Aging & Health A to Z
Unique to Older Adults
This section provides information to help older adults and their caregivers consider their disease or condition in conjunction with other health issues.
As older adults live longer, they may have more than one chronic disease. Or, they may have a health problem that can lead to another condition or injury if not properly managed. The older adult may also experience healthcare in various settings, such as the hospital, assisted living facility or at home. These situations can affect the health and function of the older adult and therefore require careful management to ensure proper care and improve or maintain quality of life.
Osteoporosis and Other Medical Conditions
Osteonecrosis of the Jaw
There are medications to treat osteoporosis called bisphosphonates. These are the most popular and widely-prescribed medications for treating osteoporosis. However, some serious side effects of these medications have been reported. Patients who take a bisphosphonate over a long period of time can be at risk of side effects. One of these is called osteonecrosis of the jaw. It occurs rarely but is a serious side effect.
Osteonecrosis is when bone tissue dies. It may occur suddenly with no warning, or after dental or oral surgery. The dead bone becomes exposed as the mucus membranes that normally cover it fall away. In severe cases, long-term infection may also occur and can last for years.
Most cases of osteonecrosis of the jaw occur in people who are taking very high doses of the medications zoledronic acid or pamidronate, for treatment of various cancers. This condition is not common in people who take normal lower doses of these drugs to treat osteoporosis.
Certain unusual fractures of the thigh bone (femur) have been reported during bisphosphonate therapy for osteoporosis, although it is extremely rare. Long-term bisphosphonate therapy may make it more difficult for bones to rebuild and make bones more fragile. But recent large studies have not found definite proof to support the idea that the risk of femur fractures increases with bisphosphonates. The evidence is unclear, and researchers are continuing to gather information.
Restrictive Lung Disease
Osteoporosis can cause other problems. It can cause something called vertebral (spinal) compression fractures. The vertebrae are the bones in your spine. When you have osteoporosis, your bones are fragile, and this can cause small breaks in your vertebrae. These small breaks make the vertebrae compress (squeeze against each other). When this happens, it can make your spine “shrink,” which makes you lose height. Fractures of the ribs can cause that as well.
These fractures can also cause something called kyphosis (also known as Dowager’s hump). Kyphosis causes poor posture and loss in height. It also may lead to a squeezed ribcage and chest. In serious cases, your lungs no longer have enough space to expand normally with each breath. You may find yourself short of breath as you lose the ability to inhale deeply. A rapid, shallow breathing pattern may result. This condition is known as “restrictive lung disease.”
Restrictive lung disease can mean that not enough oxygen is in your blood. It can also affect the health of your lung tissue. Healthcare professionals can use many different treatments. The choice of treatments depends on the causes of the ribcage compression. These treatments can include:
- exercises to improve posture and strengthen muscles
- breathing exercises
- effective coughing techniques
- relaxation exercises
- techniques for saving energy
- supplementary oxygen if needed
- treatment of the osteoporosis
- treatment of fractures if needed
- annual flu shots
Many older adults who live at home eat poorly. In one of four older people, poor nutrition is so serious that a condition known as protein-calorie malnutrition (PCM) develops. Sometimes, PCM occurs after a long hospital stay, or from loss of appetite due to a chronic disease or medication. Dental problems can also make it difficult to eat healthy foods. Poor nutrition adds to the risk of osteoporosis because it can cause a shortage in calcium and other nutrients needed to build bones. And if you do not get enough calcium, your body will remove the calcium from your bones to use it for other necessary functions.
Depending on the length of time that you have been eating poorly, you may or may not lose weight.
Your healthcare provider will be able to diagnose PCM by checking for:
- changes in body shape or weight trends
- hair that falls out or can be pulled out easily
- lack of fat under the skin
- dry, flaky skin
- loss of muscle mass
- anemia (lack of iron in the blood)
- blood changes, such as lower levels of cholesterol and protein
- shortness of breath
If you have been diagnosed with PCM, your healthcare provider or dietician will help you plan a diet to correct your lack of vitamins and help you gain weight. In serious cases, you may need to have a feeding tube until you are able to eat an adequate diet.
Nutritional strategies include:
- Eating calorie-rich and protein-rich foods (it may be very helpful to use high protein and high calorie drinks such as Ensure or Boost)
- Taking vitamin and mineral supplements
- Rehydrating – making sure you are drinking enough fluids
Osteoporosis affects all the bones of the body. The jaw often suffers severe bone loss caused by osteoporosis. It can impact the way the teeth are rooted in the jawbones. When the area of the jawbones where teeth are rooted loses bone mass, teeth become loose and may fall out. Research has found that women with osteoporosis are three times more likely to lose teeth than women who don’t have the disease.
Osteoporosis causes other dental problems besides tooth loss. For example, older people with osteoporosis can have more trouble wearing dentures and recovering from dental surgery.
Treatments for osteoporosis, such as bisphosphonate medications, may build bone in the jaw and help keep teeth firm and healthy.
Ethnic/Cultural Influences on Risk Factors
In the past, most research on osteoporosis focused on white populations. However, recent surveys have found that people of Asian descent also have relatively high rates of osteoporosis. Meanwhile, Native Americans, Hispanics, and African-Americans appear to have a lower risk. These differences may be based on genetic differences, different levels of physical activity and exercise, dietary differences (such as fewer sources of dietary calcium), or a combination of these.
Updated: November 2017
Posted: March 2012