The age of population has been extended due to modernization. Improvement in the living environment, food supply and medical advancement have prolonged our lifespan.
Aging has also imposed some new issues. Though they are the elements of the aging process, their implications become more significant with the longer lifespan.
One of it, and widely concerned by the public, is osteoporosis.
What is it?
Skeleton is the major system enable the creatures to shape, to move and to protect some of the major organs. The element is bone. It is strong but remain a certain degree of elasticity for the better function. Its strength depends on the calcium content. Loss of the calcium content below the physiotherapy need, with the increase in the chance of fracture, results in osteoporosis. Osteoporosis is defined as the bone density below 2.5 standard deviation of that in young adult. And it is measured by the Dual-Energy X ray Absorptiometry(DEXA).
Loss of calcium is a physiological process beyond the fourth decade of life. Women will be affected more during the time of menopause, due to the hormonal changes, and will have the rapid loss of calcium content, coming from the bone.
Of course, the loss of calcium can also be due to some diseases, directly or indirectly, or due to the treatment.
Neurological diseases, like stroke, myelitis, and cord compression, result in loss of musculoskeletal function. The disuse of the limbs will hasten the loss of calcium content of the bones in the involved limbs.
Other diseases include chronic kidney disease, inflammatory disease, multiple myeloma, hypothyroidism, removal of ovary at young age will also have the early loss of the bone calcium.
Some kinds of treatment, like long term corticosteroid, some anti-epileptic drugs, proton pump inhibitor, may also induce osteoporosis.
Bad habits like alcoholism, smoking, little exercise, and less diary consumption can also result in lower calcium content in the body.
Calcium has another function on our muscles. Poor calcium control may result in suboptimal muscle function. It may increase in the fall risk and, together with osteoporosis, the chance of fracture.
Osteoporosis itself is totally asymptomatic. It will draw our personal attention when we face fracture. The typical sites of osteoporosis fracture are the spine, the hip and the wrist. Haven’t said that the other bones are immuned. Osteoporotic fractures, happened in the elderly, with decrease in the physical strength and usually the presence of other comorbidities, will have more significant implications. Fractures will cause immediate loss of function, and pain. These will lead to decrease in ambulatory ability and exercise. Disuse bone loss and downgrading of the activities of daily living will be resulted.
Prevention is always the track of management. Prevention of development of osteoporosis and prevention of fractures are the two main themes. Stress that prevention, in strictly speaking, is lowering the risk.
Calcium metabolism is a dynamic process. Calcium is going in and out of the bone continuously. Building up of the bone stock is counteracted by the loss of calcium. Loss of the balance with aging and due to other secondary factors results in osteoporosis.
I always tell people that, to tackle, the strategy is mimic our saving. We save money at the younger age and use less in the older age. We can build up more calcium with better lifestyle, regular exercise, and avoid smoking and excessive drinking when we are young. To prevent / slow down the loss with regular exercise and lifestyle, again.
Inevitably, bone loss will set in, as a part of physiological process. Some medical treatment may be needed, in those with high risk of fractures and in those already suffered from osteoporotic fractures.
Calcium supplement is also a common and well accepted mode of treatment. But it is not enough in those index cases. Other medications may be needed. They are grossly divided into 2 categories, prevention bone loss and increase in bone formation.
The former is well exemplified with bisphosphonate and denosumab. The latter includes the hormonal therapy. Of course, each option has it good and bad side. It is advisable to discuss with the doctors.
To prevent fall and fractures, exercise directing to muscle strengthening and balancing has to be stressed. Environmental modification and adoption of care providers are other fields considered. Handrails in the toilet and passage, support or aids for walking, avoidance of steps are the areas we usually concern.
In case that fractures do occur, immediate medical consultation and so relevant treatment, either in the form of splintage, brace, plaster immobilization or surgery, can be offered promptly. In addition of adequate analgesics, we are trying to let the elderly to start exercise early, in order to prevent complications.
Dr Chiu Wing Fat
Specialist in Orthopaedics and Traumatology