Severe Osteoporosis: Complications, and Treatment

Darren is an 82-year-old gentleman who lives with his 90-year-old sister, Marie. Marie requires a wheelchair to get around. Darren has a severe form of osteoporosis that has resulted in back pain and a stooped posture known as kyphosis. For the past 20 years, Darren and Marie have shared a home. Even though either would find it hard to live alone, together, they have managed.

Darren and Marie are finding it increasingly difficult to manage at home. Darren takes several medications for his osteoporosis and atrial fibrillation, a condition that increases his risk for strokes. In addition, every six months or so, he suffers a bone fracture that necessitates hospitalization for surgery and physical therapy. Darren and Marie want to continue living in their home but need help to do so.

What is osteoporosis?

Bone is a living tissue that is constantly breaking down and rebuilding itself. It reaches its peak density around the age of 40. After age 40, bone density gradually decreases in men. In women, there is a more rapid decrease in bone density right after menopause.

Osteoporosis symptoms do not appear until the bones have thinned to the point where minor injuries, or sometimes no injury at all, result in fractures. These fractures frequently go unnoticed.

The most common bones to sustain fractures are the spine, wrists, ribs, upper arm, pelvis, and hips. Nearly all hip and spine fractures can be attributed to osteoporosis.

What puts you at higher risk for osteoporosis?

Many factors can increase your risk for osteoporosis. Some of these factors are modifiable, you can affect the outcome, and some are not.

Non-modifiable risk factors for osteoporosis:

• Being over the age of 65
• Having a previous spine or hip fracture
• Family history of osteoporosis or frequent fractures
• White or Asian ethnicity
• Female sex
• Medical conditions such as endocrine and gastrointestinal disorders
• Medications such as glucocorticoids, some antiseizure medications, and aluminum-containing antacids

Modifiable risk factors for osteoporosis:

• Smoking
• Excessive alcohol intake
• Excessive caffeine intake
• Lack of physical activity
• Poor muscle strength
• Vitamin D deficiency
• High salt intake
• Low calcium intake
• High oxalate intake
• Excessive vitamin A intake

What foods should you avoid with osteoporosis?

Dietary choices can decrease your risk of developing osteoporosis. For example, eating a diet rich in calcium can provide your bone cells with the minerals they need to build bone. Men aged 19 to 70 and women aged 19 to 50 should aim for 1000 mg of calcium per day. Women aged 51 and older and men aged 71 and older should aim for 1200 mg per day. Replacing calcium in the diet with supplements is not routinely recommended because it can increase the risk of kidney stones. However, it may be recommended in some cases.

To meet the Institute of Medicine’s Recommended Daily Allowance for vitamin D, men and women aged 19-70 need 600 IU of vitamin D. Men and women over age 70 need 800 IU. Fatty fish contain vitamin D. Since most foods have low vitamin D levels, many dairy products are fortified. An excellent source of vitamin D is exposure to sunlight as type B ultraviolet light.

The Bone Health & Osteoporosis Foundation recommends limiting the following foods in your diet to protect your bone health:

• Phytates: Beans and wheat bran contain phytates that interfere with calcium absorption.
• High protein: Meat and other high-protein foods can cause calcium loss.
• Salt: Sodium in salt increases the excretion of calcium in the urine.
• Alcohol: excessive alcohol consumption changes the way bones are formed.
• Oxalates: Spinach, rhubarb, beet greens, sweet potatoes, and some beans are high in oxalates, which can decrease calcium absorption.

Excessive alcohol consumption is associated with changes in the way bone is formed, and caffeine intake has been associated with bone loss in the spine in postmenopausal women.

How long can you live with severe osteoporosis?

When researchers tracked almost 59,000 people with osteoporosis and 225,000 age and sex-matched controls and followed them for 10 to 17 years, they found:

• The highest risk for death from osteoporosis is in the first months to years after sustaining a bone fracture.
• Mortality is lower in people who receive treatment for osteoporosis.
• Women diagnosed and treated for osteoporosis before they reach age 75 have a life expectancy of at least 15 years.
• Men diagnosed and treated for osteoporosis before they reach age 60 have a life expectancy of at least 15 years.
• In men younger than 80 and women younger than 60, the risk of dying was strongly increased in the first year after diagnosis and treatment of osteoporosis but decreased to stable, but slightly elevated after that.

Women younger than age 70 and men were at a higher risk of death after being diagnosed with osteoporosis when compared to their age and sex-matched peers who did not have osteoporosis.

What are the most serious complications from osteoporosis?

Osteoporosis causes approximately 2 million people to have bone fractures each year in the United States. Bone fractures of the spine and hip are the most serious complications of osteoporosis.

Having osteoporosis also increases the risk of falls due to difficulty maintaining balance. Having severe kyphosis (curvature of the spine) alters your center of gravity, making it more difficult to maintain balance.

Recovering from a fracture can require immobilization, which allows muscles to weaken and increases an asymmetry of muscle strength between the left and right side of the body as the bone heals.

Darren is at high risk for falls. He has severe kyphosis and finds that he frequently needs to support his balance by holding onto Marie’s wheelchair as he walks.

Sunland Home Care & Medical registered nurses can assess your fall and balance risk. They use a balance tracking system to assess your risk of falling. Additional tests are available if balance problems are found and fall risk is increased.

Contact us for help

Can anything be done for severe osteoporosis?

Medications cannot reverse bone loss unless it is secondary to a treatable medical condition. However, there are steps you can take to decrease bone loss and reduce your risk for fractures.

There are several FDA-approved medications for treating osteoporosis, including:

• Bisphosphonates: Bisphosphonates decrease the activity of bone cells that break down bone. These drugs are available in oral pill form and as an intravenous infusion. Side effects from bisphosphonates include stomach upset, indigestion, heartburn, and gastrointestinal reflux disease.
• Calcitonin: Calcitonin is a hormone that inhibits the activity of bone cells that break down bone. Calcitonin is well-tolerated but does have cancer risks associated with its use. Therefore, it is only used in very select people who have not been helped with other medications.
• Estrogen agonists/antagonists: Estrogen agonists/antagonists such as Raloxifene are medications that act like estrogen in some tissues, such as bone, and have anti-estrogen effects in others, such as breast tissue. Lack of estrogen is a risk factor for osteoporosis.
• Parathyroid hormone: Recombinant forms of parathyroid hormone regulate calcium levels in your body.

How can home healthcare help you manage when you have severe osteoporosis?

Darren has completed his fall risk assessment with his registered nurse from Sunland Home Care & Medical. She gave him several suggestions on how to decrease his risk for falls in their home.

Decrease your risk of falls by:

• Removing or anchoring rugs
• Using nonskid mats
• Installing handrails when possible
• Ensuring hallways and stairways are well-lighted
• Wearing supportive, non-slip shoes
• Installing shower chairs and handrails
• Scheduling yearly vision exams

Darren and Marie are working with Sunland nurses to develop long-term care plans if either or both reach the point that it is not safe to live alone. Darren has also requested four-hour daily care from Sunland caregivers to help with activities of daily living. Marie needs assistance with personal care and transportation to her medical appointments. With the help of registered nurses and caregivers from Sunland Home Care & Medical, Darren and Marie can expect to live independently for a longer period.