Osteoporosis: The Silent Threat Among Older Adults — A Minor Fall Can Lead to Fractures.
Thailand has officially transitioned into an aging society. Many families live with elderly parents and are accustomed to seeing them carry on with their daily routines as usual. However, behind these everyday routines, bone health may gradually deteriorate without noticeable symptoms. A minor fall can then become the turning point that reveals osteoporosis, a condition that can unexpectedly affect the quality of life of the entire family.
This article aims to help readers better understand osteoporosis, from its causes, symptoms, and risk factors to prevention and bone health assessment, through an interview with Dr. Pongsakorn Bupparenoo, an orthopedic trauma surgeon at the Orthopedic Center, MedPark Hospital.
What Is Osteoporosis and Why Is It Called a “Silent Threat”?
Osteoporosis is a condition characterized by reduced bone mass and deterioration of bone microarchitecture, causing bones to become porous, fragile, and more prone to fractures. The condition develops slowly over time as a part of the aging process.
“Bone density typically peaks around the age of 25 and gradually declines thereafter. Osteoporosis is known as a ‘silent threat’ because most people are unaware that their bones are weakening, as the early stages usually present no symptoms. In many cases, the condition only manifests after a fracture occurs.”
Dr. Jay - Pongsakorn Bupparenoo, an orthopedic trauma surgeon, explains that osteoporosis develops gradually and often goes unnoticed by patients.
“Osteoporosis can occur in both men and women, but it is more common in postmenopausal women because female hormones play a key role in maintaining bone strength. When hormone levels decline, bone mass decreases, making bones more fragile and increasing the risk of fractures.”
What Causes Osteoporosis and Who Is at a Higher Risk?
Although osteoporosis can affect anyone and is part of the aging process, several factors increase the risk in certain individuals. These include hormonal changes, genetic factors, and long-term lifestyle habits.
Dr. Pongsakorn explains that individuals at higher risk of osteoporosis include:
- Postmenopausal women: Rapid declines in estrogen levels after menopause can accelerate bone loss.
- Individuals with a family history of osteoporosis or previous fractures from minor trauma: This may indicate genetic risk or chronic bone fragility.
- Individuals with inadequate calcium and vitamin D intake: These nutrients are essential for bone strength, and long-term deficiency can reduce bone density.
- Individuals on corticosteroids, such as arthritis patients requiring immunosuppressive therapy, are at risk of accelerated bone loss.
- Patients with autoimmune diseases and individuals with habitual alcohol use and smoking
Warning Signs of Osteoporosis That Are Often Overlooked
“If you notice a loss of 2–3 centimeters in height, it may be due to vertebral compression fractures, which are common in osteoporosis patients. Some people may also develop a more stooped posture, feel shorter, or experience chronic back pain. Unfortunately, many people assume these changes are simply part of aging and do not seek evaluation from a specialist.”
A major concern is that many patients only seek medical attention after experiencing fractures from minor accidents at home, which often indicates that their osteoporosis is already at an advanced stage.
“Minor incidents such as a simple fall at home or even a slight twisting movement can cause fractures. The most common fracture sites in osteoporosis are the hip, spine, and wrist. These injuries can have long-term effects on health, quality of life, and daily living for patients and their families.”
Why Can a Single Fall Cause Serious Consequences for Patients with Osteoporosis?
Medical evidence shows that 1 in 5 older adults who sustain a hip fracture may die within one year. Most deaths are not due to the surgery itself, but to complications after the injury, such as pneumonia, pressure ulcers, urinary tract infections, or blood clots caused by prolonged bed rest.
Dr. Jay states that one common misconception is the concern families often have about surgery.
“Many families worry that older patients will become bedridden after surgery. In reality, surgery is often the first-line treatment and should be paired with physical therapy to help patients regain mobility sooner. In contrast, if patients forego surgery, or if surgery is performed but not followed by rehabilitation, many patients may become bedridden, which can lead to further complications.”
Treatment Approaches for Osteoporotic Fractures
Dr. Pongsakorn explains that the treatment of osteoporotic fractures does not end with surgery. Comprehensive management is required to prevent future fractures. The main treatment strategies consist of three components:
1. Pharmacological Treatment
Medication is prescribed based on the severity of bone loss. For patients at early risk, anti-resorptive medications like bisphosphonates or denosumab can slow bone loss. In patients with severe osteoporosis or those who have already experienced fractures, anabolic agents that stimulate new bone formation, such as teriparatide or romosozumab, may be considered. Doctors will determine the most suitable medication for each patient.
2. Lifestyle Modification and Muscle Strengthening
Appropriate exercise and adequate protein intake are essential, especially for older adults with both osteoporosis and sarcopenia (age-related muscle loss). Strong bones alone are not sufficient; muscles must also be strong to support the body, improve balance, and reduce the risk of falls.
3. Fracture Management and Prevention of Recurrent Fractures
For surgical intervention, doctors will determine whether internal fixation or joint replacement surgery is the most appropriate option to help patients regain mobility as soon as possible. Continued treatment, including medication and rehabilitation, is equally important to prevent future fractures in other areas.
Bone Mineral Density Testing: Know Your Risk Before a Fracture Occurs
If you do not want a ‘fracture’ to be the first sign of osteoporosis, bone mineral density (BMD) testing is the standard medical method used to assess bone strength and gauge fracture risk early.
A DEXA scan measures bone density and determines whether bone mass is normal or already decreasing, helping doctors plan prevention or treatment before fractures occur.
“BMD testing is a quick, painless test with minimal radiation exposure. It focuses on areas at high risk of fracture, such as the hip and spine. T-score results indicate future fracture risk.”
Dr. Pongsakorn recommends this test not only for older adults but also for anyone, especially those with genetic osteoporotic risk factors, interested in managing their long-term bone health.
“The earlier you know your risk, the better your chances of preventing serious events, such as fractures from even a fall.”
Preventing Osteoporosis in Everyday Life
“Caring for bone health and preventing osteoporosis is not something distant, and there is no need to wait until symptoms appear before taking action. Prevention begins with small habit changes, such as choosing foods rich in calcium, vitamin D, and protein, and engaging in weight-bearing exercises, e.g., brisk walking or balance training, to reduce the risk of falls. You should avoid smoking, excessive alcohol consumption, and a sedentary lifestyle, as these factors can accelerate bone loss.”
Dr. Jay - Pongsakorn Bupparenoo leaves readers with an important message.
“Osteoporosis often develops silently without clear warning signs, but its consequences can significantly impact quality of life. The best way to care for your bone health is to start before symptoms appear and to do so consistently, because bone health is a long-term investment in bone built up over time, much like any other aspect of physical well-being.”