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Why seniors get osteoporosis and have falls

This article is part of The Conversations series on <a href="https://theconversation.com/au/topics/older-peoples-health-33308">older people’s health</a>. It looks at the changes and processes that occur in our body as we age, the conditions we’re more likely to suffer from and what we can do to prevent them. As the world’s population lives longer, the significance of osteoporosis and fractures increases. In Australia, it is estimated that <a href="http://www.osteoporosis.org.au/sites/default/files/files/Burden%20of%20Disease%20Analysis%202012-2022.pdf">4.74 million Australians aged over 50</a> have osteoporosis, osteopenia (less severe than osteoporosis) or poor bone health. By 2022, <a href="http://www.osteoporosis.org.au/sites/default/files/files/Burden%20of%20Disease%20Analysis%202012-2022.pdf">it’s estimated this will increase</a> to 6.2 million, with one fracture occurring every 2.9 minutes. In 2012, the <a href="http://www.osteoporosis.org.au/sites/default/files/files/Burden%20of%20Disease%20Analysis%202012-2022.pdf">total cost of poor bone health</a> in adults aged over 50 was A$2.75 billion, and 64% of this cost was directly associated with treating and managing fractures. What is osteoporosis? Osteoporosis is a condition in which bones become fragile and brittle, leading to higher risk of breakage. This occurs when bones lose minerals such as calcium more quickly than the body can replace them. In Australia, osteoporosis affects <a href="http://www.osteoporosis.org.au/sites/default/files/files/Burden%20of%20Disease%20Analysis%202012-2022.pdf">one in three women and one in five men</a> over the age of 50. Referred to as a “silent” disease, osteoporosis generally has no symptoms and is rarely diagnosed until bones break or fracture. Osteoporosis is the disease and fractures are the outcome we are trying to prevent. Why do we get osteoporosis as we age? Our bones are living tissue and are in a continual state of renewal. As we age, more bone is broken down (resorbed) than is replaced by new bone. Thus our bones get thinner and more fragile as we age. This is particularly true during menopause for women and in men with lower levels of sex steroid hormones such as testosterone. “Primary osteoporosis” is bone loss that can be attributed to ageing or the known hormonal consequences of ageing, such as the decline in oestrogen and testosterone. These hormones help regulate bone renewal that occurs naturally as we age. As the level of these hormones decline from about the age of 50 in women and around 60 in men, the rate of bone breakdown is faster than the growth of new bone to replace it. Over time this leads to weaker, thinner bones. In women, the risk abruptly increases from the time of menopause, coinciding with a significant drop in circulating levels of oestrogen. “Secondary osteoporosis” occurs as a consequence of another disease (such as coeliac disease with associated calcium malabsorption), or as an adverse consequence of therapy for another disease where medication might bring it on. Thin bones of a poorer quality structure are more likely to break. The vast majority of fractures occur as a result of a fall from standing height. Vertebral or spinal fractures are the exception, frequently occurring without a fall or significant “trigger event”. Why do we fall over when we get older? There are many reasons older adults are susceptible to falls. These include side effects of some medications, vision impairments and less ability to prevent tripping over as balance, muscle mass and strength decline with age. The risk of fracture due to poor bones increases with age, and this is further enhanced by osteoporosis. Genetics also plays a role in an individual’s risk of fracture. Those of us with parents who had a hip fracture have an increased risk of fracture. The most common sites of fracture in older adults are the hip, vertebrae or spine, wrist or the humerus (upper arm or shoulder). About <a href="https://www.ncbi.nlm.nih.gov/pubmed/10083688">30% of older adults</a> fall at least once a year. The less often you fall, the less likely you are to break a bone. People aged 70 and over <a href="http://www.osteoporosis.org.au/sites/default/files/files/Burden%20of%20Disease%20Analysis%202012-2022.pdf">accounted for 70% of the total</a> acute hospital inpatient costs in 2012. Hip fractures <a href="http://www.osteoporosis.org.au/sites/default/files/files/Burden%20of%20Disease%20Analysis%202012-2022.pdf">impose the highest burden</a> both in terms of cost and decline in health-related quality of life. <a href="https://www.ncbi.nlm.nih.gov/pubmed/25792491">Results from a recent study</a> show most fracture patients have not fully recovered their previous level of quality of life by 18 months after the fracture. Preventing osteoporosis and falls Preventing falls in older people is an important way to prevent fractures. Adults who have good balance and muscle strength are often able to “save themselves” when they trip. Exercises that improve balance (such as Tai Chi) and help maintain muscle mass (weight-bearing and resistance exercises) are beneficial. Preventing osteoporosis involves regular weight-bearing and resistance exercise, adequate calcium in the diet (at least three serves of dairy or equivalent per day) and an adequate level of vitamin D in the bloodstream. Sunlight exposure on the skin is the primary source of vitamin D, but we need to practise safe sun exposure to reduce the risk of skin cancer. The recommendations vary by <a href="https://www.mja.com.au/open/2013/2/1/building-healthy-bones-throughout-life-evidence-informed-strategy-prevent-osteoporosis">skin type, latitude and season</a>. For people with moderately fair skin, six to seven minutes before 11am or after 3pm during summertime is considered sufficient. During wintertime, the daily recommended sun exposure increases to between seven and 40 minutes <a href="https://www.mja.com.au/open/2013/2/1/building-healthy-bones-throughout-life-evidence-informed-strategy-prevent-osteoporosis">depending on where you live in Australia</a>. While lifestyle factors such as nutrition and exercise can make an important difference to bone health over time, if an older adult has several risk factors for fracture their doctor may discuss the benefits of “bone active” medication. These medications slow the rate bone breaks down as we age. In general these medications halve the risk of fracture and are much more effective than lifestyle measures alone Written by Kerrie Sanders. Republished with permission of <a href="https://theconversation.com/why-older-people-get-osteoporosis-and-have-falls-68145">The Conversation.</a>

Retirement Life

Why older people get osteoporosis and have falls

Kerrie Sanders is a Professor of Musculoskeletal Science, Nutrtion and Health Economics at the Australian Catholic University’s Institute for Health and Ageing. As the world’s population lives longer, the significance of osteoporosis and fractures increases. In Australia, it is estimated that <a href="http://www.osteoporosis.org.au/sites/default/files/files/Burden%20of%20Disease%20Analysis%202012-2022.pdf">4.74 million Australians aged over 50</a> have osteoporosis, osteopenia (less severe than osteoporosis) or poor bone health. By 2022, <a href="http://www.osteoporosis.org.au/sites/default/files/files/Burden%20of%20Disease%20Analysis%202012-2022.pdf">it’s estimated this will increase</a> to 6.2 million, with one fracture occurring every 2.9 minutes. In 2012, the <a href="http://www.osteoporosis.org.au/sites/default/files/files/Burden%20of%20Disease%20Analysis%202012-2022.pdf">total cost of poor bone health</a> in adults aged over 50 was A$2.75 billion, and 64% of this cost was directly associated with treating and managing fractures. What is osteoporosis? Osteoporosis is a condition in which bones become fragile and brittle, leading to higher risk of breakage. This occurs when bones lose minerals such as calcium more quickly than the body can replace them. In Australia, osteoporosis affects <a href="http://www.osteoporosis.org.au/sites/default/files/files/Burden%20of%20Disease%20Analysis%202012-2022.pdf">one in three women and one in five men</a> over the age of 50. Referred to as a “silent” disease, osteoporosis generally has no symptoms and is rarely diagnosed until bones break or fracture. Osteoporosis is the disease and fractures are the outcome we are trying to prevent. Why do we get osteoporosis as we age? Our bones are living tissue and are in a continual state of renewal. As we age, more bone is broken down (resorbed) than is replaced by new bone. Thus our bones get thinner and more fragile as we age. This is particularly true during menopause for women and in men with lower levels of sex steroid hormones such as testosterone. “Primary osteoporosis” is bone loss that can be attributed to ageing or the known hormonal consequences of ageing, such as the decline in oestrogen and testosterone. These hormones help regulate bone renewal that occurs naturally as we age. As the level of these hormones decline from about the age of 50 in women and around 60 in men, the rate of bone breakdown is faster than the growth of new bone to replace it. Over time this leads to weaker, thinner bones. In women, the risk abruptly increases from the time of menopause, coinciding with a significant drop in circulating levels of oestrogen. “Secondary osteoporosis” occurs as a consequence of another disease (such as coeliac disease with associated calcium malabsorption), or as an adverse consequence of therapy for another disease where medication might bring it on. Thin bones of a poorer quality structure are more likely to break. The vast majority of fractures occur as a result of a fall from standing height. Vertebral or spinal fractures are the exception, frequently occurring without a fall or significant “trigger event”. Why do we fall over when we get older? There are many reasons older adults are susceptible to falls. These include side effects of some medications, vision impairments and less ability to prevent tripping over as balance, muscle mass and strength decline with age. The risk of fracture due to poor bones increases with age, and this is further enhanced by osteoporosis. Genetics also plays a role in an individual’s risk of fracture. Those of us with parents who had a hip fracture have an increased risk of fracture. The most common sites of fracture in older adults are the hip, vertebrae or spine, wrist or the humerus (upper arm or shoulder). About <a href="https://www.ncbi.nlm.nih.gov/pubmed/10083688">30% of older adults</a> fall at least once a year. The less often you fall, the less likely you are to break a bone. People aged 70 and over <a href="http://www.osteoporosis.org.au/sites/default/files/files/Burden%20of%20Disease%20Analysis%202012-2022.pdf">accounted for 70% of the total</a> acute hospital inpatient costs in 2012. Hip fractures <a href="http://www.osteoporosis.org.au/sites/default/files/files/Burden%20of%20Disease%20Analysis%202012-2022.pdf">impose the highest burden</a> both in terms of cost and decline in health-related quality of life. <a href="https://www.ncbi.nlm.nih.gov/pubmed/25792491">Results from a recent study</a> show most fracture patients have not fully recovered their previous level of quality of life by 18 months after the fracture. Preventing osteoporosis and falls Preventing falls in older people is an important way to prevent fractures. Adults who have good balance and muscle strength are often able to “save themselves” when they trip. Exercises that improve balance (such as Tai Chi) and help maintain muscle mass (weight-bearing and resistance exercises) are beneficial. Preventing osteoporosis involves regular weight-bearing and resistance exercise, adequate calcium in the diet (at least three serves of dairy or equivalent per day) and an adequate level of vitamin D in the bloodstream. Sunlight exposure on the skin is the primary source of vitamin D, but we need to practise safe sun exposure to reduce the risk of skin cancer. The recommendations vary by <a href="https://www.mja.com.au/open/2013/2/1/building-healthy-bones-throughout-life-evidence-informed-strategy-prevent-osteoporosis">skin type, latitude and season</a>. For people with moderately fair skin, six to seven minutes before 11am or after 3pm during summertime is considered sufficient. During wintertime, the daily recommended sun exposure increases to between seven and 40 minutes <a href="https://www.mja.com.au/open/2013/2/1/building-healthy-bones-throughout-life-evidence-informed-strategy-prevent-osteoporosis">depending on where you live in Australia</a>. While lifestyle factors such as nutrition and exercise can make an important difference to bone health over time, if an older adult has several risk factors for fracture their doctor may discuss the benefits of “bone active” medication. These medications slow the rate bone breaks down as we age. In general these medications halve the risk of fracture and are much more effective than lifestyle measures alone. Written by Kerrie Sanders. First appeared on <a href="https://theconversation.com/">The Conversation</a>.<img width="1" height="1" src="https://counter.theconversation.edu.au/content/68145/count.gif?distributor=republish-lightbox-advanced" alt="The Conversation"/> Related links: <a href="http://www.oversixty.co.nz/health/caring/2017/02/apps-to-stay-independent-with-age/">4 apps to help you stay independent as you age</a> <a href="http://www.oversixty.co.nz/health/caring/2017/02/why-we-become-more-forgetful-with-age/">Why we become more forgetful with age – and what you can do about it</a> <a href="http://www.oversixty.co.nz/health/caring/2017/02/spot-and-prevent-age-related-conditions/">How to spot and prevent 4 age-related health conditions</a>

Caring

How cycling reduces your risk of osteoporosis

Michael Speakerman from <a href="http://www.lifecycle55.com.au/" target="_blank">Life Cycle 55+</a> explains why cycling is a great form of exercise to combat osteoporosis. Did you know that you can significantly reduce your risk of developing osteoporosis simply by exercising regularly and ensuring you receive enough vitamin D and calcium? But before you load up on supplements and hit the pavement, understand that osteoporosis is a disease that will only respond to certain types of exercise at a certain level of intensity and has a few dependencies going on. Cycling just so happens to be a very effective way to minimize the risk of osteoporosis provided we go about it in a very specific way. How it works Few people understand the numerous benefits cycling has on both a muscular and skeletal level. Cycling is a fabulous form of exercise that tones legs and abdominals whilst considerably improving cardiovascular fitness. When we cycle, the majority of the primary muscles are activated in the downward motion of a pedal stroke (between 12 o’clock and 6 o’clock). This is important to understand as these primary muscles (in the hips and legs) - or pistons as some may say in the cycling community, are the driving force behind the power and speed that we accumulate. This translates to a tremendous workout for the quads, hamstrings, calf muscles, hip flexors and gluteus maximus (or bum), not to mention the plantar flexors and dorsiflexors of the feet. Yet whilst cycling is primarily considered a lower body workout, the upper body muscles that provide support and stabilization certainly don’t miss out. Cycling has the added bonus of activating the abs, arms, chest, back and shoulders. However, there is one possible short fall to all these benefits we receive. How different kinds of cycling affect your bones The issue surrounds the effect cycling can have on bone density. It is debatable whether cyclists are more susceptible to developing weaker bones compared to others who engage in higher impact sports. The main concern being the risk of developing osteoporosis: "A common disease affecting over one million Australians. This disease makes bones become brittle leading to a higher risk of breaks than in normal bone. Osteoporosis occurs when bones lose minerals, such as calcium, more quickly than the body can replace them, causing a loss of bone thickness (bone density or mass).” (Osteoporosis Australia) Wherein lies a catch-22 for those riders who choose riding due to its low impact appeal. If we were to simply hit an exercise bike indoors each day, we are possibly running the Osteoporosis gauntlet as we are limiting our motion and impact as well as our exposure to the sun. But, if we were to say, go mountain biking each day, the jarring and strain to the hips and legs we would endure would stimulate bone growth and development and thereby reduce the risk of developing osteoporosis. This is great for those of us that can withstand this additional pressure - however for those of us who would struggle, different means may be necessary. But not all is lost! – consider that our over 60 group mixes things up quite regularly with off trail rides, and seeing as all of our rides are outdoors we receive much needed vitamin D (on sunny days) which assists our bones to absorb calcium. So what does this all mean for Over60 cyclists? When our hormone levels decline with age, our bones lose calcium and other minerals at a faster rate, putting us at risk of developing osteoporosis. It’s important to note that muscle strain on bones whilst cycling does somewhat help stimulate bone formation. However, if we are sweating out more calcium than we are producing, we may need to supplement our training regime with some higher impact activities such as incorporating squats, single leg dead lifts or even jogging for at least 10 minutes a day to stimulate bone formation. This in conjunction with your cycling regime, along with supplementing calcium into a healthy diet, will drastically reduce the risk of osteoporosis (of course seek physician approval before accepting any dietary advice). This is particularly important for women who will see a rapid decline in estrogenic levels during menopause and who will experience a 2% loss of bone mass annually over subsequent years. Understanding osteoporosis is a relatively complex subject. But through a few simple techniques and remaining mindful of mixing things up and taking note of the importance of calcium and vitamin D, we can all make a real impact in minimising our risk of developing osteoporosis. Do you prefer to run or cycle in a gym, or in the great outdoors? Let us know in the comments below. Related links: <a href="/health/body/2016/08/cycling-could-save-you-from-alzheimers-disease/">Cycling could save you from Alzheimer’s disease</a> <a href="/health/body/2016/06/why-cycling-is-perfect-for-over-60s/">Why cycling is a perfect form of exercise for over-60s</a> <a href="/lifestyle/retirement-life/2016/05/cycling-increasing-in-popularity-over-golf/">Is cycling the new golf?</a>

Body

How to manage osteoporosis while travelling

Osteoporosis can be a debilitating condition, but as long as you’re willing to take the appropriate measures there’s no reason it should restrict your travel plans. Here are some simple, effective ways to manage osteoporosis while travelling. 1. Discuss your needs and limitations Before you book anything it’s important to understand exactly what sort of trip you have capacity to take. Because of this, it’s essential to have a frank conversation with your doctor, who can determine your fitness to travel and any medical needs or measures you’ll need to take into consideration once you’ve reached your destination. When booking your trip make sure your travel agent is aware of your condition, as well as any airline, hotel, cruise ship or tour company you make arrangements with. 2. Plan, pack and prepare When working out an itinerary, be realistic and try and avoid circumstances where the risk of falls and injury are high. Make sure you’ve packed any necessary medication, as well as assistance devices like medical walkers, walking sticks and wheelchairs, but prepare to navigate infrastructure that might not be as well-maintained. 3. Try and take it easy, and enjoy your trip While a whirlwind backpacking trip taking in 12 European countries in two weeks was fun as a teenager, now it’s simply not as realistic. Try to take care when partaking in activities that might lead to falls and injuries, like tours, hikes, sporting activities, dancing, even when you’re partaking in liquor it pays to be wary of the risks. 4. Make sure you have decent coverage When travelling you never know what’s around the bend, which is why it’s so important to make sure you have sufficient travel insurance<a rel="noopener" href="https://elevate.agatravelinsurance.com.au/oversixty?utm_source=over60&utm_medium=banner&utm_campaign=travel-insurance" target="_blank"></a>. By having a decent level of coverage you can tailor to your circumstances you can be sure that if something does go wrong while you’ve travelling overseas, you will be in a decent position to cope. Related links: <a href="http://www.oversixty.co.nz/travel/travel-tips/2016/05/10-more-travel-scams-to-watch-out-for/">10 more travel scams to watch out for</a> <a href="/travel/travel-tips/2016/05/6-things-you-need-to-know-about-travel-vaccinations/">6 things you need to know about travel vaccinations</a> <a href="/travel/travel-tips/2016/05/10-ways-to-beat-travel-sickness/">10 ways to beat travel sickness</a>

Travel Tips

The link between osteoporosis and sudden deafness

New research published by the Endocrine Society shows that those with osteoporosis are at greater risk of developing sudden deafness than those who do not have it. In fact, those with the bone disease had a 1.76 times higher risk of experiencing sudden deafness. Osteoporosis sufferers have bones that become weaker over time, leaving them more likely to break or fracture. Sudden deafness is an unexplained loss of hearing that typically affects one ear immediately or over several days. For around half of the people who develop sudden deafness, their hearing will repair itself, but it is still imperative that treatment is sought as soon as it occurs. Approximately 85 per cent of sufferers who receive treatment regain some of their hearing. “A growing body of evidence indicates that osteoporosis affects not only bone health, but the cardiovascular and cerebrovascular systems,” said Kai-Jen Tien, the author of the study from Taiwan's Chi Mei Medical Centre. “Our findings suggest sudden sensorineural hearing loss can be another broader health problem connected to osteoporosis.” The study looked at the medical records for 10,660 Taiwan residents who had been diagnosed with osteoporosis over ten years. They compared these people with 31,980 people who did not have osteoporosis. They looked at the numbers of people that were diagnosed with sudden deafness during the same period. Dr Tien indicated that the link could be due to cardiovascular risk factors, bone demineralisation, inflammation and endothelial dysfunction.

Hearing

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