Build Better Bones and caregivers
For people struggling with osteoporosis, you as a caregiver are a crucial helper in maintaining quality of life. Being able to remain in the comfort of home has palliative value beyond any other form of medicine. We aim to help prepare you so you can provide the best possible care.
Caregivers are often close family or even friends and neighbours. No matter what your relationship to the patient, your impact as a caregiver is undeniable. Your responsibilities may range from providing a steady arm for patients to lean on, to shuttling patients between physician’s visits or even making a nutrient-rich meal.
As a caregiver, you may often become well versed in the various medical specialities that may provide care for the patient as well as what sort of evaluations or treatments each has to offer. Regardless, the physical and emotional support that you provide is essential to the success of any treatment. However, don’t forget to prioritize your own health and take on only what you are capable of. The greatest quality of care is only possible if you are happy and healthy!
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Many different types of doctors can evaluate and treat osteoporosis. Start by sending your relative or friend to a primary care physician. They will likely be able to perform the assessment and may then refer them to a specialist. Among other things, the doctor will ask about the patient’s medical history and lifestyle to determine if he or she has any risk factors for osteoporosis. The doctor may also order blood or urine tests and suggest a bone mineral density (BMD) test, a quick and painless assessment. The most accurate way to measure BMD is the dual energy x-ray absorptiometry (DEXA). It can detect changes in bone density with great precision – monitoring BMD gains or losses as small as 1-2%. This provides a metric that may be used to monitor a patient’s progress over time and with treatment.
Several osteoporosis medications are available and have been proven to be effective in minimizing additional bone loss and helping reduce the risk of fractures. They are divided into two categories:
Antiresorptive medications – that slow the rate of bone loss
Anabolic medications – that increase the rate of bone formation
Your patient’s doctor can explain the benefits and side effects of each medication, and discuss with your patient the most effective course of treatment. As a caregiver, you may be asked to help your patient take medication in the appropriate dose and timeframe.
There you’ll find tips on exercises that promote good balance and help prevent falls, bone-healthy foods and ways to make the home a comfortable and safe place to live.
As a caregiver, you have most likely spent more time with the patient than the physician has, and you likely have a better understanding of their daily life and how their symptoms may fluctuate. With the patient’s consent, you can become more actively involved in their care by providing input that may greatly influence which treatments a doctor recommends. Start by simply preparing a medical record that can be brought to all doctor's appointments and hospital admissions. You can advocate for the patient by asking questions about the evaluation and treatment, by speaking up on the patient’s behalf to bring attention to their concerns, and by ensuring that the patient feels well cared for.
Some questions you could ask at the appointment are:
-What are the benefits [of a particular treatment]?
-What are the potential side effects, or will it affect ability to function independently?
-Are there alternative treatments?
For anyone with osteoporosis, keeping bones from breaking is the main challenge. As a caregiver, you can help the patient prevent stumbles, trips, and falls by removing barriers and obstacles in the home (see Home Safety). This may entail some light housekeeping to keep walkways clear of hazards and performing chores that would otherwise pose an unnecessary risk to the patient. For example, routine tasks such as lifting heavy objects or even pushing a heavy vacuum may be enough to break a bone; in-home caregivers can take over these chores. Encourage the avoidance of unnecessary risks and use tools to add support such as canes or walkers. Discourage risky activities such as climbing step ladders or moving heavy furniture. Please see our tab regarding Home Safety for more specific guidance in creating and maintaining safe environments. (Home Safety)
Good nutrition is critical to slowing the progression of osteoporosis. Specifically - calcium and vitamin D deficiencies are large contributors to bone loss. As a caregiver, you can perform in-home meal care prep to provide patients with meals and snacks that are rich in these nutrients. Finding ways to make meal time social and enjoyable can also help support nutrition. You can access our Nutrition tab to read more on this and utilize our calcium calculator to ensure that the person you care for is meeting the requirements for calcium intake in their weekly diet. (Nutrition tab)
Anyone with osteoporosis should consider lifestyle choices that will keep their bones as healthy as possible.
Limiting alcohol: intake should be limited to one alcoholic drink per day, as those who indulge more regularly may experience more significant bone loss over time. Intoxication may also increase the chances of falling and breaking a bone.
No smoking: tobacco usage increases the risk for fractures, and can delay fracture healing. Additionally, women who smoke often produce less estrogen and experience an earlier onset of menopause, when a high rate of bone loss occurs.
Weight-bearing exercise: people with osteoporosis need regular weight-bearing activities to keep bones and muscles strong which will help protect bones from undue stress and improve balance, both of which contribute to fewer bone breaks.
As a caregiver, you can help with physical activities designed to strengthen bones and muscles, by physically supporting the patient as needed. This may occur during balance-related exercises, however, it is important to provide support without placing yourself at risk for injury. If the person you are supporting needs more help than you can safely provide with any physical activity or exercise then change to an easier exercise. It is challenging to perform an exercise and pay attention to good form therefore you will be of great help by watching for the exercise to be completed correctly, which can prevent injury. Our Exercise tab provides further guidance on how to safely and effectively monitor form during exercise. (Exercise tab)
Motivation and support: Living with osteoporosis is physically and emotionally difficult, and your companionship and compassionate care is an irreplaceable service. One of the greatest roles that you as a caregiver can have is to motivate and support lifestyle changes through accountability. Your regular presence allows patients the opportunity to accomplish things they may not have been able to do on their own.
When a Fall Occurs
As a caregiver, there is a chance you will be in the home at the time someone with osteoporosis falls. This is a frightening situation for all involved. In understanding how to react to this worst-case scenario, you can be better prepared to stay calm and help in the most effective way.
Below is our formal protocol on how to take action if someone with osteoporosis suffers a fall.
Osteoporotic Patient Fall Protocol
Lower yourself so you are level with the patient and talk to them to ensure that they are conscious.
If they are unconscious, assess whether the patient is breathing by observing the rise and fall of the chest cavity or by holding two fingers below their nose to feel for breath. If they are not, call Emergency Medical Services immediately and begin CPR chest compressions if you are qualified.
If the patient is conscious, ask if they are in pain and where it is localized. Observe whether the patient has sustained any visible injury. If yes – do not move the patient and call Emergency Medical Services immediately.
If the patient is bleeding, apply pressure to the wound with a sterile pad until bleeding stops or help has arrived.
If the patient has fallen from a height, do not move the patient and call Emergency Medical Services immediately, as they may have injured their neck or spine.
If the patient has no obvious injuries and is not in pain, have them bend their strongest leg and log roll them onto that side. From there, gently roll the patient onto their stomach. If the patient experiences pain or loss of sensation at any point, cease all movement and await emergency medical services.
Once they have the support of their forearms, gently have the patient rise onto all fours, so you may more easily help them up.
Even if the patient seems to be in good health after the fall, it is strongly advised that they see a physician shortly after to assess any unforeseen injuries.
Even the best care program won’t prevent all fractures in people with severe osteoporosis. Hip fractures are some of the most common, and healing requires surgery and extensive recovery. However, there are many other fracture types and all breaks require specialized care. Caregivers make it possible to recover from these breaks at home – rather than at a care facility. In-home medication reminders and administration, personal care assistance, meal preparation, light housework, and critical companionship keep people at home where they are the most comfortable.
When you care for another it can become an all-consuming task. As a caregiver, you must also be mindful to look after your own health. It is essential that you care for yourself first to give the best possible care to others. Examples of strategies that have worked for other caregivers include using down time (for e.g. while a patient is at a health visit) to focus on yourself and your well-being. This can be going on a walk/engaging in exercises, practicing mindful meditation, calling a friend, or caring for yourself in some other way.