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Health // Doctor in the House
Rasa Fournier

Prevent Falls, Fractures In Elderly

Dr. Jennifer Loh
Chief of Endocrinology at Kaiser Permanente, Honolulu Clinic

Where did you receive your schooling and training?

I graduated from Punahou School and then completed my undergraduate studies at the University of Pennsylvania. I attended medical school at George Washington University, and then returned to the University of Pennsylvania for my internship and residency. I completed my fellowship in endocrinology at Georgetown University.

How long have you been in practice?

I have been a practicing endocrinologist at Kaiser Permanente since 2008.

What is osteoporosis?

Osteoporosis is a medical condition in which bones become porous, brittle and prone to fracture. Our goal in treating osteoporosis is to prevent a fracture from occurring, especially since major fractures, such as a hip fracture, can be life-threatening.

Does this only happen in the elderly?

Osteoporosis occurs most commonly in postmenopausal women because they lose the estrogen that protects their bones. However, younger men and women also can develop osteoporosis if they have a disease that may cause their bones to become brittle, or if they are on a medication that causes them to lose bone strength. For example, chronic use of steroids or anti-seizure medications can sometimes weaken bones and cause osteoporosis.

Are there ways to prevent osteoporosis?

One of the best ways to prevent osteoporosis is for children and young adults to develop strong, healthy bones. Achieving one’s peak bone mass is one of the most important factors for bone health. We accrue the most bone mass during our teenage years, the very time that we’re often eating the most unhealthily. It’s important to have adequate calcium intake and follow a nutritious and healthy diet during these formative years.

Too often teenagers are saying, “I need to be thin. I’m not going to drink milk, I’m going to drink diet soda,” which is nutritionally not helpful for one’s bone health. We are able to only build bone until our late 20s. After that, we slowly lose bone mass and strength throughout our lifetime.

Teenagers and young adults should avoid smoking, drinking excessive alcohol (obviously, no alcohol if you’re a minor), and they should engage in appropriate levels of weight-bearing exercise like walking, dancing, jump roping and weightlifting, in order to build healthy bones. Adults can work on maintaining healthy bones by engaging in weight-bearing exercise, getting an adequate calcium intake and avoiding smoking and drinking.

We continue to encourage our elderly to maintain these daily, healthy lifestyle habits, and we also focus on preventing falls from occurring, in order to minimize the risk of fractures.

What treatments are available?

There are several medications available to treat osteoporosis. Standard first-line treatment options are bisphosphonate medications. They have been shown to decrease the risk of fracture by 50-60 percent. Before starting medications, we assess whether your risk of fracture is high enough to justify the use of these medications. If you are considered low risk, we start with lifestyle interventions, such as taking calcium and vitamin D, exercising and not smoking or drinking. If your bones are brittle enough that you are considered high risk for a fracture, we consider prescribing medications to go along with these lifestyle interventions.

What are the symptoms of osteoporosis?

Osteoporosis is called a “silent disease” because most people have no symptoms. Some people only find out they have osteoporosis when they have a fracture resulting from minimal trauma. This is why it is important for people to get screened for osteoporosis. In general, we recommend that postmenopausal women over age 65, or men over the age of 70, have a bone density test performed to screen for osteoporosis.

Will changing your lifestyle stop osteoporosis from progressing or just slow it down?

It can stop the progression. Weight-bearing exercise, avoiding smoking and drinking alcohol, and adequate calcium and vitamin D can greatly improve bone strength.

Once you have it, what are some ways of managing it?

Lifestyle interventions are very important, as well as taking osteoporosis medication regularly. Another big component is to make sure you minimize falls, as the trauma from the fall can lead to fractures. Often, as we age, we can become less steady on our feet as our vision and hearing deteriorate.

We ask our patients to examine their homes and implement safety strategies to minimize their risk of falling. For example, we counsel people to have a rubber grip mat in their bathtub, safety handles by their toilets and by their showers. Watch out for slip rugs, since they can be slippery or easy to trip over. We ask patients to tuck away electrical cords that run through well-trafficked areas in the house. If they get up at night, we tell them to keep a nightlight on, so they can see well and won’t trip over objects in the house. On rainy days, be extra cautious when walking outside, as the sidewalk and painted surfaces can be very slick. We also tell our patients to not engage in risky behaviors like climbing walls or high ladders from which they could fall.

Overall, our goal is to help prevent our patients from having a fracture, as fractures can be debilitating. For example, 25 percent of people die within a year of a hip fracture and only 50 percent live independently one year after a hip fracture. A vertebral compression fracture can cause a lot of pain and suffering, and loss of height.

Osteoporosis is one of those diseases people don’t think about because it’s not something that they feel from day to day. It can truly be a silent disease, and that is why it is so important to call attention to the screening, prevention, medications and lifestyle interventions that can be done to prevent fractures from occurring.

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