Osteoporosis is a normal part of ageing. We would all develop osteoporosis if we lived long enough. Women in particular are at an increased risk of osteoporosis compared to men, due to the effects of menopause and subsequent oestrogen deficiency. Women can expect to lose around 1 per cent of their bone mineral density each year in the years beyond their menopause, so are likely to develop osteoporosis in old age.^4,5,14

Elderly women should consider discussing with their doctor ways to improve their bone health and whether they need specific investigations for osteoporosis.

Lifestyle factors are important for managing osteoporosis in the elderly. Adequate calcium intake, optimising vitamin D levels and age-appropriate exercise can help manage osteoporosis in the elderly woman. Exercises that focus on balance training (e.g. Tai Chi), progressive muscle strengthening (e.g. walking) can lead to a reduction in falls.⁵⁰ Reducing the risk of falls in the elderly forms an important part of treatment for reducing fractures. In addition, attention to physical illnesses or environmental factors that may predispose an individual to falls is also important in managing osteoporosis.⁵⁰

Falls

Falls are a particular problem in the elderly and in the worst case scenario can lead to hip fractures, which can be life-threatening. Frequent falls also lead to a loss of confidence and therefore greatly reduce the level of independence in the elderly population.

A break in the bone that occurs after a fall from a standing height is unusual, so in such cases individuals should be investigated for underlying osteoporosis.

Ways in which elderly people can minimise their risk of falls include:

• Ensuring there is adequate lighting within the home (and turn on lights when getting up in the night)
• Eliminating clutter within the home
• Rearranging furniture to avoid the risk of tripping over objects
• Eliminating the need for using stairs
• Medical check-ups, if concerned about health (especially if there is a walking problem)
• Reviewing medications, which may affect balance; e.g. antihypertensives, sedatives (sleeping tablets), narcotics (sedating pain killers)
• Regular vision checks
• Wearing footwear that provides support for the feet and adequate traction when walking
• Removing rugs
• Installing rails in the shower toilet and hallways
• Placing non-slip mats in the bathroom
• Using walking aides when needed, e.g. walking frames and walking sticks
• Exercise to improve balance and strengthen muscles (a physiotherapist can prescribe an appropriate program)

It may be necessary for the very frail elderly to see physiotherapists and/or occupational therapists. Physiotherapists provide assistance with provision of aides for walking. Occupational therapists make the home environment safe, for instance by installing rails.

These and many other measures can help reduce the risk of falls within the home. To obtain such services, it is recommended that you see your local doctor or contact your community health centre.

Elderly who are in care (institutionalised) 

For the elderly who are in care (institutionalised) it has been shown that the administration of additional vitamin D supplements and calcium supplements may reduce the incidence of fracture.⁵¹ Hence, it is advisable for the elderly in care to be routinely prescribed a calcium and vitamin D supplement, provided there are no abnormalities with regards to calcium metabolism.^8,12

The use of some types of hip protectors (devices worn on the hip) may also reduce the likelihood of hip fractures in the very frail elderly, who have a high risk of falls.⁵² The success of these devices relies on the elderly being compliant with their use, which can be a problem, particularly if the device is uncomfortable to wear.