Special considerations in the very elderly

Osteoporosis becomes much more prevalent with increasing age, as bone is lost progressively throughout adult life (after the age of about 40 years).  The very elderly are rarely assessed and treated for osteoporosis and low bone density, despite significant potential benefits.

Very elderly people who are mobile and in reasonable health need to consider discussing with their doctor ways to improve their bone health, and whether they need specific investigations for osteoporosis. Very elderly people who live in nursing homes and aged care establishments tend to be in poor health and not ambulatory. Many people in this group have osteoporosis or low bone density, and a high fracture risk.

Calcium and vitamin D

In men and women over 65, the intestine cannot absorb calcium from the diet as well as in youth. As a result our bodies produce a hormone that makes the bone give up its calcium into the blood stream. Known as the parathyroid hormone, its presence increases in very elderly men and women, and further contributes to the bone thinning process in old age. One of the reasons calcium supplements are given to the elderly is to try to overcome the low calcium absorption problem and to reduce the high level of parathyroid hormone which eats away at bone.

In addition, vitamin D deficiency not only has skeletal consequences, but is also associated with muscle weakness, an increased risk of falls and, as a result, an increased risk of fractures. For elderly who live in aged care homes, it has been shown that the administration of additional vitamin D supplements and calcium supplements may reduce the incidence of fracture. It is advisable for the elderly in care to be routinely prescribed a calcium and vitamin D supplement, provided there are no abnormalities with regards to calcium metabolism.

Exercise

Regardless of age, bones and muscles need exercise to retain strength so a special exercise program tailored to the very elderly who are institutionalized is very important. Improved balance, posture, coordination and muscle strength are the benefits that result from sustained weight-bearing exercise.

Fall prevention

When osteoporosis is present, even minor trauma such as coughing, minor knocks or falls can lead to fractures. Older women and men have slower response times and more often fall to the side, suffering direct impacts to the hip. Their falls are often "intrinsic", or unrelated to external obstacles, resulting from deterioration in gait and postural instability, decreased muscular performance, malnutrition, comorbidity (e.g. poor vision, cognitive impairment) and medications. The importance of muscle strength and coordination, which typically decline in the later years of life, as factors contributing to falls that result in bone fractures should not be overlooked. For more information see How to reduce the risk of falls .

It may be necessary for the very frail elderly to see physiotherapists and/or occupational therapists. Physiotherapists provide assistance with provision of aides for walking. Occupational therapists make the home environment safe, for instance by installing rails.

In addition, in the frail, very elderly, some types of hip protectors may reduce the incidence of hip fractures. The success of these devices relies upon compliance, which can be a problem if it is uncomfortable to wear. Walking aids which can be provided by a physiotherapist, can help to ensure that a very elderly person continues to be active in a nursing home environment or in his or her own home.

© International Osteoporosis Foundation 2009 | About IOF | Credits | Site Agreement