banisters for the safety of the elderly.
Floors need to be neat and tidy. I know that it sometimes difficult especially if you also have young children in the house as toys could be everywhere! Pay attention to electrical cords and telephone cords as this could pose a danger of tripping. Rugs and carpets should be flat on the floor.
In the kitchen and the bathroom: slippery floors can pose a danger as people can slip and fall. Try to keep it dry, and always caution them on the change in floor levels as they go into the other room. Bars or handles may be installed in the bathroom to hold on for stability. Consider a rubber mat in the shower.
Ensure adequate lighting. Failing eyesight makes for a greater chance of tripping on objects or floors. Hallways and stairs need to be well lit. And it is also a good idea to have a bedside lamp so that it could be easily switched on as they get up out of bed in the night.
When going out (to the mall, etc) pay particular attention to the floor, ramps and steps. Wet floors can be slippery and difference in the floor levels can cause one to trip.
In summary, Osteoporosis can be a potential risk. Simple steps can be taken to reduce the risk for falling, and by that, the risk of having a fracture.
And that lady with a hip fracture? Well glad to say that she’s doing well, after having had a partial hip replacement and is currently undergoing physiotherapy for rehab.
Dr. Saiful Akhtar Shamsudin
Columbia Asia Hospital- Bukit Rimau