Orthopaedics and Ageing: Addressing Bone Health and Mobility

Ageing has significant implications for bone health, primarily due to changes in bone density, structure, and strength. Orthopaedic conditions are often associated with ageing and osteoporosis, osteoarthritis, spinal stenosis, vertebral compression fractures, and hip fractures are common ailments among the elderly. 

It is never a bad idea to start prioritising the health of your bones. 

What Does Ageing Do To Bone Health?

Age-related changes to bone are often degenerative in nature. As we age, our hormones change and our body ceases to heal itself optimally. 

Bone Loss And Osteoporosis

As people age, bone loss becomes more prevalent. This is especially true for women after menopause when estrogen levels decline. Reduced estrogen leads to accelerated bone loss, making women more susceptible to osteoporosis. 

Osteoporosis is a condition characterised by low bone density and increased fracture risk. Men also experience age-related bone loss, although it generally occurs at a slower rate.

Decrease In Bone Density

Ageing causes a decrease in bone mineral density. The minerals in our bones,  primarily calcium and phosphate, are what give our bones the strength to withstand forces. 

A loss of these minerals can weaken the bones and make them more prone to fractures. This is one of the main reasons older people are more susceptible to fractures - they have reduced bone density, altered bone structure, and weakened bone strength. 

Change In Bone Structure

Bones undergo structural changes as they age. Our bones are made up of a strong outer layer called a cortical bone, that gives them shape and strength. The spongy inner core is called the trabecular bone. This is where bone marrow is stored and blood is produced. 

As we age, the trabecular bone, the spongy inner part of bones, may become thinner, while cortical bone, the dense outer layer, may become more porous. These changes can compromise the strength and integrity of the bones.

Slower Bone Remodelling

Bone remodelling is a continuous process of removing old bone tissue and replacing it with new bone. As people age, the balance between bone formation and resorption becomes disrupted, leading to slower bone remodelling. This can contribute to the gradual loss of bone density and strength.

Joint Degeneration

Ageing can also affect the health of joints. Cartilage, which provides cushioning and facilitates smooth joint movement, may wear down over time, leading to conditions like osteoarthritis. As our joints break down, it may lead to stiffness, pain, and reduced mobility, which may have to be treated with surgery.

Which Orthopaedic Conditions Are Associated With Ageing?

While degenerative bone conditions are more prevalent in older individuals, they can also affect younger people, albeit less commonly. 

Here are some common orthopaedic bone conditions associated with age:

• Osteoporosis is characterised by low bone density and deterioration of bone tissue, leading to increased bone fragility and susceptibility to fractures. It is more common in older adults, particularly women after menopause, but can affect both genders. Osteoporosis often goes undetected until a fracture occurs.
• Osteoarthritis is a degenerative joint disease that commonly affects weight-bearing joints such as the knees, hips, and spine. As the cartilage wears down, joints can become painful, stiff, and less mobile. 
• Spinal stenosis is characterised by the narrowing of the spaces within the spine, which can put pressure on the spinal cord and nerves. Symptoms may include back pain, numbness, tingling, and weakness in the legs.
• Vertebral compression fractures are fractures that occur in the vertebrae - the bones that make up the spine. They can cause back pain, loss of height, and changes in spinal alignment.
• Hip fractures are common among older adults, particularly those with osteoporosis. Hip fractures often require surgical intervention and have a significant impact on mobility and overall health.
• Fractures in the wrist and shoulder become more common as bone density decreases. Falls, accidents, and repetitive stress on these joints can result in fractures that may require treatment such as casting, immobilisation, or surgery.

What Can You Do To Minimise The Impact Of Ageing On Bone Health?

It's never too early or too late to start taking care of your bones. Prioritising bone health through lifestyle modifications and regular medical check-ups can significantly minimise the impact of ageing on your bones and help maintain their strength and integrity.

Dietary Changes To Improve Bone Health

Consuming a diet rich in calcium, vitamin D, and other essential nutrients is crucial for maintaining healthy bones. Try including more dairy products, leafy green vegetables, fortified foods, and calcium-rich supplements in your diet. Vitamin D helps with calcium absorption and can be obtained from sunlight exposure or supplements.

Exercise Helps To Keep Bones Strong

Regular weight-bearing exercises like walking, jogging, dancing, or weightlifting can help strengthen bones and improve bone density. These activities put stress on the bones, stimulating them to become stronger. Aim for at least 30 minutes of weight-bearing exercise most days of the week, but be sure not to overdo it, as excessive exercise can also be harmful. 

Resistance exercises, such as lifting weights or using resistance bands, can help build and maintain muscle strength, which indirectly supports bone health. Strong muscles can provide better support and protection to your bones.

Avoid Bad Habits

Smoking can decrease bone density and impair bone healing. Excessive alcohol consumption can also weaken bones and increase the risk of fractures. Minimise or avoid smoking altogether and limit alcohol intake to moderate levels.

Being under or overweight can affect bone health. Excessive weight loss or extreme dieting can lead to bone loss, while obesity can increase the risk of orthopaedic conditions like osteoarthritis and stress fractures.

Prevent Falls

Falls are a significant concern for bone health in older adults. Take precautions to reduce the risk of falls by keeping your home well-lit and free of tripping hazards, using handrails on stairs and in bathrooms, wearing appropriate footwear, and having regular vision and hearing check-ups.

Consider Going For Bone Density Screenings

Diseases like osteoporosis often go undiagnosed until someone suffers a fracture. By then, your bones have already suffered deterioration. 

Because we know that bone deterioration is associated with ageing, it would be a good idea to, consider discussing bone density screenings (such as a dual-energy X-ray absorptiometry (DXA) scan) with your healthcare provider. 

A DXA scan can assess your bone density and determine if you have osteoporosis. Early detection and treatment can help prevent further bone loss and reduce your risk of fractures.