One of the structural changes that occurs as people age is the loss of bone tissue. As the skeleton provides structure, balance, and support to the body, the loss of bone mass or density can cause joints to become stiffer and less flexible. The interior structure of a bone resembles a honeycomb. When the tiny holes become larger, the bone becomes less dense and more porous. This weakens bones, making them fragile, and more susceptible to breakage.
Age-related bone loss involves a steady and progressive decline with lower rates of calcium absorption leading to brittle bones that fracture easily.
Over 80% of all fractures in people aged over 50 years are caused by osteoporosis.1 Often called the ‘silent thief’, osteoporosis is a skeletal disorder that can cause bone loss without symptoms. Postmenopausal women are especially susceptible as the condition is closely related to estrogen deficiency. Alarmingly, at least 1 in 3 women and 1 in 5 men will suffer from an osteoporotic fracture in their lifetime, and 28% of women who suffer a hip fracture will die within one year. Men who suffer a hip fracture tend to have poorer outcomes and are more likely to die from the complications.
Protecting bone health requires not just behavioural and lifestyle modifications but also regular screening. The intake of calcium, vitamin D, weight-bearing exercises such as walking, and resistance training such as lifting weights, all contribute to bone health.
Experts recommend screening for osteoporosis with bone measurement testing as a tool to help prevent fractures in women 65 years and older, and postmenopausal women younger than 65 years. Early detection has been found to reduce the rate of hip fractures among the ageing population2.
Pharmacologic therapies are effective for people with low bone density (BMD) or those with a prior fragility fracture as well as reducing fractures in postmenopausal women. Medications appear to either reduce the rate of bone deterioration or are active in stimulating the bone-building process.
From a policy standpoint, an important prevention measure is removing the barriers to healthy ageing such as fall prevention programs and building age-friendly communities. According to Dr. Kristine Ensrud, a physician-researcher who studies aging-related disorders at the University of Minnesota and Minneapolis VA Health Care System, “To reduce the societal burden of fracture, it’s going to take a combined approach of not only focusing on the skeleton but focusing on fall prevention.”
The external environment is of great significance when considering the bone health of older people. Studies have shown that those over the age of 65 years face problems moving outdoors3. This impacts the health benefits of daily physical activity and hinders healthy ageing. The physical design of a space is a crucial element of preventing osteoporotic fractures. For example, the Netherlands is exploring the adaptation of street furniture like fences, benches, and lampposts into public gym equipment through minor modifications4.
The protection of bone health in later life and prevention of age-related conditions such as osteoporosis are aligned with the key messages of the UN Decade of Healthy Ageing which emphasizes the development of communities that foster the abilities of older people through integrated person-centred care. A proactive approach towards the health of older people must go hand-in-hand with the implementation of policies at country level.
To learn more about osteoporosis in later life and protecting bone health to ensure healthy ageing, please contact Dr. Edward Leung, Chief of Service of Department of Medicine and Geriatrics, United Christian Hospital, Hong Kong at the IFA Expert Centre, which is a unique resource for those interested or involved in the areas of ageing, vision health, human rights, vaccination and more. To contribute to the vital discourse on bone health and fall prevention, connect with Dr. Supriya Venigalla (firstname.lastname@example.org).
1 Fast facts: Osteoporosis Canada. Osteoporosis Canada. (2019, April 18). https://osteoporosis.ca/about-the-disease/fast-facts/
2 US Preventive Services Task Force. Screening for Osteoporosis to Prevent Fractures: US Preventive Services Task Force Recommendation Statement. JAMA. 2018;319(24):2521–2531. doi:10.1001/jama.2018.7498
3 Kerr, J., Marshall, S., Godbole, S., Neukam, S., Crist, K., Wasilenko, K., Golshan, S., & Buchner, D. (2012). The relationship between outdoor activity and health in older adults using GPS. International journal of environmental research and public health, 9(12), 4615–4625. https://doi.org/10.3390/ijerph9124615
4 Morris, K. (2016). (rep.). Making Cities Better for Ageing: Lessons from U.K. Age-Friendly Cities. The German Marshall Fund of the United States. Retrieved from https://www.gmfus.org/publications/making-cities-better-aging-lessons-uk-age-friendly-cities
Dr. Edward Leung President
Chief of Service of Department of Medicine and Geriatrics of United Christian Hospital