Aging & Health A to Z

Osteoporosis

Unique to Older Adults

This section provides information to help older adults and their caregivers consider their disease or condition in conjunction with other health issues.

As older adults live longer, they may have more than one chronic disease.  Or, they may have a health problem that can lead to another condition or injury if not properly managed.   The older adult may also experience healthcare in various settings, such as the hospital, assisted living facility or at home.  These situations can affect the health and function of the older adult and therefore require careful management to ensure proper care and improve or maintain quality of life.

Osteonecrosis of the Jaw

Bisphosphonates are the most popular and widely-prescribed medications for the treatment of osteoporosis. Some serious side effects of these medication have been reported. One of these, osteonecrosis of the jaw, occurs rarely in patients who take a bisphosphonate for a long period of time.

Osteonecrosis refers to the death of bone tissue. It may occur suddenly with no warning, or after dental or oral surgery. The dead bone becomes exposed as the mucus membranes that normally cover it fall away. Long-term infection may also occur and can persist for years in severe cases.

Most cases of osteonecrosis of the jaw occur in people who are taking very high doses of zoledronic acid or pamidronate for treatment of various cancers. This condition is not common in people taking normal lower doses of these drugs to treat osteoporosis.

Femur Fractures

Certain unusual fractures of the thigh bone (femur) have been reported during bisphosphonate therapy for osteoporosis, although it is extremely rare. Long-term bisphosphonate therapy may suppress bone rebuilding and make bones more fragile. But recent large studies have not found definite proof to support the idea that the risk of femur fractures increases with bisphosphonates. The evidence is unclear, and researchers are continuing to gather information. 

Restrictive Lung Disease

Osteoporosis can cause vertebral (spinal) compression fractures and fractures of the ribs that shorten the torso, and cause kyphosis (also called Dowager’s hump). Along with poor posture and loss in height, kyphosis may lead to a squeezed ribcage and chest. In serious cases, your lungs no longer have enough space to expand normally with each breath. You may find yourself short of breath as you lose the ability to inhale deeply. A rapid, shallow breathing pattern may result. This condition is known as “restrictive lung disease.”

Restrictive lung disease can mean that not enough oxygen is in your blood, and also affect the health of your lung tissue. Treatment involves a mix of approaches that addresses the causes of the ribcage compression, such as:

• exercises to improve posture and strengthen muscles
• breathing exercises and effective coughing techniques
• relaxation exercises
• techniques for conserving energy
• supplementary oxygen if needed
• treatment of the osteoporosis
• treatment of fractures if needed
• annual flu shots.

Protein-Calorie Malnutrition

Many older adults living at home eat poorly. In one of four older people, poor nutrition is so serious that a condition known as protein-calorie malnutrition (PCM) develops. Sometimes, PCM occurs after a long hospital stay, or from loss of appetite due to a chronic disease or medication. Dental problems can also make it difficult to eat healthy foods. Poor nutrition adds to the risk of osteoporosis because it can cause a deficiency in calcium and other nutrients needed to build bones. Also, your body will remove the calcium from your bones to use it for other necessary functions if you do not get enough calcium.

Depending on the length of time that you have been eating poorly, you may lose weight or not. Your healthcare professional will be able to diagnose PCM by checking for:

• changes in body shape or weight trends
• hair that falls out or can be pulled out easily
• lack of fat under the skin
• dry, flaky skin
• loss of muscle mass
• anemia
• blood changes, such as lowers levels of cholesterol and protein
• fatigue
• shortness of breath.

If you have been diagnosed with PCM, your healthcare professional or dietician will help you plan a diet to correct your lack of vitamins and help you gain weight. In serious cases, you may need to have a feeding tube until you are able to eat an adequate diet. Nutritional strategies include:

• calorie-rich and protein-rich foods (using high protein and high calorie drinks such as Ensure or Boost, or concentrated protein powders may be very helpful)
• vitamin and mineral supplements
• rehydration – making sure you are drinking enough fluids.

Dental Problems

Osteoporosis affects all the bones of the body. The jaw often suffers osteoporotic bone loss that is severe enough to impact the way the teeth are rooted in the jawbones. When the area  of the jawbones where teeth are rooted lose bone mass, teeth become loose and may fall out. Research has found that women with osteoporosis are three times more likely to lose teeth than women who don’t have the disease.

Osteoporosis causes other dental problems besides tooth loss. For example, older people with osteoporosis can have more trouble wearing dentures and recovering from dental surgery.

Treatments for osteoporosis, such as bisphosphonate medications, may build bone in the jaw and help keep teeth firm and healthy.

Ethnic/Cultural Influences on Risk Factors

In the past, most research on osteoporosis focused on white populations. Recent surveys, however, have found that not only white but also people of Asian descent have relatively high rates of osteoporosis, while Native Americans, Hispanics, and African-Americans appear to have a lower risk. These differences may be based on genetic differences, different levels of physical activity and exercise, dietary differences (fewer sources of dietary calcium), or a combination of these.

Another factor that may influence the strength of your bone mineralization is the amount of sun you get. Your skin produces vitamin D—the vitamin involved in calcium absorption by bones—in response to sunlight. But you may not be getting enough vitamin D if you:

• regularly use sunscreen
• live in a northern latitude
• cover your skin with clothing that blocks the sun’s rays (especially in cultures in which women always wear body-concealing clothing outdoors)
• spend little time in the sun during daylight hours.

Check with your healthcare professional if you aren’t sure whether your calcium intake and vitamin D levels are adequate. Simple lifestyle changes or supplements may be all that you need to keep your bones strong and healthy throughout your entire life.

Updated: March 2012
Posted:  March 2012