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            The Aga Khan University Hospital Pakistan

Fragile Bones, Hip Fractures and Care of Elderly

<p>​In the early morning of 22 November 2021, 75-year-old Mehrunisa (pseudonym) came to the emergency department of a private hospital in Karachi with a complaint of pain in the right hip. History and examination revealed that the patient slipped in the bathroom while performing Wu&#39;doo for Fajr prayers. An X-ray confirmed the fracture of the right hip. Mehrunisa&#39;s daughter and brother were counselled for surgery. The cardiac team and anaesthesia team came on board, to evaluate the risk of mortality of the patient. She moved to the operating room for the surgery. 
</p><p>Like Mehrunisa, every day several elderlies with hip fractures get admitted to different hospitals across the country. Hip fractures are a major cause of prolonged hospital admissions and lead to serious health conditions in the elderly population.
</p><p>Now the question arises, why do our senior citizens suffer from fractures more frequently? The reason is that after the fifth decade of life, demineralization of the bone starts and as we enter the middle of sixth decade of life, bones get porous, demineralized, and fragile. This condition is called Osteoporosis. Fragility fractures are fractures that result from a mechanical force that would not ordinarily cause fractures, known as low-level or low trauma or a fall from a standing height or less. Osteoporosis is an asymptomatic condition that often remains silent until it manifests as a low-trauma fracture of the hip, spine, arm, pelvis, and/or wrist, which frequently leads to hospitalization. Evidence reports that after the first osteoporotic fracture, the risk of a second fracture grows up to 50%. Half of all women and 1/4<sup>th</sup> of all men will have an osteoporosis-related fracture in their lifetimes. Women are four times as likely as men to develop the disease. Smoking, nutritional deficiency of calcium and vitamin D, hormonal changes that occur in men and women after 50 years of age, obesity and family history of old age fractures are the main contributors to osteoporosis and fragility fractures. 
</p><p>Osteoporosis-related fractures can increase pain, disability, nursing home placement, total health care costs, and fatal medical complications. Generally, older adults would experience significant functional dependency for varying amounts of time and undergo extensive rehabilitation therapies. Post-fracture time is highly stressful for the family in terms of physical, psychological, and financial burdens. People who have already suffered from osteoporotic fractures should visit a Rheumatologist, a bone specialist or a Family Physician for further treatment. Fracture risk scoring is important in osteoporotic fractures patients as well as in healthy adults after the age of 50 years and initiation of osteoporotic treatment is the key to preventing elderly fractures. The care burden period after hip fracture often prolongs to six months or beyond. It is also highly associated with older people confined to bed, which can lead to serious health complications. Seeing their loved ones dependent on daily activities is heart breaking for families and leaves deep emotional and psychological scars. 
</p><p><strong>Age alone may break your bone, but a little care will save you </strong></p><p>For a better quality of life in old age, it is important to take some precautions that save our bones. You should make regular exercise a part of daily life, take brisk walks, go out with your neighbours to a nearby park, or even participate in household activities like going for groceries daily. Milk, yoghurt, spinach, lentils, beans, salmon, and tuna should be a part of your diet. As the person gets older the muscles lose strength, the coordination between muscles and movement reduces, and our body may need support in getting up from the bed or chair. To reduce the risk of accidents/falls it would be helpful to take some precautions, such as putting a handle beside your bed, keeping a good record of your eye check-ups, avoiding roaming around if the power is off, and not walking on wet floors. Longevity of life is a blessing. Make your days more productive and happier by taking care of yourself! 

</p><p><em>Dr. Nawazish Zehra, (Research Associate) Fracture Liaison Service, Aga Khan University Hospital​</em></p>
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