Special Considerations in the Very Elderly

Osteoporosis becomes more prevalent with increasing age, as bone is lost progressively throughout adult life. The very elderly are rarely assessed and treated for osteoporosis and low bone density, despite significant potential benefits.

Very elderly who are mobile and in reasonable health should discuss with their doctor ways to improve their bone health, and whether they need specific tests and treatment for osteoporosis.

Very elderly people who live in aged care establishments can be in poor health and less mobile. Many people in this group have osteoporosis or low bone density, and a high fracture risk.

Calcium and vitamin D in the very elderly:

There is a decrease in dietary calcium intake, usually as a result of:

  • Decreased overall dietary energy intake (e.g. poorer appetite, intercurrent illnesses, social and economic factors)
  • In people over 65, the intestine cannot absorb calcium from the diet as well as in youth, resulting in the production of a hormone (parathyroid hormone) that makes the bone give up its calcium into the blood stream.

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.

There is poorer vitamin D status due to:

  • Less frequent exposure to sunlight (e.g. elderly who are housebound, institutionalized or have reduced mobility)
  • A decrease in the capacity of the skin to synthesize vitamin D

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.


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. Read more about exercise here.

Fall prevention

When osteoporosis is present, even minor trauma such as coughing, minor knocks or falls can lead to fractures. Older people 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. They may be the result of postural instability, decreased muscular performance, malnutrition, comorbidity (e.g. poor vision, cognitive impairment) and medications.

For more information see on reducing the risk of falls.

Improving quality of life after a first fracture

  • Pain medication and anti-osteoporotic medication should be started as soon as possible by the general practitioner or specialist.
  • Nutrition should be adequate, particularly protein intake and a calcium rich diet. A calcium supplement should be considered when dairy consumption is low, and vitamin D supplements might need to be taken when sunshine exposure or diet is inadequate.
  • Standing and sitting position, and mobility, can be improved with help of a physiotherapist.
  • Physiotherapy also may decrease back pain.

An ergotherapist can give advice on problems with activities of daily living or adaptations in the home.