People who serve as caregivers through the Consumer Directed Personal Assistance Program (CDPAP) take care of important tasks for patients with a host of health conditions. One of those conditions is a disease called osteoporosis, which causes porous, fragile bones that are easily broken from even mild stresses or falls. The condition occurs in both men and women.

If you have a friend or relative with osteoporosis who needs help with daily living tasks, mobility, medications, and basic vital sign checks, we’ve put together a guide on the disease.

Primary osteoporosis vs secondary osteoporosis

It’s important for an osteoporosis caregiver to know just what type a patient has. Physicians often categorize osteoporosis as either primary or secondary.

Primary osteoporosis

Primary osteoporosis is a natural occurrence in people who are aging. It occurs when a person’s bone density diminishes as a result of a drop in the body’s estrogen levels. Both men and women produce estrogen, but women’s estrogen levels tend to drop dramatically after menopause. Since menopause typically occurs in women in their 40s and 50s (the average age in the U.S. is 51), osteoporosis can show up in women earlier. In men, it tends to become a problem later in life.

Primary osteoporosis is further divided into two types. If it’s caused by a long-term lack of estrogen in women, it’s called Type I (or post-menopausal osteoporosis). This is most common 15-20 years after menopause. Type II (also called senile osteoporosis) is simply age-related (and not estrogen-dependent) and it occurs in men and women over the age of 75.

Primary osteoporosis can also occur in children whose bodies are unable to synthesize or process collagen. This can lead to a group of disorders called osteogenesis imperfecta (OI) which cause suboptimal bone density or even bone deformities.

Osteoporosis caused by other factors is characterized as secondary osteoporosis.

Secondary osteoporosis

Secondary osteoporosis is less common. There are 4 main ways that bone loss can occur to cause secondary osteoporosis:

–          A medical disorder or disease, including endocrine disorders such as hyperthyroidism or Cushing’s disease

–          Genetic/hereditary conditions such as collagen or metabolic disorders, like Marfan syndrome or Ehlers-Danlos syndrome

–          The use of certain prescription medications, such as heparin or some steroids

–          Serious nutritional deficiencies, such as scurvy, or the poor absorption of nutrients that results from alcoholism

Causes of osteoporosis

Many of us don’t think about our bones unless we break them. Therefore, we don’t realize that bone is a living tissue that our bodies are constantly renewing. When we’re young and healthy, our bodies create fresh bone tissue more quickly than our old tissue breaks down.

Researchers also believe that “peak bone mass” – the amount of bone mass we’re able to attain in our youth for optimal performance – is inherited to some extent. For example, some ethnic groups have a lower average peak bone mass than others and are therefore more susceptible to osteoporosis.

Those who are able to build strong bones when they’re young are less likely to develop osteoporosis as they age.

Causes of bone loss

Osteoporosis can happen at any age since there are many reasons the bone regeneration process can slow down.

Some risk factors for osteoporosis are out of a patient’s control, such as:

–          Gender (osteoporosis is more common among women)

–          Age

–          Ethnicity (those of European and Asian descent are at greater risk)

–          Genetics

–          Body frame (those with small body frames tend to have a higher risk)

Other risk factors can include:

–          Poor nutrition, such as a lack of Vitamin D and calcium

–          Certain medications

–          Excessive exercise (while moderate exercise can help prevent the condition, heavy endurance training can lead to weakened bones over time)

–          Lifestyle choices such as little to no exercise, smoking, or excessive drinking

Diseases linked to bone loss

Osteoporosis has also been linked to common diseases and disorders, such as:

–          Diabetes Mellitus

–          Autoimmune diseases such as lupus and rheumatoid arthritis

–          Hyperthyroidism

–          Celiac disease

–          Asthma

–          Multiple Sclerosis

These conditions do not necessarily cause osteoporosis, but often the medications used to manage them or the lifestyle needs of those who suffer from them can lead to bone loss. For example, certain anti-inflammatory medications used to treat asthma may block calcium absorption, which the body needs to build new bone.

Signs and symptoms of osteoporosis

There may be clear signs that a patient is developing osteoporosis or that their bone density is getting worse. However, some symptoms (which are more subjective) may indicate that osteoporosis is just one possible issue that the patient is facing.

Signs and symptoms of osteoporosis can include:

–          Stooped posture or a hunching of the back (known as kyphosis)

–          A loss of height over time

–          Severe back pain that might indicate a collapsed or fractured vertebrae

–          Easily broken bones (osteoporosis-related fractures most commonly occur in the hip, wrist, or spine)

–          Decreased calcitonin

–          Decreased estrogen

–          Increased parathyroid hormone

–          High levels of serum calcium or alkaline phosphatase in the blood

–          Vitamin D deficiency

Symptoms such as joint or muscle aches or difficulty getting up from a chair may be early warning signs of osteoporosis, but can indicate many other conditions as well.

If a doctor performs a bone mineral density test, a T-score of -2.5 or less indicates a patient has osteoporosis.

Management and prevention

If you are a CDPAP caregiver taking care of an elderly patient with osteoporosis, it’s important to follow a care plan to manage their symptoms as well as try to prevent further bone loss. You may need to pay close attention to diet, exercise, and other lifestyle factors.


Diet can influence a person’s risk of osteoporosis from childhood since it plays a role in reaching optimal bone mass. Throughout our lives, it’s important to eat a diet rich in the following, which positively affect bone health:

–          Protein

–          Calcium

–          Vitamin D

–          Fruits and vegetables

On the other hand, if a person has a high-calorie diet or consumes excessive alcohol regularly, it can have a negative effect on bone mass at any age.

Calcium intake is one of the most important pieces of the puzzle when it comes to staving off bone loss. Low calcium intake can even contribute to early bone loss and increase the risk of fractures. 

Those with eating disorders are also at higher risk for osteoporosis because of nutritional deficiencies. Being underweight is also a risk factor for developing weak bones.

On the other hand, being overweight is correlated with increased bone mass. But that doesn’t mean it’s something to strive for. Obesity can also put more pressure on joints and bones, weakening them over time. In addition, those who have gastrointestinal weight loss surgery to reduce the size of their stomachs also run the risk of reducing the surface area available to absorb much-needed nutrients such as calcium.

Avoid sodium

One of the biggest diet dangers to avoid if osteoporosis is a concern is sodium. Sodium can decrease the body’s ability to absorb calcium. Anyone at risk should avoid added salt in their diets, as well as the following sodium-rich foods:

–          Processed meats (such as deli meats and hot dogs)

–          Fast food (including pizza, burgers, and fries)

–          Processed meals (especially reduced-calorie frozen meals)

–          Canned soups and vegetables

Always check the label to make sure that the sodium levels are acceptable if you are cooking or grocery shopping for someone with osteoporosis.

Avoid phosphoric acid

Your best bet for beverages include those fortified with calcium and Vitamin D. However, many people choose soft drinks, which contain phosphoric acid.

The occasional carbonated beverage is fine, but the consistent consumption of soft drinks leads to calcium loss. That’s because phosphoric acid causes your body to secrete calcium in the urine, even when calcium levels are already low.

Cut back on caffeine

Those at risk of osteoporosis should also cut back on caffeine. This is most important if your body already lacks calcium. However, coffee can generally be limited to one cup a day without negatively affecting calcium levels.

While tea contains caffeine as well, there’s currently no research connecting it to calcium loss. In fact, it may contain compounds that help build strong bones.

Talk to a nutritionist about soy

It’s always important to speak to a nutritionist before radically altering someone’s diet, but if a patient is at risk for osteoporosis, you should ask specifically about soy. While researchers disagree about its potential dangers, there is some evidence that it’s not the best choice for those at risk of – or suffering from – osteoporosis.

While soy is high in calcium, it also contains compounds called oxalates which some researchers think can bind with the calcium in a person’s body and make it unavailable to use for bone regrowth.

But keep in mind that other research has provided evidence of soy being helpful for bone strength. A doctor or nutritionist should have access to the latest research and be able to tell you how to deal with soy in a patient’s diet.

Activities and exercise 

Sedentary lifestyles are common these days, especially for people with desk jobs. Those who spend a lot of time sitting have a higher risk for osteoporosis than those who are active.

Weight-bearing exercises are known to promote bone strength and good posture. If you’re an osteoporosis caregiver, you may want to encourage the following activities to help stave off bone loss or even help bones get stronger (if a patient can do them safely) :

–          Walking

–          Running

–          Jumping

–          Dancing

–          Moderate weightlifting

–          Stair-climbing

Exercise that requires balance, such as yoga or tai chi, can help reduce the risk of falls if bone health does become compromised. 


In addition to a sedentary lifestyle, those who are smokers or heavy drinkers are also at an increased risk of developing osteoporosis.

Smoking tobacco causes a range of health conditions, but it can also affect a person’s bones. It can not only lead to bone fractures and osteoporosis, but it can make it harder to heal from injuries.


Smoking affects your bones in a few different ways:

–          It can reduce the blood supply to bones 

–          Nicotine slows the body’s production of osteoblasts, which are bone-producing cells

–          It decreases the body’s absorption of calcium

–          It can affect the body’s estrogen levels, and estrogen is needed in both men and women to build and maintain strong bones


Excessive alcohol consumption can also increase your risk of developing osteoporosis as well as your likelihood of bone fractures. While the effects of moderate drinking are unclear, research shows that chronic, heavy drinking at any point in your life can affect the production of your bone-producing osteoblast cells as well as slow bone regeneration. But the mechanisms are unclear.

It also appears that chronic drinking before the age of 35 (which is when a person reaches their peak bone mass) can have long-term effects on bone health. Post-menopausal women are at risk for bone loss if they consume more than 3 oz of alcohol per day.

Of course, alcohol consumption is also correlated with more falls. If a person’s bones are already in a weakened state due to osteoporosis, they are much more likely to suffer from bone fractures if they consume alcohol.

Fracture management

Bone fractures can range from minor to severe, with the latter sometimes requiring major surgery. That’s why it’s important to try to avoid fractures altogether. However, when a person has osteoporosis, even minor bumps and falls can result in a fracture.

If a fracture occurs on a wrist, arm, ankle, or leg, it can often be treated by stabilizing the area and wearing a cast while the bone heals. However, pain management also needs to be considered. But this becomes more challenging in the elderly or those on multiple medications since narcotic pain relievers can lead to further problems. Even in otherwise healthy people, narcotics can cause oversedation, leading to even more accidents and injuries.

If a person is already mobility-challenged, caregivers will need to be extra vigilant about monitoring their mobility. The patient may need at-home physical therapy exercises. And if a patient is elderly, fracture care will likely be long-term.

Medical management

Doctors can help patients treat and prevent fractures with supplements, including calcium and Vitamin D. They may also prescribe Bisphosphonates, which are a class of drugs that help prevent the loss of bone density.

In post-menopausal women, doctors may also prescribe selective estrogen receptor modulators (SERMs) to regulate estrogen activity in the bone. Ospemifene, lasofoxifene, bazedoxifene and arzoxifene are some of the SERMs that they prescribe to prevent and treat osteoporosis in the group. As an osteoporosis caregiver, you may be in charge of monitoring and administering these medications.

Teriparatide is another means of medical management of osteoporosis for both men and women. It is a synthetic form of human parathyroid hormone that can help the body form new bone and help increase bone mineral density and strength. This helps people at risk of osteoporosis reduce their chances of getting a fracture. It is administered via injection.

Surgical management

When fractures are severe, surgery may be the only option. A serious fracture to knees, hips, or shoulders could require joint replacement surgery followed by extensive in-patient and out-patient physical therapy.

Patients who suffer from serious fractures may need closed or open reduction with internal fixation. Closed reduction is when a doctor manipulates bone fragments without opening the skin. However, when that’s not a possibility, patients may need open reduction. This is when the fracture fragments must be exposed by dissecting the surrounding tissues.

If you’re a caregiver for someone recovering from surgery, you will likely need to provide mobility assistance as well as help with at-home physical therapy.

Care plans and goals for people with osteoporosis

Caregivers perform a range of tasks for those who are elderly and/or disabled. For those with osteoporosis, caregiving can involve aiding in the administration of care plans developed in consultation with doctors and family.

Depending on the medical and other therapeutic resources available to the client, osteoporosis caregivers may also wish to get educated about the nature of the disease and be well-versed in the client’s treatment regimen. This comes in handy when physical therapy needs to be done at home.

While osteoporosis caregivers do not need to have any medical or nursing degree, they may also have knowledge about a wide variety of pain relief options, especially when medications are not appropriate.

When it comes to observing the client, caregivers play a front-line role in gathering information about behavior, posture, and even bodily functions that will be helpful for the medical team to know. This includes any changes in bowel elimination since osteoporosis can be an initial sign of bowel disease.

If you are a caregiver, it’s important to have some knowledge of osteoporosis, regardless of the medical conditions your client may experience. Elderly patients and those who are sedentary or limited in their mobility due to other medical conditions should be monitored for signs of bone weakness and protected from ac

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