Fall Prevention And Osteoporosis

What comes to your mind when someone mentions “osteoporosis”? We all know what that word conjures. Thanks to advertising, the image of an old lady hunched with a walking stick is the one that we always associate with whenever that word crops up. However, that is the least of the problems associated with osteoporosis. Osteoporosis, on its own, does not pose much of a problem. Indeed, osteoporosis, like hypertension, often has no symptoms. It is only once the patient gets a fracture from a minor fall that the problem presents; and it is this complication of osteoporosis that can give a headache to the treating doctor.

Let me illustrate this with an example. Early this week, I was called to the ER. The history: An 85 year old lady had a minor fall at one of the hypermarkets here. It was, in medical lingo, a low velocity trauma, one that if it were to happen to a young lady, would most probably leave her with no more than a sore buttock and probably some bruised ego as well. In an elderly lady, someone with weakened bone due to osteoporosis, a trivial fall like that would highly likely lead to a fracture. Coming back to this lady, she was unable to walk after the fall and complained of severe pain over the right hip. After a short chat and examination, I shifted my attention to her x-rays. The films confirmed my suspicions: the patient sustained a fracture of the right hip.

Patients with osteoporosis typically sustain a fracture in three common places; the wrist, spine (back) and the hip. Now a hip fracture could be quite a debilitating thing to get. Beside the pain, one is usually bedridden unless surgery is done to correct the situation. (You can still be up and about if you sustain a wrist fracture) And depending on the severity and displacement of the fracture, the surgical options range from putting a metal plate and screw to a hip replacement.

Advancing age not only increases the risk of osteoporosis, but it also increases the risk of a fall. Well, the elderly are more susceptible to falls due to various reasons:

They might be on medications causing drowsiness, and some high blood pressure pills can cause a transient drop in blood pressure as they get up from bed, leading to dizziness and risk of fall.

Failing eyesight might cause them to trip over obstacles or steps, especially in poorly lit areas at night.

Muscle tone decrease with advancing age, and can lead to poor balance. Also reflexes become slower, therefore making it difficult for the elderly to correct any imbalance quickly.

Can we do something about this, you might ask. If you were to pose the question to me, I would say that beside the obvious, which is prevention and treatment of osteoporosis; (you can discuss this with your regular GP or your nearest friendly neighborhood orthopedic surgeon *wink*) the prevention of fall in an osteoporotic individual is an equally important fact that is often overlooked (simply because, they wouldn’t have a fracture unless they fall would they?).