Life With Osteoporosis

In June 2014, the National Osteoporosis Society launched Life with Osteoporosis

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Living with osteoporosis

If you are living with osteoporosis, you may be wondering what this means for you and whether normal daily activities might result in broken bones. It is natural to have a range of thoughts and feelings about how to cope with being at an increased risk of breaking a bone. However, it is important to remember that, just because you have been told you have an increased risk of fractures, this doesn’t mean they are inevitable. Also, even if you do have fractures, they don’t all lead to severe problems with pain and disability.

If you find it difficult knowing that your bones may be more prone to fracture, or if you are struggling with the impact of fractures on your life, consider speaking to your doctor or health professional, or, alternatively, contact the Helpline at the National Osteoporosis Society and talk your worries through with a member of our team of nurses.

It can be a challenge finding a balance between looking after your health and not ‘wrapping yourself in cotton wool’, especially if this means you are avoiding activities and interests that are important to you. It can help to think of a diagnosis of osteoporosis as something that prompts you to make informed choices about helpful lifestyle changes and effective drug treatments that will reduce your risk of fractures in the future.

Generally life should be able to go on as normal, although some aspects of your life may be affected. For more information see our

Travel Insurance and Osteoporosis

Employment and osteoporosis

Falls, fractures and staying steady

Feeling more confident

Many people worry about breaking a bone and for some, especially in later life, fear of falling can mean they avoid tasks and activities and go out less, which can affect their confidence, independence and overall quality of life.

Limitations on your ability to get out and about may make you feel less in touch with the outside world, which can lead to social isolation, loneliness and even depression. However, it is important to remember that there are many selfhelp steps that you can take to maintain your safety and independence at home. There is also a range of support services accessible through health and social services.

What can I do to help keep myself steady?

The suggestions and activities below can help to improve steadiness and avoid falls. Choose those that feel right for you. Although falling is common in older age and may seem like something you can’t control, research has shown that ‘falls risk’ can be reduced. Falls are not inevitable and these suggestions may make a difference:

  • If you have a medical condition that makes you feel unsteady or dizzy, talk to your doctor. Getting treatments for these will make you safer.
  • Some medications can cause unsteadiness. If you are taking a number of different tablets ask your doctor or pharmacist to review them.
  • Shoes and slippers that have a patterned tread are less slippery than smooth soles. Avoid loose, backless and high-heeled footwear, as these may increase your risk of a fall.
  • Avoid clothes that are long and trailing.
  • Keep your glasses clean and hearing aids well maintained.
  • If you enjoy an alcoholic drink, be aware it might make you unsteady.
  • Eat food you enjoy but try and have a wellbalanced diet to give your body the right amounts of protein, starchy foods, vitamins and minerals for energy and stronger muscles.
  • People who become dehydrated are at greater risk of falling. Ensure that you drink enough so that your mouth is not dry and your urine is straw-coloured and not dark and concentrated.
  • Having low vitamin D levels may be a risk factor for falling. If you are over 65 and you don’t get enough vitamin D, talk to your doctor about whether you need a supplement.
  • If you have been falling, talk to your doctor or nurse as there may be specialist falls services in your local hospital.
  • Staying active as you age is the best way to fight infirmity and stay independent. Strength and balance exercises will make you steadier.

Exercise and osteoporosis

Staying steady around the home

Many falls happen in the home. Simple measures can help to reduce the risk of this happening:

  • Fit handrails on the stairs and, if it helps, next to the toilet and by the bath.
  • Move any mats so that you can’t trip over them.
  • Ensure stair carpets are not loose or frayed.
  • Use non-slip mats under rugs if they are on polished floors.
  • Fit a cage over your letterbox to avoid having to pick up letters from the floor.
  • Buy long-life light bulbs. You won’t need to change them so often. If they are not easy to reach, ask someone to change them for you.
  • Use a high-wattage light bulb on the landing and stairs so that these areas are clearly illuminated. Turn on the lights at night if you need to go to the bathroom. Clear up cluttered walkways and ensure that wires and flexes are kept out of the way
  • Mop up spills immediately using a longhandled mop to reduce the risk of slipping.
  • Get up slowly out of a chair or bed in case you feel dizzy.
  • Ask for help rather than climbing on chairs or stepladders for window cleaning.
  • Think and plan – for instance bring objects you regularly need close to you rather than overreaching for them.
  • Keep warm in your home. If your muscles get cold they won’t work so efficiently.
  • Consider installing a personal alarm in case you do fall.

Age UK has a booklet with lots more advice entitled Staying Steady. The Disabled Living Foundation produces information about choosing equipment to maintain safety and independence at home. Please see the contact details at the end of this section.

What can I do to protect my hips if I fall?

If you are older and at risk of falling, hip-protector pants are available that can help to cushion the force of a fall. These underwear garments have protective hard shells built into cotton pants covering your hips to absorb the impact of a fall. Although research studies have not proved conclusively that they prevent broken bones, they might make a difference if you are motivated to wear them.

Hip protectors and osteoporosis

Living With Fractures

Living with fractures

As explained in about osteoporosis, pain and other problems associated with osteoporosis are caused by the fractures it causes, and these experiences can vary from person to person.

Osteoporosis does not affect the healing process. So if you have a fracture it will usually heal in about six to twelve weeks although, like any broken bone, sometimes it can take longer. If you are having problems coping at home after your fracture, there are services such as physiotherapy and occupational therapy that can help you to regain your independence.

As with any broken bone, it is really important that you are eating healthily to help with your recovery and the healing process; see here for more information about a well-balanced diet. It is especially important that you have enough protein to help the healing process, especially if you are older and frailer.

If you smoke, a fracture may take significantly longer to heal as smoking alters the blood supply to the bones. Ask your doctor or practice nurse for help with giving up smoking to give your bones the best chance of healing well.

Some broken bones require an operation to aid healing; others get better on their own. Sometimes a fracture needs to be immobilised (or kept still) for a period of time, but with other fractures this isn’t necessary. Here are three common fractures that can be caused by osteoporosis, how they are treated and how healing is promoted.

Wrist fracture

A plaster cast will usually be applied in hospital to stabilise the break and aid healing. A hospital stay will not usually be necessary. The plaster cast will stay on until the bone has healed, usually for about six weeks. You will be advised about appropriate exercises to help strengthen your muscles and get back to normal activities.

Occasionally an operation may be needed to re-align and stabilise the bones. Sometimes wires are used to hold the bones in position and a partial cast is applied in the operating theatre. After a few days, when the swelling has gone down, a full cast is applied.

A small proportion of people with wrist fractures may go on to develop longer-term problems, such as osteoarthritis of the wrist. A rare but painful complication of wrist fracture is a condition known as complex regional pain syndrome (CRPS). To reduce your chance of developing CRPS it is important to do the recommended exercises before and after the cast is removed. 

Complex regional pain syndrome and osteoporosis

 

Hip fracture

Broken hips most commonly occur in people over 75 years of age who fall directly onto their hip. An operation is normally required to fix or replace the upper end of the thigh bone that has broken (see photos opposite). Your surgeon will want to repair the break as soon as possible, but this may be delayed if you have a urine or chest infection, low levels of red blood cells (anaemia) or heart problems. You will either have a general anaesthetic or an injection into your spine to completely numb the lower half of your body.

The quicker you get up after surgery, the more successful your recovery is likely to be as this reduces your risk of problems such as a chest infection and clotting issues. You will usually be up and out of bed the next day with the help of a physiotherapist and a walking frame, and gradually become more mobile as the days progress. After the operation you will have regular, strong pain-relieving injections or a patient-controlled analgesia pump, which provides a pain-relieving drug straight into a vein. This allows you to control your pain by giving yourself safe amounts of medicine.

If you were already quite frail before breaking your hip, you may need a period of rehabilitation after your operation so that you can go home safely. The length of stay in hospital can be between five days and three weeks. A physiotherapist should give you specific advice about appropriate exercises to help with your recovery.

Operation to mend a hip fracture

There are other fractures that may occur with osteoporosis such as fractures of a rib, an upper arm or the pelvis. If you experience one of these, talk to your doctor or ask to see a physiotherapist for advice about what you can expect and also about appropriate exercises (or limits to your activities) to aid your recovery.

Spinal compression fracture

The experience of compression fractures is varied. For some people these fractures occur suddenly with severe and disabling pain, but for many the compression of the bone is ‘silent’, causing little or no pain.

These are usually stable fractures so you do not need an operation and you do not need to wear a special spinal brace to keep your back immobile. In fact it is important that you keep as mobile as you can to help to prevent problems such as chest infections, constipation and even blood clots. Keeping mobile will also help to maintain your muscle strength and reduce further pain problems. Taking a pain-relieving medication can help with the pain and will also help you to stay as active as you can. However, if pain is severe in the early stages, you may need to reduce your mobility for a while, although this isn’t necessary to aid healing.

In the longer term, whether or not your spinal fractures are painful, you may notice you have lost some height or are beginning to get an outward curve at the top of your spine (see What is Osteopororsis for more information on how these changes in your spine occur).

Many people recover well from painful compression fractures but some will go on to experience chronic (persistent) back pain due to the effects of the changes in spinal shape. Sometimes these fractures can lead to being less active, having sleep problems, feeling emotionally low and reduced general health. Height loss and postural changes can cause shortness of breath and your stomach may feel squashed and bloated. This can make day-to-day living more difficult.

For hints and tips on how to overcome various problems associated with broken bones caused by osteoporosis 

Daily Living after Fractures

Caring for someone with fractures

Out and About after Fractures

 

A compression fracture seems different from a normal broken bone so why is it painful and what can I expect?

It is still a broken bone in the sense that there is a break in the outermost layer. Nerves are therefore stimulated, sending signals to the spinal cord and up to your brain.

Often, during a fracture, blood vessels in the bone are torn and bleed, and back muscles can go into spasm as they try to hold the broken bone together. These changes create further pressure on nerve endings. This immediate pain is often described as ‘acute pain’. You may experience it immediately when a bone breaks and it will usually lessen over the following six to twelve weeks, as the injured tissue and bone heal.

Why am I still getting pain after my spinal fracture has healed?

Even though a fracture has healed, sometimes pain improves but doesn’t go away completely, with pain coming and going or occasionally becoming constant. Pain that lasts beyond the expected healing time, sometimes defined as longer than three months, is called persistent pain or ‘chronic pain’. If the fracture has healed, there will be other causes of the pain:

  • Nerves leave the spinal cord and travel between the individual spinal bones to all areas of the body. It is possible for a spinal fracture to pinch or irritate one or more of these nerves, causing pain. Sometimes this pinching or irritation of the nerve carries on after healing because the bone has healed into a flattened or wedge shape. Occasionally, pain persists when nerves carrying pain signals have become overly sensitive and continue to ‘fire off’ pain signals even though the fracture has healed.
  • Joints and ligaments, where spinal bones join together, are put under strain as they try to adapt to the new shape of the spine. Sometimes arthritis in your back may be aggravated by the change in the natural curve of the spine caused by osteoporosis. For more information see our

    Osteoarthritis and Osteoporosis

  • Painful muscle spasms can happen with a new spinal fracture due to inflammation around the fracture and the altered stresses and strains on the back muscles caused by the new shape of the spine. However, when a spinal fracture has healed, unfortunately these spasms may still occur because of ongoing muscle strain. Height loss and changes in the natural curves of the spine can over-stretch or shorten some back and torso (chest and abdominal) muscles. These may become easily tired when pulled and strained in ways they are not used to and may be prone to going into spasm. Typically, a spasm can happen when lifting an object, or when pushing, pulling, bending or twisting, such as when using a vacuum cleaner. Occasionally even a small movement can set off a muscle spasm.

    Pain Managment after Fractures