Proper Diet, Exercise, Smoking, Drinking Avoidance, Tests Promote Bone Health In Seniors, Federal Agencies Say (2 of 2)

A separate 2002 study published in the Journal of the American College of Nutrition instructs osteoporosis patients to take calcium with phosphorus to ward off deficiency in the latter mineral.

Researchers explain that patients suffering from osteoporosis ought to take calcium phosphate because, if they increase their intake of calcium without phosphorus, they heighten their risk for falls and deficiency in phosphorus, which lead to rendering calcium less successful in protecting bones from loss.

Phosphorus is needed to combine calcium with bone and this important task is completed in the intestinal tract, researchers explain.

The NIH, CDC and the U.S. Surgeon General also asks senior patients to make regular their intake of vitamin D, which is critical to the absorption of calcium and bone health. Vitamin D is created in the skin through exposure to the sun.

While most individuals receive sufficient vitamin D naturally through such foods as milk and mushrooms, research finds that the supply of vitamin D is lowered in seniors, especially those who stay home away from sunlight, and at wintertime. Doctors are urged by the agencies to recommend that the senior patients supplement their intake of vitamin without overdosing.

About 40 percent to 100 percent of male and female seniors nationwide and staying at home lack an adequate supply of vitamin D. A 2002 study of long-term care senior patients, aged 85 and older, found that 91 percent took vitamin D supplementation, nearly 50 percent were vitamin D-insufficient and 16 percent were outright vitamin D-deficient.

For the ambulatory senior population, aged 78 and older where most patients took vitamin D supplements, 81 percent were deemed to be vitamin D-insufficient or deficient.

A lower supply of vitamin D in seniors leads to muscle weakness as well as compromised bone health. Muscle weakness translates into lessened physical capacity, which means a greater risk of falling and bone fractures.

Studies of vitamin D found that the nutrient affects muscle cell growth and function by binding to a receptor. Seniors who improved their intake of vitamin D and supplementation enjoyed muscle strength, walking ability and overall physical capacity, reducing the incidence of falls and non-spinal bone fractures.

Lastly, a 2002 study at the National Cheung Kung University Hospital in Tainan, Taiwan found that seniors who drank tea regularly built strong bones and decreased their risk of contracting osteoporosis. The study appears in the Archives of Internal Medicine.

Namely, individuals who drank two cups per day of black, green or oolong tea were discovered to have more solid bone material. Researchers point to the presence of fluoride, caffeine and phytoestrogen, the ingredients of which all contribute to bone mineral density and strength.

University researchers questioned 497 men and 540 women, aged 30 and older, about drinking tea, and all were administered a bone mineral density test. About 48.4 percent of the participants were tea drinkers for at least 10 years.

They reported drinking mostly green or oolong tea without milk, removing the calcium content of a dairy product. The study found those who drank tea steadily for more than ten years had the highest level of bone mineral density. Their level was 6.2 percent more than in those who did not habitually consume tea.

Regular physical exercise

The NIH, CDC and the U.S. Surgeon General asks senior patients to start an exercise regimen to prevent and treat osteoporosis and bone fractures. Physical exercise improves bone health and increases muscle strength, coordination and balance, leading to a reduction in falls and greater maximum overall health, the agencies say.

They say individuals who exercise regularly gain more peak bone mass, particularly “maximum bone density and strength” than those who don’t. There are two types of physical exercise: weight-bearing exercise and resistance exercise.

Individuals aged 40 and older are asked to consult their doctors before starting and to select exercise specialists qualified in physiology, physical education, physical therapy and other disciplines to lead activities.

Patients benefit when they engage the first variety, weight-bearing exercise, in which their bones and muscles “work against gravity.” These activities include walking, climbing stairs, dancing and playing tennis.

The second category, resistance exercises, use muscles to build muscle mass and bone. Examples include weight training/strength training with free weights or weight machines.

Other activities include Tai Chi, hiking, jogging and gardening.

Research shows that both weight-bearing and resistance exercise boosts the bone mineral density and strength of the spine and walking by itself enhances the status of the hip and spine in postmenopausal women and seniors aged 85 and older.

However, both groups of seniors must undergo an exam to determine the most suitable regimen for their physical ability and level of illness, the agencies say. Patients should test for muscle strength, range of motion, level of physical activity, fitness, gait and balance problems before embarking on a plan of exercise.

Seniors are asked to steer clear from activities that put them at risk for falling such as skiing and skating and “those with too much impact such as jogging and jumping rope”.

While certain exercises can benefit the hips, for instance, of postmenopausal women, they also can lead to fractures of the spine so their intensity and resistance may be need to be re-adjusted, researchers say.

Meanwhile, the agencies say, patients should not succumb to fear of falling and avoid exercise altogether. To help overcome fear, they caution seniors to achieve proper posture, to use handrails on staircases and bend from the hips and knees and not from the waist when lifting.

They also advise against seniors wearing slippery shoes; slouching when standing, walking or sitting at desks; moving too quickly; taking part in sports that lend to twisting such as golf and bending from the waist such as sit-ups or toe touches.

Non-weight-bearing exercise examples include bicycling and swimming but, while both build strong muscles and contribute to heart health, they are not effective for building bones, the agencies say.

The Surgeon General and guidelines from the American Heart Association recommend that all seniors aged 65 and older take part in moderate-intensity aerobic exercise for at least 30 minutes five days a week or vigorous-intensity activity for 20 minutes three days of the week.
Avoidance of tobacco and alcohol

The agencies forbid tobacco consumption among seniors, especially those with osteoporosis, declaring it harmful to the bones as well as for heart and lung health. Research finds one year of having quit smoking substantially increased bone mineral density in the femoral bones and hips in postmenopausal women.

Additionally, ending tobacco use has lowered the risk of hip fracture in female seniors after 10 years of such cessation as compared with younger adult women who continue smoking.

Researchers also say a female senior who drink two to three ounces of alcohol per day damages her skeleton. The same applies to drinking in younger women and men. Those who drink most heavily are more vulnerable to bone loss and fractures because malnourishment leads to a greater risk of falls.

Review of chronic illness medications

The NIH, CDC and the Surgeon General also warns seniors, their families and their doctors to perform a review of medications taken to treat a variety of chronic diseases associated with old age that lead to bone loss through a risk of developing osteoporosis or suffering fractures.

These include glucocorticoids or a class of medicines that treat a range of serious illnesses such as arthritis, Crohn’s disease, lupus and disorders of the lungs, kidney and liver, researchers say.

Other types of drugs that cause bone loss include treatment with anti-seizure drugs such as phenytoin, commercially known as Dilantin, and barbiturates; gonadtropin-releasing hormones used to treat endometriosis; excess use of aluminum-bearing antacids; cancer therapies, and; excess thyroid hormone.

Specifically, the use of the commercial drug Prilosec, also known as omeprazole to treat acid reflux disease, may ultimately lead to the onset of osteoporosis, 2002 research from the University of Minnesota shows.

When taken with calcium carbonate, Prilosec decreases calcium absorption in women aged 65 or older, which may lead to developing osteoporosis. The drug works by holding down the backflow of acids from the stomach to the esophagus. Still, the human body cannot process calcium without acid.

According to the study, which was presented at a yearly meeting of the American Geriatrics Society, out of a total of 18 women over aged 65 and taking Prilosec, about 16 had lowered calcium absorption levels.

The agencies urge seniors to speak with their physicians about whether to continue, stop or change medications with medical assistance or on their own.

Federal research projects that nearly 30 percent of individuals aged 65 and older, who stay at home, will fall at least once a year with the fall rate being higher in nursing homes and other senior long-term or short-term care facilities. Most falls will cause fractures with the most severe category being hip fractures.

Over 50 scientific studies published after 1988 have sought to address the question of whether a variety of medications cause these falls and injury though few have been designed in this manner. Many flaws in study design complicate the ability to make the connection between drugs and falls.

Despite such challenges, federal research has made important findings on the topic. Some have found that patients taking psychotropic drugs have twice the risk of falling and enduring fractures, compared with those not consuming such medicines.

As a result, physicians, pharmacists and nurses may prioritize reducing the use of psychotropic drugs by seniors in nursing homes or other forms of senior long-term or short-term care. Additionally, researchers and policymakers who advocate “aging in place” for seniors may lobby against the use of psychotropic drugs among elderly individuals who choose to stay at home.

Other studies have found that the use of nonsteroidal anti-inflammatory drugs is linked to falling and are expanding their examination of this class of medicines.

Most especially, researchers point to antidepressants, a class of drugs that have been connected by every major study to falls. Studies are focusing on the effects of selective serotonin such as 5-hydroxytryptamine, also known as 5-HT, and reuptake inhibitors and tricyclic antidepressants on falls.

Benzodiazepines with their long-term effects may impact falls through dosage rather than through drug half-life. Researchers are still determining the effects of drugs that treat heart conditions on falls.

Meanwhile, diuretics have been identified as a class of drugs not associated with falls and, in fact, thiazide diuretics, may avoid fractures by delaying the development of osteoporosis.

Medical testing

All seniors, most especially those aged 85 and older, must take an exam for the secondary causes of osteoporosis as part of a larger review of osteoporosis, the federal agencies say.

In general, a bone mineral density (BMD) test is considered the best exam for measuring bone health. The BMD test can recognize osteoporosis, determine one’s risk for fractures and measure a patient’s response to osteoporosis treatment.

The World Health Organization (WHO) has set definitions of units of standard deviations (SD) for DXA test results based on the peak bone mineral density of a healthy 30-year-old adult and a patient is assigned a T-score. A score of 0 is considered a BMD comparable with the norm for a healthy adult.

The more standard deviations (SD) there are below 0, shown as negative numbers, the lower your BMD and the greater risk of fracture. Bone density within the positive 1 or negative 1 range of the young adult mean is normal.

Low bone mass is indicated by a BMD score between 1 and 2.5 SD below the adult mean. Osteoporosis is defined as testing for a bone mineral density of 2.5 score or more below the average for young adults BMD for premenopausal women.

Severe osteoporosis is defined at more than 2.5 SD below the adult mean and in the incidence of one or more bone fractures. This same value can be used for both women and men.

Researchers particularly recommend that physicians diagnose osteoporosis in the proximal femur with the most common BMD test known as the dual energy X-ray absorptiometry or DXA test even though other sites and other methods of testing are effective and can be used to project fractures.

A patient’s bone mineral density can also be compared to that of an individual of the same age. This form of measure gives him or her a Z-score. Because a low BMD score is common among seniors, comparisons with the BMD of an individual of the same age can be misguiding. As a result, a diagnosis of osteoporosis or low bone mass is based on A T-score. Still, a Z-score can be useful for determining whether a disease causes bone loss.

While hip fracture prediction with bone mineral density and strength testing in itself is as valid as blood pressure reading to determine a risk for stroke, the value of the bone mineral density can be improved by other factors such as the biochemical indexes of bone resorption and fracture risk factors.

Factors outside of bone mineral density include age, previous fracture, premature menopause, a history of hip fracture and the use of oral corticosteroids. Physicians are encouraged to use a 10-year probability of fracture as the most effective measurement to determine intervention levels.

Treatments are available affordably for men and women if hip fracture probability over 10 years averages from 2 percent to 10 percent, depending on the age of patients.

Use of medical devices and therapies

Seniors can offset the risk of bone loss, bone fractures and osteoporosis by using medical devices and therapies other than medication. For example, federal research finds that hip protectors lower the risk of hip fracture among individuals most at risk for falls. Most hip protectors are reusable underwear that are worn over the hips.

One side of the piece of clothing is a thin layer of lightweight foam plastic. Hip protectors are worn by individuals with balance and posture problems and those who fall down and damage their hips as opposed to the more typical fall forward with hands and knees taking the hit.

However, clinical studies have found that at least one-third of seniors would not wear hip protectors or wore them for only short periods of time because of their lack of comfort or physical fit.

SOURCES:

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Vladimire Herard, M.S.

A print journalist for 23 years, Vladimire Herard wrote for the National Senior Living Providers Network, (nslpn.com), the Guidance Channel and Longtermcare.com. Under CD Publications, Ms. Herard wrote about senior health, substance abuse prevention, and elderly housing. Under Inside Washington Publishers, she covered health care financing for Inside HCFA and food and product safety issues for FDAWeek. Ms. Herard also covered education, crime, and county affairs for daily newspapers such as the Chicago Defender. She currently serves as Chief Communications Officer for several companies, covering senior long-term care, the pharmaceutical industry, regulatory issues and education. Ms. Herard resides in Chicago.

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