Bone Health: New Evidence

Elderly may at times be at risk of developing brittle bone disease (osteoporosis), which puts one at high risk of fractures even from an otherwise benign falls.

Usually your primary care doctor will check your bone density based on your age and other risk factors using the DXA scan.

It goes without saying that smoking cessation and limiting alcohol intake is vital. Decreasing caffeine intake to <2.5 cups of coffee or <5 cups of tea per day is also important to help keep your bones strong. 

Sometimes special medications may need to be prescribed, known as bisphosphonates [detail on these is beyond the scope of current topic].

Many patient take vitamin D and calcium supplements. What is the evidence that it helps?

It should be noted that new evidence suggests that supplementing vitamin D using once weekly or once monthly dosing may actually increase the risk of falls and fractures, instead of providing protection [https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4300188, http://www.medscape.com/viewarticle/856706#vp_1], and it may be prudent to discuss this with your doctor.

Additionally, there is new evidence that calcium pills may increase heart attacks and strokes [https://geminiresearchnews.com/2016/05/calcium-supplements-can-increase-risk-of-heart-attack-stroke], so many recommend getting calcium as part of your diet, not pills [http://www.osteoporosis.ca/osteoporosis-and-you/men-and-osteoporosis/calcium-and-vitamin-d/]. See Table 2 at https://ods.od.nih.gov/factsheets/Calcium-HealthProfessional for a list of foods rich in calcium and how much calcium these foods contain, in order to achieve goal calcium intake in diet. For most men 51-70 years old goal daily calcium in diet should be 1000 mg, while for men 71 and older or women 51 and older 1200 mg a day is recommended. 

Finally, weight bearing activities like walking or jogging have been shown to help strengthen bones.

[DISCLAIMER: Data presented here is for educational purpose only. You should speak to your doctor before applying what's presented here to yourself or others, as all of these details need to be fine-tuned on case by case basis by a qualified health care provider]

Dr Atanelov, MD

CEO, Steady Strides: Fall Prevention and Stroke Rehabilitation Medical Institute

Fall Prevention: Community Based Programs

Community [that is to say not clinician led] interventions can be very worthwhile in preventing falls as supported by published evidence. 

There is strong evidence that Tai Chi has been shown to help with fall reduction. Fortunately many senior centers and other community venues can help you find a local Tai Chi instructor.

NCOA, the National Council of Aging [https://www.ncoa.org/healthy-aging/falls-prevention], has been providing grants for local agencies to spread community based interventinos proven to prevent falls, e.g. OTAGO, Stepping ON, CAPABLE, FallsTalk, A Matter of Balance, etc... [https://www.ncoa.org/healthy-aging/falls-prevention/falls-prevention-programs-for-older-adults]. If you or your loved ones are at risk of falls, it may be helpful to call your local area of aging to find out which of these programs are offered in your locale.

Please speak with a qualified provider to help you choose which of these programs is best for you. 

Dr Atanelov, MD

CEO, Steady Strides: Fall Prevention and Stroke Rehabilitation Medical Institute

 

Fall Prevention: How is it done?

Falls can be nasty!

95% of hip fractures and majority of brain injuries in the elderly are due to falls. Neither of these two sound too much fun... Unfortunately, falls risk increases with age.

How can we avoid falls? [DISCLAIMER: Data presented here is for educational purpose only. You should speak to your doctor before applying what's presented here to yourself or others, as all of these details need to be fine-tuned on case by case basis by a qualified health care provider]

Centers for Disease Control and Prevention has published a nifty resource to address the problem of falls under acronym STEADI: Stopping Elderly Accidents, Death and Injury. I strongly recommend using this site: https://www.cdc.gov/steadi/patient.html to get some information on this topic. 

What are some of the take away points from the CDC website?

1. If you fell twice this year or once with a traumatic fall, you are at risk of falls

2. Stay active to prevent falls

3. Get your vision checked regularly 

4. Keep your home free of tripping hazards

5. Tell your doctor if you fall

This last point can be pretty important. Unfortunately, many people believe that if you fell you should only see a physical therapist. Physical therapy is often crucial! Yet, according to the CDC's STEADI guidelines physician also needs to be involved in fall prevention care, for there are often medical problems that contribute to falls which need to be addressed in a timely fashion. 

Many primary care physicians may not be educated how to care for patients at risk of falls, so CDC has created a STEADI algorithm for physicians to help them start caring for you.

[DISCLAIMER: Data presented here is for educational purpose only. You should speak to your doctor before applying what's presented here to yourself or others, as all of these details need to be fine-tuned on case by case basis by a qualified health care provider]

Dr Atanelov, MD

CEO Steady Strides: Fall Prevention and Stroke Rehab Medical Institute