How do we prevent fractures in the elderly?

No one likes the idea of sustaining a fracture. They’re painful, cause immobility during the time in which we need to rest and therefore lead to weakening of the muscles that we’re not using.

Fractures are also more likely to occur in the elderly population, due to weakening bones and a declining sense of balance.

Fractures in elderly people can be quite substantial injuries, as they often cause a significant impairment of independence and ability to care for themselves.

It is estimated that the 1 year mortality rate following a fractured hip, is anywhere between 14% and 58%. This means that one year post hip fracture, between 14 and 58% of patients will not survive. This statistic is influenced by all of the things that come with declining independence, such as less of a likelihood to eat or take medication, resulting in sickness.

My blogs are usually quite light-hearted, and I realise that so far this one isn’t. That’s because I personally see too many patients suffering unnecessarily from the after effects of fractures, or putting themselves at unnecessary risk by failing to adopt preventative actions.

So, why are the elderly particularly at risk of fracture?

Our bones are made up of bone cells, as well as minerals. One of those minerals is calcium. The minerals within our bones help to strengthen them, kind of like adding cement to sand or rocks.

As we age, we lose some of the mineralisation from our bones. They become weak, and more brittle. Therefore, more likely to snap from less pressure.

Elderly people often also neglect their diets, and opt for easy and quick dinners. They may not be ingesting as much calcium as they need to keep their bones strong, especially if they don’t drink milk or include cheese, yoghurt or leafy greens in their diets.

Fractures in elderly people can be quite substantial injuries, as they often cause a significant impairment of independence and ability to care for themselves.

The elderly often spend more time inside than the rest of us, and thus miss out on vital exposure to moderate sunlight. Our bodies produce vitamin D when we come in contact with sunlight. Vitamin D helps our gut absorb the calcium from our food, so without it, our bones might miss out on receiving the amount of calcium that they need.

In this perfect storm of weakened bones, it doesn’t take much of a knock to cause a fracture. The double-whammy of bad news however, is that elderly people will fall over or knock themselves far more frequently than young people. This is because our sense of proprioception (our body’s awareness of where our limbs sit in space) declines with age, particularly if we don’t pay attention to training it.

Unfortunately for us females, we’re even more at risk. The drop in estrogen following menopause exacerbates the weakening of bones experienced with normal ageing processes.

So, what can be done?

Fortunately it’s not all doom and gloom, but optimal results and prevention of fractures definitely requires a proactive approach from the patient and their support network.

First of all, the easy stuff.

• Diet.

Ensuring adequate Calcium intake is vital. If the patient is reluctant to eat dairy/leafy greens, then discuss the possibility of a calcium supplement with the GP.

• Exposure to sunlight.

Our bodies never stop producing Vitamin D, however always require sunlight in order to do so. Sensible exposure of face and arms for 10 minutes before 9 or after 3 should be adequate.

• Regular check-ups.

GP’s are usually fabulous at checking Vitamin D and calcium levels frequently, and will order a bone density scan if indicated. Stay on top of your GP check-ups!

Now, the stuff that requires more effort.

• Weight bearing exercise

Weight bearing just means that your body is holding itself up, or is working with some resistance. Swimming, for instance, is not weight bearing whereas walking is.

The cells in our bones continue to grow, die and get replaced all throughout our lifetime, the same as our skin or hair cells do. As such, the cells in your arm bone are completely different to the ones that were there 10 years ago!

Our bodies are clever, and will lay down more bone cells in areas that they’re needed. If we exercise with effort and require our bones to “do some work”, we’re signalling our body to lay down more bone mass to assist with the effort required. Therefore, weight bearing exercise (yes, even gentle walking) can assist with the prevention of a loss of bone mass, and potentially even improve it.

The key to this is that the exercise must be relatively frequent, not just once a week. Speak to a healthcare professional for appropriate exercises.

• Proprioceptive training (balance training).

Without a good awareness of where our limbs are sitting in space, our brain is just guessing at where to put our foot when we walk. If our brain isn’t sure if our foot is 1cm or 5 cm off the floor, we have a tendency to over correct or underestimate our required movements, leading to a risk of falling over.

If we exercise with effort and require our bones to “do some work”, we’re signalling our body to lay down more bone mass to assist with the effort required.

We can train our sense of awareness and balance of our limbs. Good exercises to start with initially are things like drawing the alphabet with your big toe on both sides (whilst sitting!). These exercises can be progressed to balancing on one foot, or calf raises, plus many others. These exercises are best prescribed by a health professional such as an osteopath, who will be able to assess the patient’s proprioception and tailor a rehab plan specifically.

Falls and fractures can often be prevented. Many community and hospital groups run “falls prevention” programs, which can be really great to attend in conjunction with working with a GP and osteopath.

It might look like a bit of effort, but it will all be worth it in the long run!

All the best,

Claire