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

Lifestyle factors in relation to management of osteoporosis in the elderly are important. Adequate calcium intake, optimising vitamin D levels and some form of exercise that is appropriate to the level of function for the individual, can help manage osteoporosis in the elderly woman. Exercises which focus on balance training (eg. Tai Chi), progressive muscle strengthening (eg walking) can lead to a reduction of falls.⁵⁰ By reducing the likelihood of falls, this may well lead to a reduction in fractures. As yet, studies evaluating the effect of exercise on fracture rates in the elderly are not available. 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 as they can result in fractures particularly of the hip. They also lead to psychological problems and loss of confidence in the elderly due to fear of falling again. Falls from a standing position are generally associated with a significant amount of force and in theory anyone, even individuals without osteoporosis could sustain a fracture.

However, when osteoporosis is present, minor trauma will also lead to fractures, such as coughing, knocks on the limbs and even simple falls. Any fracture occurring from minimal trauma should be investigated as it may indicate underlying osteoporosis.

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

• Ensuring there is adequate lighting within the home/ Turn on light 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)
• Review of medications, which may affect balance eg. antihypertensives, sedatives (sleeping tablets), narcotics (sedating pain killers),
• Vision checks should be regularly conducted (to reduce the risk of falls due to poor eye sight)
• Wearing correct foot wear to provide support for the feet and adequate traction when walking
• Remove rugs
• Installing rails in the shower toilet and hallways
• Place non-slip mats in the bathroom
• Use walking aides when needed eg. 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 measures and many other measures can help reduce the risk of falls within the home. To obtain such services it is recommended that women see their local doctor or contact their 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

In addition, the use of some types of hip protectors, which are 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.

Content updated February 20, 2006