Harvard osteoporosis expert and geriatrician Sarah Berry, M.D., MPH, recently shared her expertise in fracture prevention for elderly residents with osteoporosis and multiple comorbidities with McKnight’s. These vulnerable residents can feel overwhelmed and resistant when it comes to treatment options. But preventive strategies do work – and life-changing falls are not inevitable, she says.
Q. What are the greatest challenges to keeping older adults with osteoporosis and multi-morbidity safer from falls and hip fractures?
A: Osteoporosis is a silent disease. Older adults with osteoporosis don’t feel like their bones are weak. Even when a fracture occurs, it can be difficult to convince a patient to take medications for osteoporosis because the person feels so overwhelmed with treatment for the fracture or is fearful of drug side effects. A second challenge is a lack of awareness that falls are serious and preventable. Many older adults – and providers – assume that falls are inevitable as we age and they may not consider proven falls prevention strategies.
Q: How should clinicians approach drug treatment to prevent hip fractures in this population?
A: Clinicians should estimate an individual’s risk of fracture using a validated calculator, like FRAX. In addition, they should consider factors such as gait abnormalities and cognitive impairment, which may further increase risk. Older adults at high risk for fracture with at least a two-year life expectancy should have a discussion about the risks and benefits of osteoporosis medications, and together with their clinician, arrive at a treatment plan. It is also important to consider fall prevention strategies, including stopping or reducing the dose of medications associated with falls and fracture. This can make a difference in the risk of injury for long-term care residents.
Q: How do you counsel LTC residents when they express fear of medication side effects or are overwhelmed by treatment?
A: I remind patients that these drugs prevent many typical hip fractures, whereas serious side effects are less common. I also let them know that the serious side effects seldom occur during the first five years of treatment. By doing nothing, older adults will continue to experience a high burden of hip fracture despite the availability of preventive strategies.
Bio in brief: Dr. Berry studies outcomes following hip fractures in nursing home and community settings. She currently serves as:
- Associate Director, Musculoskeletal Research Center and Associate Scientist, Hinda and Arthur Marcus Institute for Aging Research
- Associate Professor of Medicine, Harvard Medical School, Beth Israel Deaconess Medical Center
- Program Director, Harvard Multicampus Geriatric Medicine Fellowship