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Osteoporosis in the elderly

 
, medical expert
Last reviewed: 05.07.2025
 
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Osteoporosis in the elderly is a skeletal disease characterized by decreased bone mass and microstructural damage to bone tissue, leading to increased bone fragility and, consequently, to an increased risk of fracture.

In osteoporosis, two main processes of bone metabolism are distinguished, each of which leads to a decrease in bone mass:

  • a high degree of bone resorption is not compensated by normal or increased bone formation;
  • the resorption process is at a normal level, but the level of bone formation decreases.

Osteoporosis can be primary: juvenile, idiopathic in young adults, postmenopausal (type 1) and senile (type 2); or secondary - with thyrotoxicosis, Itsenko-Cushing's disease and syndrome, hypogonadism, hyperparathyroidism, type 1 diabetes mellitus, hypopituitarism, liver disease, chronic renal failure, malabsorption syndrome, rheumatoid arthritis, sarcoidosis, malignant tumors, immobilization, treatment with certain drugs (corticosteroids, barbiturates, heparin, anticonvulsants, immunosuppressants, aluminum-containing antacids).

In elderly and senile people, there are both primary and secondary causes of osteoporosis. The total loss of compact substance by the age of 70 reaches 19% in men and 32% in women. The loss of spongy substance after 25 years, regardless of gender, is, on average, 1% per year and by the age of 70 reaches 40%.

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What causes osteoporosis in older people?

Predisposing factors for osteoporosis are:

  • Gender and build: men have thicker and stronger bones due to the large amount of testosterone; women experience more active bone resorption, especially during menopause (up to 1-2% per year in 50% of cases) or after removal of the ovaries (they slow down during childbirth - each birth reduces the risk of fractures by 9%); tall and thin people are more susceptible to osteoporosis than people of dense build and short stature.
  • Sedentary lifestyle: prolonged immobilization leads to osteoporosis, as does being in zero gravity.
  • Vitamin D deficiency: it is involved in the process of regulating calcium absorption in the intestines and the mechanism of bone tissue formation (vitania is synthesized in the body under the influence of sunlight or comes in ready-made form with butter, fish oil, eggs, liver and milk).
  • Alcohol and smoking: Alcohol, regardless of gender, leads to a decrease in bone mass; smoking has a greater effect on the rate of development of osteoporosis in women.
  • Heredity: There is a certain influence of genetic and family factors on bone density (for example, osteoporosis is rare in representatives of the Negroid race), and the contribution of hereditary factors to the variability of this indicator is up to 80%.
  • Nutritional factors: Bone is composed primarily of calcium and phosphorus, which are deposited in a protein matrix called osteoid, and calcium balance is dependent on dietary calcium intake, intestinal calcium absorption, and the extent of calcium excretion in urine, sweat, and feces.

How does osteoporosis manifest itself in older people?

The most susceptible to osteoporosis are the proximal humerus, distal radius, spine, femoral neck, greater trochanter, and tibia condyles.

Osteoporosis in the elderly is called a "silent" epidemic, as it often has few symptoms and is detected only when bone fractures are present. However, most patients complain of back pain (between the shoulder blades or in the lumbosacral region), which intensifies after physical exertion, prolonged stay in one position (standing or sitting). These pains are relieved or disappear after lying down to rest, which patients require many times during the day. The anamnesis may indicate episodes of acute back pain, which were regarded as lumbosacral radiculitis due to osteochondrosis and deforming spondylosis. Indirect signs of the disease include senile stoop (hump), night leg cramps, increased fatigue, periodontal disease, brittle nails and premature graying. And although the presence of these symptoms is not 100% confirmation of the diagnosis, it still allows us to determine the range of studies necessary to clarify it.

How to recognize osteoporosis in the elderly?

Traditional X-ray examination can detect a decrease in bone density from 25-30%. However, X-ray examination of the thoracic vertebrae is important, as the decrease in density often begins earlier than in other parts of the spinal column.

Bone densitometry, which measures the level of absorption of X-rays by bone substance, allows us to estimate bone density as the basis of its strength. However, osteoporosis in the elderly is a disease of the protein matrix of the bone, and the mineral content changes secondarily, and, in addition, this method is not entirely accurate due to the measurement of only the projected mineral density (it depends significantly on the thickness of the bone) and the heterogeneity of bone tissue (with age, the fat content in the bone marrow increases, which reduces the absorption coefficient).

The dual-energy X-ray absorptiometry technique is recognized as the “gold standard” in the diagnosis of osteoporosis, as it has a number of advantageous qualities: the ability to examine the axial skeleton, good sensitivity and specificity, high accuracy and low reproducibility error, low radiation dose (less than 0.03 mEv), relative cheapness and speed of examination.

Computed tomography (volume spiral CT) allows the trabecular structure of both the spine and the femur to be examined, although it remains an expensive method with a high radiation load. Magnetic resonance imaging can be used with the same success.

Quantitative ultrasound (ultrasound densitometry) provides information not only on the mineral content, but also on other bone properties that determine its “quality” (strength). This method can be used to examine the heel bone, tibia, phalanges, and other superficial bones.

How is osteoporosis treated in the elderly?

Treatment of osteoporosis is a complex problem. Since the disease has a multicomponent pathogenesis and heterogeneous nature. The objectives of osteoporosis treatment are:

  • slowing down or stopping the loss of bone mass, its increase is desirable during treatment;
  • preventing the development of bone fractures;
  • normalization of bone metabolism indicators;
  • reduction or disappearance of pain, improvement of the general condition of the patient;

Expanding motor activity, maximizing the restoration of working capacity and improving the patient's quality of life. Systematic treatment of osteoporosis includes:

  1. use of a diet balanced in calcium and phosphorus salts, protein: dairy products, small fish with bones, sardines, sprats, vegetables (especially green), sesame, almonds, peanuts, pumpkin and sunflower seeds, dried apricots, figs;
  2. painkillers during periods of exacerbation (non-steroidal anti-inflammatory drugs, analgesics);
  3. use of muscle relaxants; dosed physical exercise and therapeutic exercise;
  4. wearing corsets;
  5. massage 3-6 months after the start of drug therapy.

All means of pathogenetic treatment of osteoporosis can be conditionally divided into three groups:

  • drugs that predominantly suppress bone resorption: natural estrogens (estrogen-gestagen drugs), calcitonins (miacalcic, sibacalcin calcitrin), biophosphonates (etidronate, alendronate, resodronate);
  • drugs that stimulate bone formation: fluoride salts (sodium fluoride, monofluorophosphates), parathyroid hormone fragments, somatotropic hormone, anabolic steroids; drugs with a multifaceted effect on both processes of bone remodeling: vitamin D1 and vitamin D3, active metabolites of vitamin D3, alphacalcidon, calcitriol, osteogenon.

How can osteoporosis be prevented in older adults?

Prevention of osteoporosis should be aimed at timely identification and elimination of risk factors for the disease, diagnosis and adequate treatment in the early stages of the disease (before fractures occur).

The following measures are preventive:

  • weight loss with a chain of reducing the load on the spine and joints;
  • painstaking daily therapeutic exercises aimed specifically at the affected part of the skeleton;
  • avoid lifting heavy objects (weights over 2-3 kg);
  • adherence to a diet (refusal of concentrated broths, canned foods, smoked foods, coffee, chocolate;
  • use of various combined food additives, vitamin preparations. Of great importance in preventing the consequences of severe osteoporosis is the implementation of a set of social and individual measures to prevent injuries in elderly and old people.

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