Many elderly persons are at risk for falls because of poor coordination, poor vision, muscle weakness, confusion, and use of hypnotics or other medications that alter the sensorium. The use of hip pads by elderly patients can reduce the incidence of hip fracture despite continued falls. Increasing physical activity may increase bone mineral density and lead to increased stability and muscle strength. Levels of these cytokines rise with the loss of estrogen and enhance bone resorption through increased recruitment, differentiation, and activation of osteoclasts. Although calcitonin levels are decreased in women compared with men, calcitonin deficiency does not appear to be important in age-related osteoporosis.
Physical stress tends to increase bone mass, whereas immobilization furthers bone loss.
Insufficient dietary intake of Ca, P, and vitamin D is associated with age-related bone loss. Late menarche and early menopause, nulliparity, caffeine ingestion, alcohol use, and cigarette smoking are also important determinants of decreased bone mass. Thus, although blacks and Hispanics can develop osteoporosis, they generally do so at a later age than whites and Asians. Idiopathic osteoporosis is uncommon but occurs in children and young adults of both sexes with normal gonadal function. Although six times more common in women, it also occurs in men after castration or with low levels of serum testosterone and is directly related to the loss of gonadal function.