Osteoporosis (Brittle Bones) and Frailty

What is It?

Osteoporosis is a condition that weakens bones, making them break easily as the result of minor events (e.g., lifting, twisting, falling). It slowly weakens bones over a long period of time. This means it goes mostly undiagnosed until a fracture occurs.

Figure from Osteoporosis Canada’s “Your Guide to Strong Bones” (2014)

Osteoporosis greatly increases the risk of fragility fractures (fractures that result from minor events), especially in the hip, spine, and wrist. This matters because hip and spine fractures can lead to increased risk of mortality, while fractures in general can lead to a reduced ability to move freely and reduced quality of life, and an increase in pain, fear of falling, risk of future fractures, and increased risk of dependence on home care or assisted living.

Osteoporosis has no clinical symptoms, meaning it is often not diagnosed until a fracture is experienced. There is currently no single known cause for osteoporosis. It is therefore important to talk to your doctor and/or healthcare professionals about factors that increase your risk of fracture, for example: age, family history, past fractures. It is especially important to seek fracture risk assessment if you are a female, as gender is a risk factor for developing osteoporosis (although males are also at risk). As well as a detailed history, a bone mineral density (BMD) test may be performed to arrive at a diagnosis.

Once diagnosed, it may be impossible to halt the process, but it can be slowed through treatment. There are three main treatment elements: nutrition, exercise, and medication. Eating a balanced diet is important, especially getting the recommended amount of calcium, vitamin D (e.g., taking a supplement), and protein (e.g., meats, beans, nuts, egg whites). Exercise routines that include a variety of types of exercise are good for bone health. For example, strength training, posture exercises (to keep you standing tall instead of hunched over), balance exercises, and aerobic exercises. It is important that exercise routines are tailored to the individual and the severity of the osteoporosis diagnosis, as some exercise may increase the risk of fracture. A variety of medications exist that treat osteoporosis, and sticking to a medication routine is important.

Osteoporosis can be prevented and managed through nutrition and exercise. Preventing osteoporosis starts early. You should ensure you get proper nutrition and participate in regular physical activity throughout childhood, and continue these practices into adulthood. Avoid heavy drinking and smoking, as these are risk factors. If you experience a fracture at age 50 or older, talk to your doctor about your osteoporosis risk factors and have an assessment done to ensure an early diagnosis—which can lead to better outcomes.

What is Its Connection to Frailty?

Older adults living with frailty are more likely to experience issues with bone health. This means that older adults living with frailty are more likely to be diagnosed with osteoporosis, are more likely to experience a fracture, and/or have a higher risk of future fractures. As well, osteoporosis can affect the rate at which frailty advances. Older adults who experience a fracture have an increased risk of frailty. If an older adult living with frailty experiences a fracture, they are at an increased risk of developing more severe frailty.

Research shows that frailty assessments can predict risk of fracture and are comparable to fracture risk assessments. This means that frailty assessments could be good tools for predicting and managing osteoporosis and fracture risk, and aid in decision-making around osteoporosis.

The message: “measuring grades of frailty may aid in fracture risk evaluation and fracture prevention for the elderly” (Li et al., 2017). What does this mean? Identifying and diagnosing frailty may help in the prevention and management of osteoporosis, but more research is needed. Frailty and osteoporosis often co-occur (happen together), but research is needed to find out if frailty is a cause or consequence of osteoporosis and to find out more about the connection between the two conditions. Either way, it’s important to be aware of the connection between frailty and osteoporosis.

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