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 KINO GERIATRICS 
The Fall and Osteoporosis
 BY DR. LAWRENCE LEE 

People aged 65 and older have the highest risk of falling, with 30% of people older than 65 and 50% of people older than 80 falling at least once a year. .

WHILE A FALL IS SERIOUS AT ANY AGE, in the elderly it often poses as a major threat to their ‘quality of life, often causing a decline in self-care ability and participation in physical and social activities. Fear of falling often is like a vicious cycle, further limiting one’s activity and resulting in prolonged bedrest, which further aggravates the situation where elderly will eventually suffer from loss of muscle bulk and strength following disuse from reduced mobility. This sequence of reactions often leads to premature admission to care homes as well as a financial burden to the individual and society as a whole.

Falls and fall-related injuries - something that most elderly fear - are a common and serious problem for old people. People aged 65 and older have the highest risk of falling, with 30% of people older than 65 and 50% of people older than 80 falling at least once a year. Malaysia like many Asian countries around the region is facing an ageing tsunami. A population survey revealed that currently 7.1 % of Malaysians are over aged 65 and, in 3 years’ time, this figure will approach 10%. Therefore, it is a problem that can only get worse as the population ages, bringing in its wake higher healthcare costs and lower quality of life for those affected. Despite the serious impact in an ageing population like Malaysia, falls in the elderly are often viewed as an inevitable consequence of ageing and often ignored in clinical practice resulting in multiple falls at home eventually needing to be admitted to hospital due to osteoporotic bone fractures.

         

Given the problems associated with falls, the Malaysian Society of Geriatric Medicine recommends any individual aged 65 or older be evaluated if he or she has a fall or complains of difficulty with balance. This evaluation is meant to prevent the next fall and it typically has multiple contributing factors including vision (cataracts, macular degeneration, glaucoma or diabetic eye changes), uncontrolled pain (due to arthritis, particularly in the back, hips or knees) , muscle weakness (often related to a prolonged period of inactivity), medications (risk of falls increases with number of medications an individual takes; lightheadedness, particularly when getting up from lying down or seated, can be an indicator that blood pressure medications are too strong; psychotropic medications like antidepressants and antipsychotic medications all increase the danger of falls). By addressing these issues, the possibility of falls can be reduced.

The most serious and feared complication following a fall is to sustain an osteoporotic fracture. Osteoporosis is a bone disease that occurs when the body loses too much bone, makes too little bone or both, and becomes weaker as we get older. It is often called a silent killer because one can’t feel bones weakening. Breaking a bone is often the first sign of osteoporosis or a patient may notice that he or she is getting shorter or their upper back is curving forward. Over the age of 60, 1 in 2 females will develop osteoporosis while 1 in 5 men will suffer from this silent disease. The most frightening thing about osteoporosis is that it is silent and the consequences of osteoporotic fractures can be devastating. Typically fractures occur at the wrist, hip and backbone. The most serious fracture is the hip fracture-20% of patients post hip fracture will die within a year and only half survived after 5 years. 1 in 3 becomes wheelchair bound and almost 80% will lose independence and self-caring ability.

                               

Therefore it is prudent to recognize the risk factors associated with osteoporosis. These include: Positive family history; age over 60; early menopause before age 45; slender body frame; previous fracture after minimal trauma; smoking; drinking alcohol; being housebound; low exposure to sunlight; medications like steroids, anticancer drugs etc.; other diseases e.g. thyroid problems and diabetes. A diagnosis for osteoporosis will either require a bone densitometry scan which is radiation free and simple to do, widely available in hospitals. The prevention of osteoporosis involves a diet rich in calcium and vitamin D as well as exercise three times a week especially the weight bearing ones like walking or jogging. Once diagnosis is obtained and evaluated by a doctor, treatment should be started. The choices of medications are multiple and it is best to discuss the options with your doctor. Knowing the risk factors and implementation of preventive measures and treatment are critical to maintaining your health and wellbeing.

Dr Lawrence Lee HK is a Consultant Geriatrician (Elderly Medicine) in Timberland Medical Centre Kuching Sarawak.

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