Osteoporosis is a bone disease that is highly prevalent within the older adult population. Often referred to as a silent disease due to its lack of clear outward symptoms, osteroporosis weakens bone structure and durability, increasing the risk of fractures. The areas of the hip, spine, and wrists are the most vulnerable to bone fracture. Some risk factors for osteoporosis are modifiable, such as poor diet and smoking, but others are non-modifiable, such as age. The risk of the disease increases as one grows older, starting in the late-30s.
There are a variety of treatment options for osteoporosis, including drugs that prevent or delay the loss of bone, physical exercise programs, and dietary changes, including increased dose of calcium, vitamin D, and magnesium.
According to orthopaedic surgeons in a recent article published in the journal Current Geriatrics Reports, some drugs used to treat osteoporosis may actually increase the risk of small fractures in the thigh bone. Thus, these drugs should be prescribed with extreme caution. The surgeons who wrote the article come from Loyola University Medical Center and Loyola University Chicago Stritch School of Medicine. They report, “Attempts to medically manage osteoporosis have created a new ‘atypical’ fracture pattern that must be recognized and managed appropriately.”
Drug treatments for osteoporosis, known as bisphosphonates, are used to increase mineral density of the bone. Evidence has shown that these drugs reduce fractures in the vertebrae by over 50% and fractures in other regions by 40%. However, these drugs have also been found to increase the risk of atypical femur fractures. These fractures often occur with little to no force or trauma, and are commonly preceded by pain. Most patients with osteoporosis who begin to experience atypical femur fractures have been taking bisphosphonates for an average of three years.
Bisphosphonate use should be stopped immediately if atypical femur fractures occur. It is also recommended that these patients should maximize their vitamin D and calcium supplementation. According to the authors, “The current recommended dosing of calcium and vitamin D are under debate and may be too low for the majority of those affected.” Moreover, “Physicians responsible for the management of osteoporosis must be aware of this issue, be able to diagnose these fractures before they are complete and have a strategy for managing bisphosphonate therapy long term.”
The lifetime risk of experiencing a bone fracture due to osteoporosis is 40 to 50% in women and 13 to 22% in men. Hip fractures may only account for 15% of osteoporosis-related fractures, but they are still highly associated with adverse patient outcomes, decreased quality of life, and increased financial burden. They account for more than 70% of frailty fracture-related healthcare costs. Although surgical techniques and implants have improved, the risk of mortality related to geriatric hip fractures has remained in the 20 to 30% range for more than 30 years.
Elderly residents in nursing homes and assisted living facilities are especially vulnerable to fractures related to frailty and osteoporosis. Appropriate safety measures must be taken by care staff to ensure that the risk of falls and fractures is minimal. If you or a loved one has experienced a fall or fracture due to insufficient care by a nursing home or assisted living facility staff, contact us today for a free consultation. We believe that all older adults in residential care facilities are entitled to high quality care. Facilities that fail to provide their patients with the care they need are reprehensible.