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Falls are common, often dreaded events in the lives of older people. Aside
from the obvious injuries and even death that may result, falling can cause
wide-ranging consequences, including loss of independence, mental decline, and
decreased activity and mobility.
Falls are the leading cause of fatal and non-fatal injuries to older people
in the United States. Each year, more than 11 million people over age 65 fall --
one of every three senior citizens.
The treatment of injuries and complications associated with falls costs more than $20 billion each year. Already a serious national health concern,
increases in falls and injuries among older people could reach epidemic levels
as the population ages.
Fortunately, research has shown that the majority of falls are preventable.
Many medical risk factors for falling can be controlled. Simple common sense
precautions can reduce, if not eliminate, this serious threat to the health and
well being of older persons.
Who falls?
Older women, especially Caucasian, are at highest risk. The number of
falls and the severity of injury increase with age and in seniors who, for
whatever reason, experience loss of physical conditioning, mobility and balance.
Users of many prescription and over-the-counter medications (polypharmacy) fall
more often. Alcohol use often contributes to falling problems. Those with
medical conditions affecting balance and walking ability, such as Parkinson's
disease and stroke, also are vulnerable.
Where do falls occur?
While you might expect falls to occur with risky activities, such as
walking outdoors or in bad weather, most falls (more than 60 percent) happen in
the home. Falls in the community account for 30 percent, and only 10 percent of
falls occur in institutions such as nursing homes. Remember that falls can
happen any time, any place and to anyone, even when the person is engaging in
ordinary activities.
Preventing falls
Preventing falls is important at any age, but it is especially
important for those who have osteoporosis, because their bones are more fragile
and easily broken. Each year, about one-third of individuals 65 years and older
will fall, and some will be disabled by the broken bones that can follow. In
many cases, a fall can be precipitated by medications such as sedatives, muscle
relaxants and blood pressure drugs that can cause dizziness, lightheadedness or
loss of balance. When two or more medications are used in combination, these
side effects may be aggravated. Falls also result from diminished hearing,
vision, muscle strength, coordination and reflexes, as well as from diseases
that affect balance.
What to do to reduce your risk of falls
- Regular follow-up visits -- Get proper medical evaluation and
treatment for conditions causing physical changes. Do not assume you are
just "getting older."
- Floors -- Remove all loose wires, cords and throw rugs. Minimize
clutter. Make sure rugs are anchored and smooth. Keep furniture in its
accustomed place.
- Bathroom -- Install grab bars and non-skid tape in the tub or
shower.
- Lighting -- Make sure halls, stairways and entrances are well lit.
Install a night light in your bathroom. Turn lights on if you get up in the
middle of the night.
- Kitchen-- Install non-skid rubber mats near the sink and stove.
Clean spills immediately.
- Stairs -- Make sure treads, rails and rugs are secure.
- Other precautions -- Wear sturdy, rubber-soled shoes. Keep your
intake of alcoholic beverages to a minimum. Ask your health care provider
whether any of your medications might cause you to fall. Avoid risky
behaviors. Do not become unduly fearful about falling, as fear will only
encourage inactivity and immobility.
- Take action -- Inactivity is dangerous. Exercise improves strength,
balance, coordination and flexibility, which can all help you avoid falling
in the first place.
What is osteoporosis (brittle bones)?
Osteoporosis is a debilitating disease that can be prevented and
treated. Osteoporosis causes bones to become fragile and, therefore, more likely
to break. If not prevented or if left untreated, osteoporosis can progress
painlessly until a bone breaks. These broken bones, also known as fractures,
occur typically in the hip, spine and wrist.
Any bone can be affected, but of special concern are fractures of the hip and
spine. A hip fracture almost always requires hospitalization and major surgery.
It can impair a person's ability to walk unassisted and may cause prolonged or
permanent disability--or even death. Spinal or vertebral fractures also have
serious consequences, including loss of height, severe back pain and deformity.
Millions of Americans are at risk of developing osteoporosis. While women are
four times more likely than are men to develop the disease, men also suffer from
osteoporosis.
Who is at risk?
There are many factors that determine who will develop osteoporosis.
The first step in prevention is to determine whether you are at risk. The risk
factors include:
- Age -- The older you are, the greater your risk of osteoporosis.
Your bones become weaker and less dense as you age.
- Gender -- Your chances of developing osteoporosis are greater if
you are a woman. Women have less bone tissue and lose bone more rapidly than
do men because of the changes involved in menopause.
- Race -- Caucasian and Asian women are more likely to develop
osteoporosis. However, African American and Hispanic women are at a
significant risk for developing the disease.
- Bone structure and body weight -- Small-boned and thin women are at
greater risk.
- Menopause/menstrual history -- Normal or early menopause (brought
about naturally or because of surgery) increases your risk of developing
osteoporosis. In addition, women who stop menstruating before menopause
because of conditions such as anorexia or bulimia, or because of excessive
physical exercise, also may lose bone tissue and develop osteoporosis.
- Lifestyle -- By smoking, drinking too much alcohol, consuming an
inadequate amount of calcium, or getting little or no weight-bearing
exercise, you increase your chances of developing osteoporosis.
- Medications and disease -- Osteoporosis is associated with certain
medications (such as cortisone-like drugs) and is a recognized complication
of a number of medical conditions, including endocrine disorders (having an
overactive thyroid gland), rheumatoid arthritis and immobilization.
- Family history -- Susceptibility to fractures may be, in part,
hereditary. Young women whose mothers have a history of vertebral fractures
also seem to have reduced bone mass.
Understanding bone and bone health
It is important to understand that bone is not a hard and lifeless
structure. It is, in fact, complex, living tissue. Our bones provide structural
support for muscles, protect vital organs, and store the calcium essential for
bone density and strength.
Because bones are constantly changing, they can heal and may be affected by
diet and exercise. Until about age 35, you build and store bone efficiently.
Then, as part of the natural aging process, your bones begin to break down
faster than new bone can be formed. In women, bone loss accelerates after
menopause, when your ovaries stop producing estrogen--the hormone that protects
against bone loss.
Assessing your bone health
To determine if you have osteoporosis or may be at risk for the
disease, your doctor will ask you a variety of questions about your lifestyle
and medical history. Your doctor will want to know if anyone in your family has
suffered from osteoporosis or if they have fractured bones.
Based on a comprehensive medical assessment, your doctor may recommend that
you have your bone mass measured. A bone mass measurement is the only way to
tell if you have osteoporosis. Specialized tests called bone density tests can
measure bone density in various sites of the body. If the test is conducted at
intervals of a year or more, it can detect osteoporosis before a fracture
occurs, predict your chances of having a fracture in the future, determine your
rate of bone loss and/or monitor the effects of treatment.
What if I have osteoporosis?
Although there is no cure for osteoporosis, there are steps you can
take to slow its progress.
Experts recommend 1,000 mg of calcium a day for women on estrogen replacement
therapy and 1,500 mg of calcium daily for women not receiving estrogen therapy.
While exercise is good for someone with osteoporosis, it should not put any
sudden or excessive strain on your bones. Care should be taken when lifting
heavy objects, such as bags of groceries, young children, etc.
If you have osteoporosis, it's important to minimize your chances of breaking
a bone. Take steps to prevent falls. As extra insurance against fractures, your
health care provider can recommend specific exercises to strengthen and support
your back
Guide to osteoporosis prevention
- All women should receive counseling on their risk factors for
osteoporosis. Osteoporosis is a silent risk factor for fractures, just as
hypertension (high blood pressure) is for stroke.
- All post-menopausal women who suffer a fracture should be tested for
osteoporosis using the bone mineral density method. This test will determine
the severity of the disease.
- All post-menopausal women age 65 and older should receive a bone mineral
density test regardless of additional risk factors. Women in this group
should maintain an adequate intake of dietary calcium (at least 1,200 mg per
day use supplements if necessary) and Vitamin D (400 to 800 IU per day).
- All people at risk for osteoporosis should perform weight-bearing
exercises and muscle-strengthening exercises to reduce the risk of falls and
fractures.
- Avoid tobacco and drink alcohol in moderation.
- All post-menopausal women who suffer vertebral (spine) or hip fractures
should be considered as candidates for treatment of osteoporosis.
- Women with no other risk factors whose bone mineral density T-scores are
below 2.0 should begin therapy to reduce the risk of fractures. Women
whose bone mineral density T-scores are below 1.5 and have other risk
factors should begin therapy to reduce the risk of fractures.
- Pharmacologic (medicine) treatment options for osteoporosis prevention or
treatment are estrogen replacement therapy, evista, fosamax, actonel and
miacalcin nasal spray.
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