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Osteoporosis Puts Nursing Home Patients At A Heightened Risk For Fractures Related To Falls

Picture-333I have a lot of clients who almost apologically tell me how their loved ones ‘brittle bones’ are responsible for the extensive nature of their injury .  Sure, their bones may be weakened and brittle, but that is not a defense to a claim against a nursing home or hospital for providing inadequate care.

The law has a long-standing tradition where a defendant (wrongdoing person or facility) takes the plaintiff (injured person) as they find him or her.  In other words, the fact that a person was in a weakened state at the time of their injury really has no bearing on the case, except for the fact that the resulting damages from their poor care may be more extensive for a person in a weakened condition than if the injury occurred to a younger person without such complicating factors.

Without a doubt, complications from brittle bones are one of the most problematic things facing many nursing home patients who suffer a fall at a facility.

What is Osteoporosis?

As you age, your bones get weaker, increasing your risk of osteoporosis (a disease that causes weak, porous bones). This can significantly increase your risk of dangerous bone breaks (fractures). Weak bones are caused by low levels of calcium, phosphorous, and other mineral levels in the bone. This mineral loss causes your bones to become brittle and eventually lose their internal support structures. 

Approximately 44 million people (~ 55% of the U.S. population) in the United States suffer from low bone density and 10 million of those people actually suffer from osteoporosis. About 30% of Caucasian postmenopausal women in the United States have osteoporosis, and 54% have osteopenia (lower than normal bone mineral density). 

Signs and Symptoms of OsteoporosisPicture-343

Osteoporosis does not usually have any signs or symptoms until it is pretty far advanced. Weakened bones can cause back pain, loss of height over time, a stooped posture, and broken bones. However, you can have osteoporosis for years without symptoms, until you suffer from a serious bone break. Therefore, you should have a doctor perform a bone density test if you are:

  • A woman older than age 65
  • A man older than age 70
  • A person over 50 who has suffered from a broken bone during their lifetime
  • A person who takes medications associated with osteoporosis (prednisone, aromatase inhibitors, or anti-seizure drugs)
  •  A postmenopausal woman (when estrogen levels drop at menopause, bone loss increases dramatically) with at least one osteoporosis risk factor
  • A postmenopausal woman who recently stopped taking hormone therapy
  •  A woman who experienced early menopause

Risk Factors

There are some lifestyle related risk factors you can change to help improve bone strength, including:

  • Low calcium intake
  • Tobacco use
  • Eating disorders
  • Sedentary lifestyle
  • Excessive alcohol consumption
  • Corticosteroid medications

However, there are also risk factors that you cannot change, including:

  • Being a woman
  • Aging
  • Being of white or Asian decent
  • Family history of osteoporosis
  • Above normal levels of thyroid hormone
  • Medical conditions and procedures that affect bone health (stomach surgery, Crohn’s disease, celiac disease, hyperthyroidism, and Cushing’s disease).

Prevention of Osteoporosis

Your bone mineral density (BMD) peaks when you are in your early 30s and starts declining as you age. Your likelihood of developing osteoporosis depends on how much bone mass you attained in your 20s and early 30s (the more bone mass you have, the less likely you are to develop osteoporosis) and how quickly you lose it.

Prevention entails accumulating as much bone density as possible during your early life by eating healthy, getting enough calcium, being physical active, not smoking, and maintaining a healthy lifestyle and maintaining those practices during your later years.

Increased risk of fractures related to falls in patients with Osteoporosis

Older, brittle bones are more vulnerable to serious bone breaks and compression because they lack the internal support structures to withstand impacts and pressure. Even a relatively mild injury can cause bone breaks. And, women suffering from osteoporosis are twice as likely to suffer from bone fractures when compared to men with osteoporosis. Older adults are at increased risk for dangerous falls because of balance problems, weakness, illness, bad vision,

Bone fractures are most common in the spine and hips (bones that directly support your weight), and the wrists (from bracing yourself with your hands as you fall). A 10% bone mass loss in the vertebrae can double the risk of vertebral fractures and a 10% loss of bone mass can cause a 2.5 times greater risk of hip fracture.

Hip fractures are one of the most common injuries for elderly people. They usually occur because of a fall and can cause serious and even life-threatening medical complications. Elderly persons can also suffer from compression fractures in their spine, which occur when the vertebrae (back bones) become so weak that they compress or collapse. This can cause severe pain and a stooped posture.

Osteoporotic bone fractures can cause decreased quality of life, severe pain, disability, and reduced mobility. Maintaining mobility is a significant concern as you age and healthy bones can help you maintain your health, safety, mobility, and independence. One of the best things you can do for yourself if take care of your bones at an early age by exercising, receiving adequate levels of calcium, eating a healthy diet, and not smoking. It is never too late to do something about your bone health.

Therefore, nursing home staff should take steps to improve and maintain the bone health of all residents. Nursing home facilities should encourage safe and appropriate exercise and activity, provide proper nutrition, providing calcium supplements if necessary, and reducing the risk of dangerous falls.

Fall prevention is one of the most important things nursing homes can do to ensure that residents do not suffer dangerous injuries. Osteoporosis and weak bones are common in many older adults, so preventative measures to protect the entire population is often the most effective tool to reduce complications for residents with osteoporosis.

Your family member deserves to receive necessary and appropriate care to achieve and maintain their best possible physical health and well-being. Although your family member is older and aging, they still deserve to receive the steps and care necessary to retain their independence, health, and dignity.

Lastly, should your loved one sustain an injury during an admission to a nursing home or assisted living facility, don’t assume that their osteoporosis precludes them from pursuing a claim against the facility.  Rather, the resulting injuries may likely be compensable regardless of their physical condition at the time of the incident.

Resources:

International Osteoporosis Foundation

National Institute of Arthritis and Muscoskeletal and Skin Diseases: Osteoporosis

The Johns Hopkins Arthritis Center: Osteoporosis Information – A Geriatrician’s Perspective

Related Nursing Homes Abuse Blog Entries:

Nursing Home Sued After Resident Fractures Both Hips In Separate Falls

Nursing Home Waits 19 Hours To Provide Medical Treatment To Resident Who Fractured Her Hip During Sabina Lift Transfer

How Many Falls Is Enough To Impose Responsibility On Nursing Home?

Nursing Home Cited For Mistreatment Of Resident Following Investigation Of Resident’s Fractured Neck

 

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  • micah c smith

    As long as you only list select facts, I will provide some more.
    Aside from nuclear tech. long term healthcare is the most heavily regulated industry in the U.S. and that is a fact. High risk patient’s are not at a lower risk for falls because they are living with nurses instead of their home or their children’s home. Show me a device that can monitor an ambulatory PT with dementia that cannot remember to use assistive devices despite medical staff prompting and I’ll make you more money than all your years in law combined. Nursing homes are not for 1 on 1 care. Patient’s in a nursing HOME have a RIGHT TO FALL versus being RESTRAINED. Unlike the hospital the nursing home is not an acute setting and lacks many of the interventions hospitals are able to use without patient rights being violated.
    Many times the weekend bone state, previous undetected hairline or compression fractures can lead to a spontaneous fracture with NO OR LITTLE STRESS. I have seen hips break as a patient stood up, heard the crack, and then they fell… supporting documentation:
    Consult Pharm. 2009 Feb;24(2):100-2, 105-8, 110-2.
    Spontaneous fracture: multiple causes.
    Wick JY.
    National Cancer Institute, National Institutes of Health, Bethesda, MD, USA.
    Abstract
    Spontaneous fractures occur in seemingly normal bone with no apparent blunt-force trauma. Spontaneous fracture occurs primarily in two distinct groups of patients: the very active young and the elderly. Researchers and clinicians have used several terms interchangeably for spontaneous fracture, including pathologic fracture, fragility fracture, compression fracture, or fatigue or insufficiency fracture. Among the most common causes of spontaneous fracture are osteoporosis (calcium deficiency and corticosteroid-induced), malignancy, overexposure to vitamin A, periprosthetic weakening, Brucellosis, cerebral palsy (especially in children), and osteodystrophy because of chronic renal failure. Preliminary research observations indicate that spontaneous fracture may be a rare adverse outcome associated with bisphosphonates.

  • Micah-
    While spontaneous fractures may occur in some patients, I thinks it’s important to look at both the circumstances surrounding the fracture as well as the x-ray films themselves before ruling out trauma.
    Certainly, a radiologist is in the best position to evaluate the type of fracture based on his or her interpretation of the films.
    With respect to your comments that ‘patients have a right to fall’– I tend to disagree. Surely, not all falls can be avoided. However, there are many situations where a patient has a history of falls, yet no assistance is provided for many fall-prone activities such as transfers and showering.
    Given the dire fall-related consequences such as fractures, brain bleeds– and even death, facilities should take reasonable steps to protect their patients.

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