Posted: November 17th, 2022

Osteoporosis, Aging and Osteoporosis in Elderly

What is Osteoporosis

Osteoporosis, a common skeletal disorder, causes one’s bones to lose their natural strength and become more prone to fracture and inability to support one’s body weight, or in other words, when bone tissue deteriorates faster than it is replaced. Because of lower bone mass and bone quality, this disorder is much more common in people over the age of 50. It can, however, be diagnosed in men and women of any age. In fact, osteoporosis has been diagnosed in over two million Canadians. Women in menopause are more likely to develop this disorder because their bodies no longer produce estrogen, which is an important factor in bone strength maintenance.

Stooping and Osteoporosis

Osteoporosis is classified into two types:

Primary osteoporosis is most common in women approaching menopause. This type has no ‘direct cause’ or origin, but rather develops as we age, peaking at menopause.
Secondary osteoporosis: This type can affect people of all ages, including children and the elderly, and is typically caused by the use of various medications such as corticosteroids, malnutrition, excessive exercise, or chronic illnesses such as anorexia nervosa. This is not to say that exercise is always bad, but some women who exercise excessively may lose their menstrual cycle, causing their ovaries to stop producing estrogen normally.
Symptoms
Osteoporotic fractures most commonly occur in the forearm, hip, or vertebrae, but they can occur in any bone structure, including the pelvis, ribs, and so on. Vertebral fractures can also cause back pain, a loss of height, and functional impairment, or the inability to function in a specific part of the body. However, aside from fractures and chronic back pains, osteoporosis has no visible symptoms. Back pains can occur while standing still and worsen when performing daily activities, such as sneezing and coughing.

Are you more likely to develop osteoporosis?
As previously stated, the drop in estrogen levels during menopause in women is a major risk factor for osteoporosis, but there are other risk factors, some of which are controllable and others which are not.
These are some examples:
-A lack of physical activity (Less active bones lead to weaker bone quality, and faster bone deterioration)
-Low calcium and vitamin D levels (Calcium and vitamin D are both necessary for the body to maintain bone strength and health).
-Family Background (Osteoporosis can run in families, and if your family or relatives have a history of it, you have an increased risk as well)
-Body Shape (Thin-boned and skinny individuals, or those who have had a vertebrae fracture in the past are at a greater risk of being diagnosed with osteoporosis)

Treatment and Prevention
Leading an active and healthy lifestyle, as with most common age-related disorders, is an excellent way to prevent Osteoporosis. Because our bones are made of calcium and are influenced by vitamin D levels, eating foods high in vitamin D and calcium are excellent ways to combat deteriorating bone quality as we age. It is recommended that you see your doctor on a regular basis as you get older, especially if you experience frequent back pain on a daily basis.

Your doctor may recommend the following treatment options:

-Testosterone Replacement (Used in men when osteoporosis is caused by hypogonadism)
-Bisphosphonates (Medication that slows down bone breakdown) (Medication that slows down bone breakdown)
-Denosumab (Injection that lowers risk of fracture and strengthens bones) (Injection that lowers risk of fracture and strengthens bones)
Hormone Replacement Therapy (HRT) (For women who reached menopause and lack estrogen)
Analogues of Parathyroid Hormone (Helps body build bone faster than it deteriorates, and treats severe cases of osteoporosis)
-Modulators of Selective Estrogen Receptors (Used in prevention and treatment for women)

The elderly and osteoporosis

Osteoporosis in the elderly is a skeleton disease characterized by a decrease in bone mass and microstructural damage to bone tissue, resulting in increased bone fragility and, as a result, an increased risk of fracture.

In osteoporosis, two major bone metabolism processes are distinguished, each of which results in a decrease in bone mass:

A high degree of bone resorption is not compensated by normal or increased bone formation; the resorption process is normal, but bone formation decreases.
Primary osteoporosis can be juvenile, idiopathic in young adults, postmenopausal (type 1), or senile (type 2); or secondary – with thyrotoxicosis, illness and Cushing syndrome, hypogonadism, hyperparathyroidism, type 1 diabetes mellitus, hypopituitarism, liver diseases, chronic renal failure, malabsorption syndrome, rheumatoid arthritis, sarc (corticosteroids , barbiturates, heparin, anticonvulsants, immunosuppressants, aluminum-containing antacids).

Osteoporosis can be caused by both primary and secondary factors in the elderly. By the age of 70, men have lost 19% of their compact substance, while women have lost 32%. After 25 years, regardless of sex, the loss of a spongy substance is on average 1% per year, and after 70 years, it can be up to 40%.

What causes elderly osteoporosis?
Osteoporosis risk factors include:

Gender and composition: in men, the bone is initially thicker and stronger due to the high amount of testosterone; in women, the processes of bone resorption are more active, especially during menopause (in 50% – up to 1-2% per year) or after ovaries removal (they slow down at childbirth – every birth reduces the risk of fractures by 9%); tall and thin people are more susceptible to osteoporosis than people of dense physique and short stature.
Inactive lifestyle: prolonged immobility causes osteoporosis, as does being in zero gravity.
Vitamin D deficiency: It regulates calcium absorption in the intestines and is involved in the formation of bone tissue (vitality is synthesized in the body under the influence of sunlight or comes in ready form with oil, fish oil, eggs, liver and milk).
Alcohol and smoking: both cause a decrease in bone mass, regardless of gender; smoking has a greater impact on the progression of osteoporosis in women.
Heredity: There is a certain influence of genetic and family factors on bone density (for example, osteoporosis is rare in members of the Negroid race), and hereditary factors contribute up to 80% of the variability of this indicator.
Nutritional factors: bone is primarily composed of calcium and phosphorus, which are deposited in a protein matrix known as the osteoid, and calcium balance is determined by dietary calcium intake, calcium absorption in the intestine, and the degree of excretion in the urine and then the feces.
What are the symptoms of osteoporosis in the elderly?

The proximal humerus, distal radius, spine, femoral neck, large spit, and leg cramps are the most vulnerable to osteoporosis.

Osteoporosis in the elderly is referred to as a “silent” epidemic because it frequently manifests as a low-symptom pattern and is detected in the presence of bone fractures. However, the majority of patients report back pain (between the shoulder blades or in the lumbosacral region), which worsens after exercise and persists for an extended period of time (standing or sitting). These pains are relieved or disappear after lying down, which patients must do several times throughout the day. There may be indications of episodes of acute back pain in the anamnesis, which were diagnosed as lumbosacral radiculitis due to osteochondrosis and deforming spondylosis. Senile stoop (hump), nocturnal leg cramps, fatigue, paradontosis, brittle nails, and premature graying are all indirect symptoms of the disease. And, while the presence of these symptoms does not provide 100% confirmation of the diagnosis, it does allow you to determine the scope of studies required to refine it.

How do you spot osteoporosis in the elderly?
Traditional X-ray examination allows for the detection of a decrease in bone density of 25-30%. Nonetheless, thoracic vertebral radiographs are important because the loss of density in these vertebrae often begins earlier than in other parts of the spinal column.

Bone densitometry, which measures the amount of X-ray absorption by bone substance, allows for the estimation of bone density as the foundation of its strength. However, osteoporosis in the elderly is a disease of the protein matrix of the bone, and the mineral content changes again, and this technique is not entirely accurate due to only measuring the projection mineral density (which depends significantly on the thickness of the bone) and bone tissue heterogeneity (increases with age the fat content in the bone marrow, which decreases the absorption coefficient).

Dual-energy x-ray absorptiometry is considered the “gold standard” in the diagnosis of osteoporosis due to a number of advantages, including the ability to examine the axial skeleton, good sensitivity and specificity, high accuracy and low reproducibility error, low radiation dose (less than 0.03 meV), relative cheapness, and speed of research.

Although computed tomography (volumetric spiral CT) allows for the investigation of the trabecular structure of both the spine and the femur, it is still an expensive method with a high radiation load. Magnetic resonance imaging can be used with the same success.

Quantitative ultrasound (ultrasonic densitometry) reveals not only the mineral content of bone, but also other properties that determine its “quality” (strength). The heel, tibia, phalanges of the fingers, and other surface-located bones can be examined using this method.

What is the treatment for osteoporosis in the elderly?
Osteoporosis treatment is a difficult issue. Because of the disease’s multicomponent pathogenesis and heterogeneous nature. The following are the goals of osteoporosis treatment:

Slowing or stopping bone mass loss is desirable on the background of treatment; preventing bone fractures; normalization of bone metabolism; reduction or disappearance of pain syndrome, improvement of the patient’s general condition; expansion of motor activity, maximum possible restoration of work capacity, and improvement of the patient’s quality of life Systematic osteoporosis treatment includes:

application of a calcium and phosphorus salts-balanced diet, protein: dairy products, small fish with bones, sardines, sprats, vegetables (especially green ones), sesame, almonds, peanuts, pumpkin and sunflower seeds, dried apricots, figs; pain relievers during exacerbation (non-steroidal anti-inflammatory drugs, analgesics); use of muscle relaxants; dosed physical exercises and exercise therapy; wearing cor
All osteoporosis pathogenetic treatment options can be divided into three categories:

Natural estrogens (estragen-gestagenic preparations), calcitonins (myacalcic, sibacalcine calcitrine), bio-phosphonates (etidronate, alendronate, and resorcinol); preparations stimulating bone formation: fluoride salts (sodium fluoride, monoflurophosphates), parathyroid hormone fragments, somatotropic hormone, anabolic steroids; preparations with a multifaceted effect
How can osteoporosis in the elderly be avoided?
Osteoporosis prevention should focus on the early detection and elimination of risk factors for the disease, as well as the diagnosis and appropriate treatment of the disease (before the onset of fractures).

Proactive measures include the following:

Weight loss through a chain of reducing the load on the spine and joints; painstaking daily medical gymnastics directed precisely to the affected section of the skeleton; refusal to lift weights (weight more than 2-3 kg); diet adherence (refusal of concentrated broths, canned food, smoked products, coffee, chocolate; use of various combined food additives, vitamin preparations). The implementation of a set of social and individual measures to prevent injuries in the elderly and senile is critical in preventing the consequences of severe osteoporosis.

Aging and Osteoporosis

Exercise Can Help You Protect Your Bones

Illustration of two tennis players.
Although bones appear to be solid, the inside of a bone is actually filled with honeycomb-like holes. Bone tissues are constantly being broken down and rebuilt. Some cells form new bone tissue, while others dissolve bone and release the minerals within.

We begin to lose more bone than we build as we get older. The tiny holes within bones grow larger, and the solid outer layer thins. In other words, our bones become less dense as we age. Hard bones become spongy, and spongy bones become spongier. If the loss of bone density progresses too far, the condition is known as osteoporosis. It is estimated that over 10 million people in the United States have osteoporosis.

Broken bones are common in car accidents. However, if your bones are dense enough, they should be able to withstand most falls. Bones weakened by osteoporosis, on the other hand, are more likely to fracture.

“It’s just like any other engineering material,” says NIH osteoporosis expert Dr. Joan McGowan. “It reaches a point where the structures aren’t adequate to support the weight you’re putting on them” if you fall and slam your weight onto a fragile bone. If the bone breaks, it is a strong indication that the person is suffering from osteoporosis.

Broken bones can cause serious issues for seniors. Osteoporosis is common in the hip, and hip fractures can lead to a downward spiral of disability and loss of independence. Wrist and spine osteoporosis are also common.

The hormone estrogen aids in the formation and repair of bones. After menopause, a woman’s estrogen levels fall, and bone loss accelerates. As a result, osteoporosis is most common in older women. Men, too, can develop osteoporosis.

“A third of all hip fractures occur in men, yet the problem of osteoporosis in men is frequently downplayed or ignored,” says Dr. Eric Orwoll, a physician-researcher at Oregon Health and Science University who studies osteoporosis. According to Orwoll, men fare worse than women after a hip fracture.

Experts recommend that women begin getting screened for osteoporosis at the age of 65. Women under the age of 65 who are at high risk of fractures should be screened as well. Men should talk to their doctors about screening recommendations.

A bone mineral density test is used to screen at the hip and spine. The most common test is called DXA, which stands for dual-energy X-ray absorptiometry. It’s as painless as having an X-ray. Your findings are frequently presented as a T-score, which compares your bone density to that of a healthy young woman. A T-score of 2.5 or less suggests osteoporosis.

There are numerous things you can do to reduce your risk of osteoporosis. Getting plenty of calcium, vitamin D, and exercise is a good place to start, according to Orwoll.

Calcium is a mineral that helps bones maintain their strength. It can be obtained from foods such as milk and milk products, dark green leafy vegetables such as kale and collard greens, or from dietary supplements. Women over the age of 50 require 1,200 mg of calcium per day. Men need 1,000 mg per day between the ages of 51 and 70, and 1,200 mg per day after that.

Calcium absorption is aided by vitamin D. As you get older, your body requires more vitamin D, which is produced by your skin when you are exposed to sunlight. Vitamin D can also be obtained through dietary supplements and foods such as milk, eggs, fatty fish, and fortified cereals. Consult your doctor to ensure you’re getting a sufficient amount of vitamin D. There can be issues if you get too little or too much.

Exercise, particularly weight-bearing exercise, is also beneficial to the bones. Jogging, walking, tennis, and dancing are examples of weight-bearing exercises. The pull of muscles serves as a reminder to the cells in your bones that they must maintain tissue density.

Smoking, on the other hand, weakens bones. Heavy drinking does as well, and makes people more prone to falling. Certain medications may also raise the risk of osteoporosis. Having a family member with osteoporosis can also increase your risk.

The good news is that even if you have osteoporosis, it is not too late to start caring for your bones. Because your bones are constantly rebuilding themselves, you can help tip the scales in favor of more bone growth by providing them with exercise, calcium, and vitamin D.

Several medications can also aid in the prevention of bone loss. Bisphosphonates are the most commonly used. These medications are typically prescribed to people who have been diagnosed with osteoporosis following a DXA test, or to those who have had a fracture that indicates their bones are too weak. Bisphosphonates have been more thoroughly tested in women, but they are also approved for men.

Researchers are attempting to create drugs that promote bone growth. For the time being, there is only one option: parathyroid hormone. It is effective at bone building and has been approved for women and men with osteoporosis who are at high risk of fracture.

Another important way to avoid broken bones is to avoid falls and fractures in the first place. Every year, more than 2 million so-called fragility fractures (which would not have occurred if the bones had been stronger) occur in the United States. “It’s going to take a combined approach of not only focusing on the skeleton but also focusing on fall prevention to reduce the societal burden of fracture,” says Dr. Kristine Ensrud, a physician-researcher at the University of Minnesota and the Minneapolis VA Health Care System who studies aging-related disorders.

Many factors, such as a person’s balance and the number of trip hazards in the environment, can influence the risk of a fall. The type of fall is also important. Wrist fractures are common when someone falls forward or backward. “It’s the active older person who trips and reaches out,” McGowan explains. Hip fractures frequently occur when a person falls to the side. Your hip may be able to withstand weight that moves up and down, but not an impact from the opposite direction.

“That’s why exercise that improves balance and confidence is so effective at preventing fractures,” McGowan explains. Tai chi, for example, won’t provide the loads needed to build bone mass, but it can improve balance and coordination, making you more likely to catch yourself before falling.

Researchers funded by the NIH are looking for better ways to predict how strong your bones are and how likely you are to break a bone. However, for the time being, the DXA test is the best measure, and many seniors, including older women, do not receive it, according to Ensrud. “Ask your health care provider about the possibility of a bone density test if you’re concerned about your bone health,” she adds.

References
Arnold, M., Rajagukguk, Y. V., & Gramza-Michałowska, A. (2021). Functional food for elderly high in antioxidant and chicken eggshell calcium to reduce the risk of osteoporosis—a narrative review. Foods, 10(3), 656.
Chandra, A., & Rajawat, J. (2021). Skeletal aging and osteoporosis: mechanisms and therapeutics. International journal of molecular sciences essay writers, 22(7), 3553.
Mullender, M. G., Van Der Meer, D. D., Huiskes, R., & Lips, P. (1996). Osteocyte density changes in aging and osteoporosis. Bone, 18(2), 109-113.
Yang, R., Zhang, J., Li, J., Qin, R., Chen, J., Wang, R., … & Miao, D. (2022). Inhibition of Nrf2 degradation alleviates age-related osteoporosis induced by 1, 25-Dihydroxyvitamin D deficiency. Free Radical Biology and Medicine, 178, 246-261.
Wang, Q. Y., Ding, N., Dong, Y. H., Wen, Z. X., Chen, R., Liu, S. Y., … & Ou, Y. N. (2021). Pharmacological treatment of osteoporosis in elderly people: a systematic review and meta-analysis. Gerontology, 67(5), 517-527.

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