30.APR.2020 5 MIN READ | 5 MIN READ

Each year, 1 in 3 adults above the age of 65 experiences a fall. In Singapore, such falls are the leading cause of injury among the elderly. We take a look at osteoporosis and osteoarthritis, the 2 conditions contributing to these numbers.

Bone and joint issues are common among the elderly

Orthogeriatrics, or geriatric orthopaedics, refers to the management of orthopaedic problems (disorders in the bones, joints, muscles, tendons and ligaments) in the elderly. Your risk of orthopaedic issues such as hip fractures, osteoporosis and osteoarthritis increases with age, and these medical conditions are a leading cause of falls among the elderly.

In orthopaedic care for the elderly, osteoporosis and osteoarthritis are 2 of the main issues.

Osteoporosis

Elderly care osteoporosis

Definition. Osteoporosis is a bone condition which occurs when bones lose their strength and mass. This happens when bone tissue is lost at a higher rate than it is produced. As this happens, bones become more fragile and prone to fracture. Bones in the hip, spine and wrist are particularly susceptible to fractures.

Symptoms. Described as a “silent disease”, there are generally no symptoms in the early stages of this condition. At an advanced stage, you may experience symptoms such as back pain (especially in the lower back), a stooped posture, height loss over time, and increased proneness to fractures in the hip, spine and wrist.

Causes. Factors that increase your risk of developing osteoporosis include:

  • Being female – twice as many women than men have osteoporosis. Women are more prone to developing osteoporosis as up to 20% of bone mass can be lost in the 5 – 7 years after menopause
  • Early menopause before 45 years old
  • Being Caucasian or Asian
  • Being older – generally, our bone mass peaks in our 20s, and begins to decrease after
  • Having a family history of osteoporosis
  • Insufficient intake of vitamin D and calcium
  • Being underweight
  • Having certain illnesses, such as rheumatoid arthritis and thyroid problems
  • Taking certain medication, such as thyroid medication and corticosteroids (usually prescribed to treat diseases such as asthma and arthritis)

Treatment and Prevention. Osteoporosis is highly treatable. Your doctor may prescribe medication such as bisphosphonates, calcium and vitamin D supplements to help increase bone density. To prevent osteoporosis, it is important to exercise regularly to build stronger and denser bones, and observe a healthy diet. Avoid excessive consumption of alcohol, caffeine and sodium as these foods can lead to bone loss and/or affect bone formation.

Osteoarthritis

Elderly care osteoarthritis

Definition. Osteoarthritis is a degenerative condition of the joints, and is the most common form of arthritis (inflammation of the joints). It occurs when the protective cartilage at the end of bones are worn down, causing the bones in our joints to rub against one another. Although those above 60 are more likely to be affected by osteoarthritis, an increasing number of younger and active Singaporeans have been diagnosed with premature osteoarthritis from sports injuries.

Symptoms. Osteoarthritis symptoms usually develop slowly and increase in severity over time. While osteoarthritis can occur in any joint, it commonly affects joints in the hands, knees, hips and spine. Common symptoms include pain, stiffness, tenderness, loss of flexibility, swelling and a grating sensation in our joints.

Causes. Factors that increase your risk of developing osteoarthritis include:

  • Age – as we age, our joint cartilage is more likely to experience wear-and-tear, resulting in osteoarthritis
  • Gender – females have a higher risk of developing osteoarthritis than men. While the reason behind this is unclear, it may be related to hormonal differences between men and women
  • Trauma from sports injuries such as Anterior Cruciate Ligament (ACL) strains and tears, torn cartilages, dislocated joints and ligament injuries can cause osteoarthritis, even if you have since healed from these injuries
  • Being overweight
  • Having diabetes
  • Having a family history of osteoarthritis

Treatment and Prevention. Losing weight, doing low-impact exercises and taking joint supplements such as glucosamine regularly can help to slow down the development of osteoarthritis. In terms of treatment, doctors can undertake cartilage repair procedures and complete joint replacement procedures in severe cases.

Fall risks: Osteoporosis and osteoarthritis

Elderly care fall risks

Osteoporosis and osteoarthritis are 2 conditions that can lead to mobility issues among the elderly, increasing their chances of falling. Falls are common among older adults and can cause minor injuries such as bruises and scratches, but may also result in more serious injuries such as fractures and head trauma. These can lead to reduced physical function, early admission to long-term care facilities and increased mortality rates. The incidence of hip fractures are on the rise and the implementation of hip fracture pathways has led to improve outcomes in Singapore and beyond. A comprehensive management protocol for hip fractures with early surgery and physiotherapy has also shown that age is not a factor for improved function after surgery for hip fractures.

As the consequences of falling can lead to altered quality of life, precautions should be taken to reduce our risk of falling. Fortunately, there are simple and practical ways we can do this.

Elderly fall prevention tips

  1. Remove hazards around the home. The simplest way to reduce your likelihood of falls is to remove loose items such as electrical wires, slippery rugs, and clutter. Hazardous house fixtures such as uneven floorboards are some examples of things that can cause tripping.
  2. Install safety devices in your home. Installing safety devices such as handrails and grab bars in areas such as toilets and stairways can go a long way in supporting your mobility around the home. Non-slip mats are a good option to prevent slipping in the bathroom.
  3. Ensure your house is adequately lit. Keeping your home sufficiently bright can reduce your chances of tripping over objects on the ground. Consider putting lights (such as lamps, ceiling lights or torch lights) around areas like your bedrooms, bathrooms and stairways.
  4. Consult your doctor. Your doctor can work with you to craft a fall-prevention plan. Your doctor can review aspects of your lifestyle and health such as your medication and existing medical conditions (eg. eye and ear disorders) that may be contributing to your risk of falling.

Final Advice

Both osteoporosis and osteoarthritis are treatable conditions which left untreated, can increase your risk of falling. Do consult a doctor early if you suspect that you may have either condition.

 

Following the end of the circuit breaker period, Parkway East Hospital and our 24-hour A&E clinics will continue to deliver essential healthcare services to those in need. If you or your family members require treatment for a medical condition, make an appointment with a specialist.

Rest assured we have implemented measures to safeguard the health of our patients, visitors and staff. Learn more about how we keep our hospitals safe.

To help stay COVID-safe, we are #FightingCOVIDAsFamily.

 

Article reviewed by Dr Hitendra K Doshi, orthopaedic surgeon at Parkway East Hospital

References

Agency for Integrated Care. (n.d.). Retrieved 20 March 2020 from https://www.aic.sg/health-conditions/Osteoporosis

Chumari, A. (n.d.). Fall Prevention: A Serious Matter for the Elderly. Retrieved 20 March 2020 from https://www.healthxchange.sg/seniors/ageing-concerns/fall-prevention-elderly


Corey Whelan, David Heitz, and Valencia Higuera. (2018, January 9). Osteoarthritis: Symptoms, Treatments, and Causes. Healthline. Retrieved 20 March 2020 from https://www.healthline.com/health/osteoarthritis

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Falls Prevention Programme. (2019, December 9). Retrieved 20 March 2020 from https://www.healthhub.sg/live-healthy/12/falls_prevention_programme


Doshi, H. K. (2014). Functional Improvement of self-care in the elderly after hip fracture: Is age a factor? Archives of Orthopaedic and Trauma Surgery.

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Doshi, H. K. (2013). Principles of Osteoporotic Fracture Treatment. Best Practice & Research Clinical Rheumatology 27. 757–769

Myers, W. (2015, February 27). 9 Ways to Prevent Falling at Home. Everyday Health. Retrieved 20 March 2020 from https://www.everydayhealth.com/longevity/future-planning/prevent-falls-at-home.aspx

Osteoarthritis. (2020, February 22). Retrieved 20 March 2020 from https://www.mayoclinic.org/diseases-conditions/osteoarthritis/symptoms-causes/syc-20351925

Osteoporosis - Symptoms and causes. (2019, June 19). Mayo Clinic. Retrieved 20 March 2020 from https://www.mayoclinic.org/diseases-conditions/osteoporosis/symptoms-causes/syc-20351968

Reduce The Risk Of Falling. (2019, July 11). Retrieved 20 March 2020 from https://orangevalley.sg/reduce-the-risk-of-falling/


Roth, E. (2016, October 21). 7 Common Causes of Osteoarthritis. Healthline. Retrieved 20 March 2020 from https://www.healthline.com/health/common-causes-osteoarthritis

The Healthline Editorial Team. (2016, June 8). Osteoarthritis prevention. Healthline. Retrieved 20 March 2020 from https://www.healthline.com/health/osteoarthritis-prevention

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30.APR.2020
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Hitendra K Doshi
Orthopaedic Surgeon
Parkway East Hospital

Dr Hitendra K Doshi is an orthopaedic surgeon practising at Gleneagles Hospital and Parkway East Hospital, Singapore. Besides general orthopaedics, he specialises in the treatment and management of patients with complex fractures and patients requiring joint replacement, with a particular interest in the ageing population.