Care For Old Bone, Don’t Ignore Osteoporosis

HIP fractures are closely associated with falls among older people, and unfortunately come with a high risk of disability and death.

It is predicted that by 2050, six million hip fractures will occur yearly, with half of them in Asia due to the silver tsunami that is expected to hit this region in the next decade.

Fragility fractures affect older people all over the world.

However, because Asians in general have a smaller bone frame and less bone mass, we’re more susceptible to them.

”We’re also lacking in our awareness of bone health because we are not interested in looking at bone disease (i.e. osteoporosis or weakening bones) as a chronic non-communicable dis­ease.

“Most governments are concerned with diabetes, cardiovascular health, hypertension, cancer, even dengue, but fractures in older people are not the focus, even though we are seeing increasing numbers of older people with them,” laments consult­ant orthopaedic surgeon Dato’ Dr Lee Joon Kiong.

What people are unaware of is that vertebrae fractures are actually the most common fracture among the elderly worldwide.

What’s more frightening is that they can occur without a fall.

Says Dr Lee: ”It’s scary that 80-90% of vertebrae fractures can happen when you sneeze, cough, bend forward to lift your grandchild or carry something light.

This is where orthogeriatric care – an approach that focuses on the comprehensive assessment, treatment and rehabilitation of elderly patients who have sustained orthopaedic injuries – comes in.

The multidisciplinary health­ care team should comprise the orthopaedic surgeon; geriatrician or family medicine physician; dietician; rehabilitation specialist or physiotherapist; and other specialists as needed, to ensure the patient’s wellness is optimised before and after surgery.

When the elderly come to the hospital for fractures, they already have multiple illnesses, which puts them at high risk for surgery.

Say an 80-year-old has persistent bone pain and consults the orthopaedic surgeon who tells her she needs surgery.

”The patient is admitted, and ideally, she should also be seen by a physician or geriatrician because they need to sort out and stabilise all her medical problems to reduce post-surgery complications.

”The longer she stays in the ward and lies down, the faster her health deteriorates.

“She is also stressed, affected psychologically and gets depressed.

“She needs to be immediately mobilised to prevent complications and sent home to the environment she is familiar with.

”However, all these things can be prevented by the combined care from the orthogeriatric team,” says Dr Lee.

The concept is common in western countries, but new in Asia as there are very few geriatricians around.

A few years ago, Dr Lee and several orthopaedic surgeons established the Malaysian Bone Health Optimisation Network (MyBone) to educate all orthopaedic surgeons on the importance of treating osteoporosis and advocate the responsibility of assessing bone health.

”We hope that through the promotion of this concept, every orthopaedic surgeon will be more proactive in paying attention to and treating osteoporosis, thereby increasing the treatment rate and reducing the occurrence of fractures and secondary fractures,” he says.

According to the International Society for Clinical Densitometry guidelines which Malaysia follows, women above 65 and men above 70 should go for a bone density scan (known as a DXA scan) to measure bone mineral density and bone loss.

Many medical specialities can start a patient on these medicines, but Dr Lee says that it’s beat that primary care physicians continue monitoring the patient.

Dr Lee concludes: “Ultimately, we don’t want our elderly to die bedridden with sores.

”We want them to also enjoy the last five to 10 years of life.

“Osteoporosis is preventable, so let’s do our work together.”

For full article, source: The Star