Fragile Bones, Hip Fractures and Care Of the Elderly
World Osteoporosis Day
Dr Nawazish Zehra, Research Associate, Fracture Liaison Service
Department of Pathology and Laboratory Medicine
It was early morning on the 22nd November 2021, when 75-year-old Mehrunisa (pseudonym) came to the emergency department of a private hospital in Karachi with the complaining of pain in the right hip. History and an examination revealed that the patient had slipped in the bathroom while performing Wu’doo for prayers. The x-ray confirmed the fracture of her right hip and Mehrunisa’s daughter and brother were counselled for surgery. The cardiac and anaesthesia team came onboard to evaluate the risk of mortality of the patient and she was moved to the operating room.
Like Mehrunisa, every day several elderly people with hip fractures get admitted to different hospitals across the country. Hip fractures are the major cause of prolonged hospital admissions in the elderly population and can cause serious health complications.
Why do our senior citizens suffer from fractures more frequently? After the 5th decade of life demineralization of the bone starts and as we enter the middle of 6th decade of life, bones get porous, demineralized, and fragile. This condition is called osteoporosis. Fragility fractures are fractures that result from mechanical force that would not ordinarily cause fractures, known as low-level or low trauma or a fall from a standing height or less. Osteoporosis is an asymptomatic condition that often remains silent until it manifests as a low-trauma fracture of the hip, spine, arm, pelvis, and/or wrist, which frequently leads to hospitalization. Evidence reports that after the first osteoporotic fracture, the risk of a second fracture grows by up to 50%. One in two women and one in four men will have an osteoporosis-related fracture in their lifetimes. Women are four times more likely to develop the disease than men. Smoking, nutritional deficiency of calcium and vitamin D, hormonal changes that occur in men and women after 50 years of age, obesity and family history of old age fractures are main contributors of osteoporosis and fragility fractures.
Osteoporosis-related fractures can increase pain, disability, nursing home placement, health care costs, and fatal medical complications. Generally, older adults will experience significant functional dependency for varying amounts of time and undergo extensive rehabilitation therapies. Post fracture time is highly stressful for the family in terms of physical, psychological, and financial burdens. People who have already suffered from osteoporotic fractures should visit a rheumatologist, bone specialist or general physician for further treatment of bones. Fracture risk scoring is important in osteoporotic fractures patients as well as in healthy adults after the age of 50 and initiation of osteoporotic treatment is the key to preventing these fractures. The care burden period after hip fracture is often prolonged to six months or beyond, leading to confinement to the bed which can cause further complications. Seeing loved ones dependent for daily activities is heartbreaking for families and leaves deep emotional and psychological scars.
Age alone may break your bone, but a little care will save you.
For better quality of life in our old age it is important to take some precautions that save our bones. You can indulge in regular exercises, take brisk walks, go out with your neighbors to nearby parks, or even participate in household activities like going for groceries on a daily basis. Milk, yoghurt, spinach, lentils, beans, salmon, and tuna must be a part of your diet. As one gets older the power of our muscle decreases, the coordination between muscles and movement reduces, and our body may need support in getting up. To reduce the risk of accidents/falls it would be helpful to take some precautions, such as putting a handle beside your bed, keeping a good record of your eye checkups, avoiding roaming around if the power is cut, and not walking on wet floors. Longevity of life is a blessing; make your days more productive and happier by taking care of yourself.
