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Bone health is a serious concern for older adults. As you age, your bones get weaker as they lose their internal support structures. Older, weaker bones are more susceptible to serious bone breaks (fractures) because they have lower levels of important minerals including calcium and phosphorous. 

Osteopenia is a lower than normal peak bone mineral density (BMD). While not as severe as osteoporosis, it does increase your risk for osteoporosis. Bone mineral density is an indicator for how strong and healthy your bones are. BMD peaks in your late 20s to early 30s, after which it starts to decline. If your BMD is between 1.0 and 2.49 standard deviations below the average peak BMD, you suffer from ostenpenia. 

Women have a lower peak BMD than men and menopause causes hormone changes that speed up the loss of bone mass, which increases their risk of developing osteoporosis and osteopenia. In the United States, about 30% of Caucasian postmenopausal women in the United States have osteoporosis, and 54% have osteopenia.

For older adults, proper bone health is not just a matter of maintaining overall health; proper bone health can also affect mobility and independence. It is never too late to take steps to improve or maintain good bone health in order to prevent dangerous fractures. These lifestyle changes include:

• Receiving proper levels of calcium in your diet (maybe including a calcium supplement combined with vitamin D)
• Not using tobacco products (they can weaken bones)
• Not consuming excessive amounts of alcohol
• Exercising and remaining active (bone forms in response to stress, so weight-bearing exercises are good choices)
• Taking caution to avoid dangerous bone breaks
• Getting early treatment for eating disorders (low body weight can increase the risk of hip fracture)

Osteopenia does not have any symptoms, but doctors can diagnose low BMD with a bone density scan. This can help you and your doctor decide if bone strengthening drugs are an appropriate treatment option. Many women who have menopause also have osteopenia. 

Some doctors recommend osteoporosis medicine including Fosamax, Boniva, or hormone therapy right away to prevent further bone loss. However, as with any medication, these drugs have side effects and associated risks. Other doctors recommend that you exercise and take calcium. And, some researchers caution that many younger postmenopausal women are taking drugs that they don’t need because osteopenia is just a risk marker for osteoporosis. 

The World Health Organization developed a tool that helps predict a person’s overall risk of major fracture over the next 10 years by factoring in a variety of risk factors including: age, bone mineral density test results, family history of osteoporosis, use of oral steroids, whether or not you have rheumatoid arthritis, and whether or not you smoke. And, the National Osteoporosis Foundation revised its treatment guidelines as follows: drugs should be considered for postmenopausal women and men age 50 and older who have a 10-year probability of a major osteoporosis-related fracture ≥ 20% or a 10-year probability of hip fracture of ≥ 3%. 

If you or a family member is a nursing home resident it is important to ensure that you are receiving adequate calcium in your diet and proper activity and exercise to promote bone formation. Also, if you have risk factors for osteoporosis, you should have a bone mineral density test performed in order to determine your chances of developing osteoporosis and suffering dangerous bone breaks. Your bones are an important factor in maintaining independence and mobility, and nursing homes should ensure that you maintain proper bone health. If you are worried that a family member not receiving proper nutrition or BMD testing, it is important to talk with the nursing home staff as soon as possible to address the problem. 

Sources:

WebMD: Osteoporosis Health Center - Osteopenia

University of Washington: Department of Radiology – Osteopenia

U.S. News: Health – Grappling with a diagnosis of Osteopenia

Better Bones: Rethinking Osteoporosis

Pub Med: Vitamin K deficiency and osteopenia in elderly women with Alzheimer’s disease

JAMA: Osteopenia and Preventing Fractures

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I have a lot of clients who almost apologically tell me how their loved ones 'brittle bones' are responsible for the extensive nature of their injury .  Sure, their bones may be weakened and brittle, but that is not a defense to a claim against a nursing home or hospital for providing inadequate care.

The law has a long-standing tradition where a defendant (wrongdoing person or facility) takes the plaintiff (injured person) as they find him or her.  In other words, the fact that a person was in a weakened state at the time of their injury really has no bearing on the case, except for the fact that the resulting damages from their poor care may be more extensive for a person in a weakened condition than if the injury occurred to a younger person without such complicating factors.

Without a doubt, complications from brittle bones are one of the most problematic things facing many nursing home patients who suffer a fall at a facility.

What is Osteoporosis?

As you age, your bones get weaker, increasing your risk of osteoporosis (a disease that causes weak, porous bones). This can significantly increase your risk of dangerous bone breaks (fractures). Weak bones are caused by low levels of calcium, phosphorous, and other mineral levels in the bone. This mineral loss causes your bones to become brittle and eventually lose their internal support structures. 

Approximately 44 million people (~ 55% of the U.S. population) in the United States suffer from low bone density and 10 million of those people actually suffer from osteoporosis. About 30% of Caucasian postmenopausal women in the United States have osteoporosis, and 54% have osteopenia (lower than normal bone mineral density). 

Signs and Symptoms of Osteoporosis

Osteoporosis does not usually have any signs or symptoms until it is pretty far advanced. Weakened bones can cause back pain, loss of height over time, a stooped posture, and broken bones. However, you can have osteoporosis for years without symptoms, until you suffer from a serious bone break. Therefore, you should have a doctor perform a bone density test if you are:

• A woman older than age 65
• A man older than age 70
• A person over 50 who has suffered from a broken bone during their lifetime
• A person who takes medications associated with osteoporosis (prednisone, aromatase inhibitors, or anti-seizure drugs)
•  A postmenopausal woman (when estrogen levels drop at menopause, bone loss increases dramatically) with at least one osteoporosis risk factor
• A postmenopausal woman who recently stopped taking hormone therapy
•  A woman who experienced early menopause

Risk Factors

There are some lifestyle related risk factors you can change to help improve bone strength, including:

• Low calcium intake
• Tobacco use
• Eating disorders
• Sedentary lifestyle
• Excessive alcohol consumption
• Corticosteroid medications

However, there are also risk factors that you cannot change, including:

• Being a woman  
• Aging
• Being of white or Asian decent
• Family history of osteoporosis
• Above normal levels of thyroid hormone
• Medical conditions and procedures that affect bone health (stomach surgery, Crohn’s disease, celiac disease, hyperthyroidism, and Cushing’s disease).

Prevention of Osteoporosis

Your bone mineral density (BMD) peaks when you are in your early 30s and starts declining as you age. Your likelihood of developing osteoporosis depends on how much bone mass you attained in your 20s and early 30s (the more bone mass you have, the less likely you are to develop osteoporosis) and how quickly you lose it. 

Prevention entails accumulating as much bone density as possible during your early life by eating healthy, getting enough calcium, being physical active, not smoking, and maintaining a healthy lifestyle and maintaining those practices during your later years. 

Increased risk of fractures related to falls in patients with Osteoporosis

Older, brittle bones are more vulnerable to serious bone breaks and compression because they lack the internal support structures to withstand impacts and pressure. Even a relatively mild injury can cause bone breaks. And, women suffering from osteoporosis are twice as likely to suffer from bone fractures when compared to men with osteoporosis. Older adults are at increased risk for dangerous falls because of balance problems, weakness, illness, bad vision,

Bone fractures are most common in the spine and hips (bones that directly support your weight), and the wrists (from bracing yourself with your hands as you fall). A 10% bone mass loss in the vertebrae can double the risk of vertebral fractures and a 10% loss of bone mass can cause a 2.5 times greater risk of hip fracture. 

Hip fractures are one of the most common injuries for elderly people. They usually occur because of a fall and can cause serious and even life-threatening medical complications. Elderly persons can also suffer from compression fractures in their spine, which occur when the vertebrae (back bones) become so weak that they compress or collapse. This can cause severe pain and a stooped posture. 

Osteoporotic bone fractures can cause decreased quality of life, severe pain, disability, and reduced mobility. Maintaining mobility is a significant concern as you age and healthy bones can help you maintain your health, safety, mobility, and independence. One of the best things you can do for yourself if take care of your bones at an early age by exercising, receiving adequate levels of calcium, eating a healthy diet, and not smoking. It is never too late to do something about your bone health. 

Therefore, nursing home staff should take steps to improve and maintain the bone health of all residents. Nursing home facilities should encourage safe and appropriate exercise and activity, provide proper nutrition, providing calcium supplements if necessary, and reducing the risk of dangerous falls.  

Fall prevention is one of the most important things nursing homes can do to ensure that residents do not suffer dangerous injuries. Osteoporosis and weak bones are common in many older adults, so preventative measures to protect the entire population is often the most effective tool to reduce complications for residents with osteoporosis. 

Your family member deserves to receive necessary and appropriate care to achieve and maintain their best possible physical health and well-being. Although your family member is older and aging, they still deserve to receive the steps and care necessary to retain their independence, health, and dignity. 

Lastly, should your loved one sustain an injury during an admission to a nursing home or assisted living facility, don't assume that their osteoporosis precludes them from pursuing a claim against the facility.  Rather, the resulting injuries may likely be compensable regardless of their physical condition at the time of the incident.

Resources:

International Osteoporosis Foundation

National Institute of Arthritis and Muscoskeletal and Skin Diseases: Osteoporosis

The Johns Hopkins Arthritis Center: Osteoporosis Information – A Geriatrician’s Perspective

Related Nursing Homes Abuse Blog Entries:

Nursing Home Sued After Resident Fractures Both Hips In Separate Falls

Nursing Home Waits 19 Hours To Provide Medical Treatment To Resident Who Fractured Her Hip During Sabina Lift Transfer

How Many Falls Is Enough To Impose Responsibility On Nursing Home?

Nursing Home Cited For Mistreatment Of Resident Following Investigation Of Resident's Fractured Neck

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