SIES ICE

Subject– Geriatric counselling

Academic year – 2020 - 2021

Group members: -
Mugdha Mhatre – PGDC 05
Jinal Patel – PGDC 06
Banashree Bhatia – PGDGC 03
Mukta Dhage- PGDGC 08
Sanyukta Majgaonkar – PGDGC 13
 INDEX

SR.NO. TOPICS PG.NO.

1. HISTORY OF OSTEOPOROSIS 2

2. MEDICAL ASPECT 4

3. SYMPYOMS AND CAUSES 5

4. PROBLEMS FACED BY SENIOR 7

CITIZENS AND THEIR FAMILIES

5. ROLE OF COUNSELLOR 14

6. NGO AND OTHER SERVICES AVAILABLE 19

7. REFERANCES 21

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Osteoporosis literally means porous bone. The medical community defines
osteoporosis as a skeletal disorder in which bone strength is reduced as a result
of loss of bone mass and through the deterioration of the bone architecture. The
consequence of these changes is an increased fracture risk. Fractures that occur
as a result of low-trauma are known as fragility fractures. In simpler words, the
inside of a healthy bone has small spaces, like a honeycomb. Osteoporosis
increases the size of these spaces, causing the bone to lose strength and density.
In addition, the outside of the bone grows weaker and thinner.

It is the most common reason for a broken bone among the elderly. Bones that
commonly break include the vertebrae in the spine, the bones of the forearm, and
the hip.

Osteoporosis is a common condition and becomes more common with increasing

age. One in two women over the age of 50 is likely to experience an osteoporotic
fracture in their lifetime. For men this is less common and it is estimated that
one in five males over the age of 50 will experience an osteoporotic fracture

Osteoporosis means "porous bones", from Greek: οστούν/ostoun meaning "bone"

and πόρος/poros meaning "pore"

The link between age-related reductions in bone density and fracture risk goes
back at least to Astley Cooper, and the term "osteoporosis" and recognition of
its pathological appearance is generally attributed to the French pathologist Jean

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Lobstein. The American endocrinologist Fuller Albright linked osteoporosis with
the postmenopausal state.

Osteoporosis has enormous public health consequences due to the morbidity and
mortality of the resulting fractures and the associated healthcare expenditure,
particularly as aging populations increase in many parts of the world. As there is
no cure, it is important to identify early life influences on later bone mineral
density, which may aid the development of interventions to optimize bone health
and reduce osteoporosis risk.

TYPES OF FRACTURES DUE TO OSTEOPOROSIS

Hip fractures
Hip fractures are responsible for the most serious consequences of
osteoporosis. In the United States, more than 250,000 hip fractures annually
are attributable to osteoporosis. A 50-year-old white woman is estimated to
have a 17.5% lifetime risk of fracture of the proximal femur. The incidence of
hip fractures increases each decade from the sixth through the ninth for both
women and men for all populations. The highest incidence is found among men
and women ages 80 or older.

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Vertebral fractures
Between 35 and 50% of all women over 50 had at least one vertebral fracture.
In the United States, 700,000 vertebral fractures occur annually, but only
about a third are recognized. In a series of 9704 women aged 68.8 on average
studied for 15 years, 324 had already suffered a vertebral fracture at entry
into the study and 18.2% developed a vertebral fracture, but that risk rose to
41.4% in women who had a previous vertebral fracture.

Wrist fractures
In the United States, 250,000 wrist fractures annually are attributable to
osteoporosis.[135] Wrist fractures are the third most common type of
osteoporotic fractures. The lifetime risk of sustaining a colles fracture is about
16% for white women. By the time women reach age 70, about 20% have had at
least one wrist fracture.

Rib fracture
Fragility fractures of the ribs are common in men as young as age 35. These are
often overlooked as signs of osteoporosis, as these men are often physically
active and suffer the fracture in the course of physical activity. An example
would be as a result of falling while water skiing or jet skiing. However, a quick
test of the individual's testosterone level following the diagnosis of the
fracture will readily reveal whether that individual might be at risk.

- Medications

- Alendronate (Fosamax), a weekly pill

- Risedronate (Actonel), a weekly or monthly pill
- Ibandronate (Boniva), a monthly pill or quarterly intravenous (IV) infusion
- Zoledronic acid (Reclast), an annual IV infusion

Also, daily vitamins and calcium pills can be beneficial.

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There typically are no symptoms in the early stages of bone loss. It is highly
essential to visit doctor or go for a check-up regularly if one feels that there is
risk of fracture or unreasonable pain. You might want to talk to your doctor
about osteoporosis if you went through early menopause or took corticosteroids
for several months at a time, or if either of your parents had hip fractures But
once your bones have been weakened by osteoporosis, you might have signs and
symptoms that include:

- Back pain, caused by a fractured or collapsed vertebra

- Loss of height over time
- A stooped posture
- A bone that breaks much more easily than expected

Who gets osteoporosis?

Osteoporosis is common in the UK, and the risk increases with age. Anyone can
get osteoporosis but women are about four times more likely than men to
develop it. There are two main reasons for this:

The process of bone loss speeds up for several years after the menopause,
when the ovaries stop producing the female sex hormone oestrogen.

Men generally reach a higher level of bone density before the process of bone
loss begins. Bone loss still occurs in men but it has to be more severe before
osteoporosis occurs.

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• Causes -

A number of factors can increase the likelihood that you'll develop

osteoporosis — including your age, race, lifestyle choices, and medical
conditions and treatments, some unchangeable risk etc. some include: -

- Lack of estrogen in the body – If you have an early menopause (before

the age of 45)
- Lack of weight-bearing exercise – Exercise encourages bone development,
and lack of exercise means you'll be more at risk of losing calcium from
the bones and so developing osteoporosis.
- Poor diet – If your diet doesn’t include enough calcium or vitamin D, or if
you're very underweight, you'll be at greater risk of osteoporosis.
- Heavy smoking – Tobacco is directly toxic to bones. In women it lowers
the estrogen level and may cause early menopause. In men, smoking lowers
testosterone activity and this can also weaken the bones.
- Heavy drinking – Drinking a lot of alcohol reduces the body’s ability to
make bone. It also increases the risk of breaking a bone as a result of a
fall.
- Family history – Osteoporosis does run in families, probably because
there are inherited factors that affect bone development.

Other factors that may affect your risk include: ethnicity, low body weight,
previous fractures, medical conditions.

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The extent to which osteoporosis affects the life of a person can be varied
depending on the severity of their condition. Some people may be restricted in
terms of performing household chores, going for long walks, perusing interests
like gardening, knitting, dancing, cooking etc., while others may find little to no
difference in their day-to-day lives. Nevertheless, most people suffering for
osteoporosis may have an
attitude change with respect to
the caution they take when
carrying bags or bending to lift
things from the floor. Since it is
a condition which affects the
strength of bones, senior
citizens are likely to face more
problems when dealing with it.
Weak, brittle bones make
everyday life increasingly
difficult for senior citizens and
bring about a number of
challenges, including:

 Falls and Fractures

One of the most common effect of osteoporosis is poor balance control. It

gets difficult to carry the weight of the body due to the loss of bone and
muscle mass, and fragile bones which leads to frequent falls or fractures.
Spinal, hip and wrist fractures are common in senior citizens with
osteoporosis. The muscles also become weaker and some may face a change
in their posture. Hunched back, change in walking style or gait, loss of
height are all possible effects of osteoporosis or fractures in the elderly.
Some may even suffer from breathing or digestive issues due to spinal
fractures.

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 Pain

a) Bone fractures are painful, and patients with osteoporosis often

experience persistent pain. Though the initial pain normally subsides
by the end of the healing and rehabilitation period (6 to 8 weeks),
one might also experience pain due to a series of compression
fractures in the spine. For
instance, in some cases, spinal
fractures can occur even without
falling due to the weakening of
the bones in the spine to the
point of crumbling. When the
spine collapses from such
fractures, it curves over, pushing
the stomach forward. This
affects the ribs, which often end
up sitting on the pelvic bone,
causing the rubbing of bone against
bone which in turn leads to pain.

b) Senior citizens may have a low threshold towards pain due to various
factors such as age or other health related issues, which might make
it harder for them to cope with osteoporosis. It is necessary to have
an accurate diagnosis of the pain in order to be aware of or rule out
other serious conditions.

 Limited Mobility and difficulty with certain tasks

a) Persistent pain and fractures take time to heal which makes mobility
a challenge. This in turn makes osteoporosis worse and cause other
health problems as well. For instance, hip fractures are common for
people with osteoporosis, and the treatment for a hip fracture can
include staying in bed for a long period of time. This can increase the
risk of blood clots, bed sores, stiff joints, pneumonia and other
infections.

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b) Most find it difficult to go for walks or do certain physical tasks for
a longer period of time and require breaks every once in a while to
avoid the onset of pain. For example, someone who has a passion for
gardening, may find it difficult to manage tedious jobs such as
digging, lifting pots or mowing the lawn. Thus they resort to sitting
on stools and taking short breaks while gardening. Even knitting
might become a challenging task for some since their hand starts
paining while holding the needle.

c) Senior citizens also find it difficult to manage daily tasks such as

shopping or lifting grocery bags on their own. They may need to take
the help of their family, friends, caregiver or a stranger to carry
their shopping bags, or remove stuff from the higher or lower
shelves in a supermarket.
This can cause a feeling of
embarrassment, helplessness
and guilt because of not being
able to perform daily tasks
without help, and burdening
others to do it for them.
Although these things can be
easily managed by online
shopping, it might be
challenging and confusing for
some senior citizens to learn
and use the benefits of technology
effectively.

d) For a few people, dressing up and personal care can also be a problem.
Bending down and putting socks/tights, pants and shoes can be
difficult for them. Thus they need the assistance and support of
either their family or hired help.

e) Cooking can also be bothersome for a few. Lifting heavy utensils,

standing while cooking, kneading the dough can get challenging for

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 older people with osteoporosis. This, along with the earlier points
can be a major hindrance for older people who live alone.

 Changes in Lifestyle

Along with being cautious about lifting things or bending, there are some
lifestyle changes that a person suffering from osteoporosis might have to
make:
a) Changes in the diet would be necessary to strengthen the bones.
Foods which are high in calcium and Vitamin D substitutes must be
included in one’s diet.
b) Including exercising in their daily routine would be helpful to control
their weight and also increase the bone mass. This can be challenging
for some senior citizens since the only form of exercise they are
comfortable with is walking. And even when it comes to walking, they
may have the fear of falling on certain surfaces.
Some also prefer resorting to yoga or Tai Chi to strengthen their
emotional well-being along with their physical well-being.

c) Smoking must be stopped and alcohol can be consumed only in

moderation.
d) Senior citizens would also need to install some support equipment
like handrails in the bathroom, on stairs and around the bed;

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 elevated toilet seats, extra steps, and rubber mats or rough tiles in
bathrooms to avoid the risk of falling.
e) Some might have to resort to using a wheelchair or a walker for
moving around.

 Financial Burdens

a) Osteoporosis can turn out to be an expensive condition for senior

citizens or those who have frequent falls or severe osteoporosis.
Along with trips to the hospital for fractures or check-ups,
physiotherapy and occupational therapy is recommended which can
be an expensive affair.
b) In case of senior citizens with severe osteoporosis, it is advisable to
have someone who can support them throughout the day. Thus, hiring
a professional nurse or caregiver is an additional cost that they
might have to bear in order to avoid frequent falls and pull through
daily activities with relative ease.
c) Buying comfortable equipment and gadgets, making necessary
changes in the house for better adaptability and mobility would also
lead to an increase in the financial burden.

 Depression

a) Studies have shown a correlation between bone loss and depression.

Those with osteoporosis experience depression and feelings of
isolation because of pain and limited mobility. Their emotional well-
being takes a toll during difficult times which can cause mental
issues.
b) Changes in the appearance (abnormal posture, deformed frame,
stooped shoulders) can be a cause of embarrassment and isolating
oneself from the outside world. This leads to loss of self-esteem,
loneliness and depression.
c) Loss of control or independence over one’s own life can also be a
cause of depression in patients with osteoporosis. It is difficult for

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 them to accept help for basic things that they probably could earlier
manage on their own.
d) The financial burdens can also have a negative effect on the patient’s
sense of well-being and security.

 Death

Though osteoporosis in and of itself is not a fatal disease, there is still a

chance of death in some cases. For any kind of fracture, surgery would
surely be required for the senior citizen. This could lead to multiple
complications during, as well as after the surgery. Studies show that most
elderly pass away within the first year of their surgery. This unfortunate
possibility of death in such situations is because the patient is unable to
cope with the pain, medications needed, treatment provided or care that is
required after the surgery.

The support from family and friends plays a very important role for the elderly
who are struggling with osteoporosis. But this silent disease negatively impacts
not only the patient, but also their family.

 Because of limited mobility and other restrictions, patients might feel

a wide range of negative emotions, all which are directed upon those
close to them. A lot of medicines also have side
effects such as mood swings, nausea,
headache which all lead to frustration for
the patient. This can get difficult for the
family members to handle if it occurs
frequently. Constantly being at the
receiving end of negative comments,
irritations, anger, frustration etc., can be
exhausting for them. It also gets difficult
for them to get a break from their duty if the
patient is solely dependent on them.

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 A lot of care and caution needs to be administered to senior citizens
with osteoporosis. In case they cannot afford some hired help, it is the
family members who support the patient completely. This can get
physically as well as emotionally taxing since they have to look after not
only their routine life, but also give special attention to the elderly.
 Adjustments in diets and schedules need to be made with respect to
the convenience of the senior citizen.
 Osteoporosis can affect the closest relationships as well as more
distant ones. In case even one of the partners suffers from
osteoporosis, tension can build between them since both try to adjust
with the changes in lifestyle that come along with it.
Intimate relations are often strictly limited or stopped altogether due
to the fear of causing fractures. This can lead to the couple drifting
apart.
 In most scenarios, the one who takes care of the patient is the one who
deals with majority of the negative comments and behaviors. They are
rarely appreciated for their efforts and help, and this can lead to
discouragement and lack of motivation to help on the part of the helper.

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 Learning that osteoporosis disease has NO cure can damage one
emotionally as well as physically. But proper treatment can help protect and
strengthen, slow the breakdown of bone in your body, and some treatments
can spur the growth of new bone. If one not in the right mindset when
dealing with critical life moments, it can negatively affect every aspect of
your life from work to family and even social engagements. Feelings and
thoughts about osteoporosis varied depending on how the condition
affected their everyday life. People whose lives were not changed or only
slightly changed, by osteoporosis said that it had not affected them too
much emotionally. Others remarked that their initial reactions to their
diagnosis had improved as they learnt more about the condition and its
management. Positive thoughts and a pro-active attitude have helped
others cope with physical problems.

1. Counsellors can help the client to regulate their emotions and not to
stuff it. *(Remember client can the person diagnosed with osteoporosis
or any caregiver of it)

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- Counsellors should engage the clients to embrace their feelings. It’s 100%
natural to feel stressed and anxious about it. Remember embracing your
emotion means acknowledging your emotions regarding your diagnosis is not
the same as accepting it as inevitable or incurable. Some people described
feeling a range of emotions including: denial, shock, anger, ‘lucky’ to have
been diagnosed, depression, sadness, fear of falling and having a fracture,
lack of confidence following a fall and fracture, loss of independence in old
age, fear of disability, positive and confident etc.

- E.g.- the clients left the doctor’s office with pamphlet containing
information on various drugs and drug treatment options. Also, Google and
the internet has added to his anxiety levels. He is faced with conflicting
information from a variety of different sources- some trustworthy, and
some, not so much. Here the counsellor should tell them to take unhurried
deep belly breath to help him calm down and then can give factual
information to the client and recommend doctors which are well known and
‘SUITABLE’ for the client. Also mention that Don’t be too hard on yourself.
You’re allowed to be overwhelmed with a wide range of emotions concerning
the steps to come. Once they are able to harness feelings, you can begin to
move past them into solution mode. Give yourself permission to ask for help
from friends, family and even strangers. Also accept help when offered.

2. Counsellors can help create appropriate solutions and make SMART goals
for them and their caregivers.

- Everyone is unique. What works for one person won’t necessarily be the
best option for someone else. Counsellors have to be aware how their
mental and physical body works and provide guidance on that. Stress,

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 anxiety, depression, lack of support [environmental/financial] along with
physical health problems can be present. Hence it is important to maintain
emotional wellness with simple practical ways. Here are some ways to
overcome stress and anxiety.
- While solving physical problems associated with osteoporosis is important,
it’s equally important to treat your mental well-being. Break tasks into
manageable bits and deal with them one at a time.

a. EXERCISE - Certain exercises can also help prevent further bone loss
while you’re working to rebuild bone mass through supplementation and
lifestyle changes. Weight bearing exercise, Walking, Jogging, Climbing
Stairs, music/dance and movement, tai chi, Pilates, Barre and Yoga.
Listening to music when working out helps you move to the beat or flow
of the music, but it also has stress-relieving effects. Work with a
physical therapist - they help you design an exercise program that’s
best for you and find safe and effective ways to do your day-to-day
activities. Be in touch with bone health care team (physician, clinical
nurse, pharmacist, dietitian, physiotherapist, occupational therapist,
endocrinologist and geriatrician.
b. MEDIDATE - Taking a short amount of time out of your daily routine to
practice these techniques can add to your overall quality of life. When
practiced regularly, visual meditation allows your brain to develop new
pathways that can help with some of the following symptoms associated
with high anxiety levels: Hard-to-Control Worries, Poor Sleep,
Irritability etc.
c. BREATHING- Properly practice mindful breathing exercises to ease
stress and anxiety. Try to practice mindful breathing at least 15
minutes a day. If the thought of finding 15 spare minutes adds to your
stress level, start with 5 or even 3. Find a position (sitting or lying down)
that helps you feel calm and relaxed. Take it one breath at a time.
Notice how each breath feels as you inhale and exhale. If you notice
your mind wandering, simply redirect your thoughts to your breathing.
d. SPEND TIME WITH NATURE - Beauty of nature has a way of easing
the mind. Whether you’re upset, depressed or simply have a headache,
tuning into the sounds, smells, and beauty of nature can have a positive
effect

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 e. EAT NUTRITENT DENSE FOOD - Choosing nutrient-dense foods can
provide natural stress relief. Eliminate behaviours that are bad for your
bones, such as smoking and drinking excessive amounts of alcohol (more
than two drinks a day) or beverages that contain caffeine (more than
four per day). Get the recommended daily intake of calcium – ideally
from food. Adopt a bone-healthy lifestyle - Your bone health is not just
a medical concern. It requires attention to your lifestyle. Also make
sure to decrease the risk of the fracture.
f. BUILDING SUPPORT SYSTEM - Friends and family are a great support
system. However, it may be difficult for them to understand exactly
what you’re going through, especially if they haven’t gone through it
themselves. For some, it can be hard to speak openly about difficult
subjects with those closest to them. One may feel that you’re adding
some sort of burden to them when talking about hard to discuss topics-
although, they’d likely disagree.

• Seek professional advice: A professional therapist will listen to your

feelings and provide you with ways to change your thought patterns for the
better. They will also receive effective and healthy coping mechanisms
specifically tailored for them. Get help for depression. There are
medications and psychotherapies that can help people with depression.

E.g. Fear of falling in kitchen and bathroom can be a major concern for them.
Changes in your appearance due to osteoporosis also can affect your emotional
health. Many people with osteoporosis have abnormal curving of the spine and
can’t stand up straight, when you see yourself so stooped, it can have an emotional
impact. You also may lose height. Abnormal posture and deformity may cause you
to feel embarrassed. You may become reluctant to be seen in public so you don’t
go out. But staying away from friends and family can lead to loneliness, which can
lead to depression. Self-esteem may also be affected by osteoporosis. Physical
problems, like carrying or lifting, left many of those we talked to with a feeling
of losing control and realisation that they need to be dependent on others and
can lead to low confidence which also affects personal and professional life.
Sexuality and intimacy are important aspects of life. Sexual desire may not be
affected by the disease, but there may be physical limitations imposed by chronic
pain, fatigue or low energy levels, and fear of fracture. A person with

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osteoporosis may worry about not being able to please a healthy partner. They
may have anxiety either about their own bodies or about causing harm to their
partner may result in impotence. Other factors that may contribute to
unsatisfactory sexual relations include: Changes in physical appearance, Negative
self-image, Limited mobility, dealing with everyday survival, Altered emotional
state, Avoidance etc.

- If sexual life is being affected by a diagnosis of osteoporosis, partners may

want to consult with a professional such as a psychotherapist or sexual health
clinician to discuss your concerns. This person may be able to help you explore
different sexual techniques and alternative methods of achieving intimacy.
Touching, hugging, open communication and patience are as important as sexual
performance in maintaining emotional intimacy. A willingness to explore and a
sense of humour don’t hurt, either!

- Several therapies have been adapted for use with elderly people, including
Rational Emotive Behavior Therapy (REBT) and Cognitive Behavior Therapy (CBT).
These two therapies emphasize the importance of irrational or dysfunctional
beliefs in the creation of emotional disturbance, and tend to use a number of
cognitive, emotive, and behavioral methods of disputing and changing these
beliefs for more functional ones.

• Join support group: Participating in a support group for people with

osteoporosis can help you see you’re not alone, People who live with the
condition often have the best coping tips and share them in support groups.
• Find a community of like-minded people / do what makes you happy /
find your hobby: Whether it be an in-person support group or an online
forum, talking to someone with similar problems or goals can be encouraging
for them. Let them engage in their hobby and do what makes them happy.

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1. ARTHRITIS FOUNDATION OF INDIA TRUST (AFI)

AFI works with an aim to take Osteoporosis and Bone Health knowledge to
common people, for which they undertake various communication programmes.
The whole idea of making AFI was to carry out organized social work in the field
of osteoporosis and place this issue on the National Health Agenda.AFI regularly
holds awareness and free health check-up camps where Free Bone Mineral
Densitometry test and medicine distribution is done. For AFI it’s an on-going
effort, they have tried to make people conscious by successfully organizing free
BMD camps, literature distribution and education through video presentations
and also publishing articles on Osteoporosis. The organization also wishes to have
creative partnership with diverse organizations to realize their goals as no health
campaign is complete without involving members from other social fields.

2. HELPAGE INDIA

HelpAge India opened ‘Aarogya Kavach- a multi-facility health package ‘in

Puducherry in 2015.With musculoskeletal disorders being all too common in old
age, many suffer silently without access to help which can improve their
condition.Recognising the acute need for geriatric physiotherapy, especially for
those who cannot afford such services, NGO HelpAge India has been
implementing ‘Aarogya Kavach- a multi-facility health package’ in centres across
India. With two sections, preventive and curative, the equipment are specially
designed for use by the elderly. It focuses on the fitness and rehabilitation of
users. It targets ailments like back pain, arthritis, osteoporosis, muscle atrophy,
gait and balance problems, and other age-related mobility challenges.
Some of the equipment include the physiotherapy electro therapy combo
machine which has a muscle stimulator for stroke patients, Interferential
therapy unit and a TENS unit.package’ in centres across India.

3. OSTEOPOROSIS FOUNDATION INDIA (OFI)

OFI works in collaboration with International Osteoporosis Foundation
It is a Registered Not-for-profit Indian organization founded in 2008.
It is dedicated to Women's Health, funding Innovative Research and Improving
the Quality of Life for people suffering from Osteoporosis and supports Bone
Science through grants, publications and educational programs.

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4. INTERNATIONAL OSTEOPOROSIS FOUNDATION:

Partnering with 209 national societies in 96 global locations, as well as scientists

and companies around the world, IOF works towards the prevention, diagnosis
and treatment of osteoporosis and bone, muscle and joint disorders.

The main focus of their efforts is on:

Research-IOF is at the forefront of research in the field of bone, muscle and

joint disorders

Training and Education-IOF provides training and resources to ensure bone,

muscle and joint disorders are addressed

Promoting our Global Network-IOF works with organizations around the world
to improve bone, muscle and joint health

Policy and Advocacy-IOF calls on decision-makers to make bone, muscle and

joint health a priority for healthcare systems

Global Campaigning- IOF leads a global movement for change to raise public
awareness and promote action on bone, muscle and joint health.

5.RELIVA- PHYSIOTHERAPY AND REHAB

ReLiva Physiotherapy is a physiotherapy specialist with a wide network of

Physiotherapy clinics, outsourced physiotherapy for hospitals and home visits.
They offer service for a wide variety of conditions like back pain, frozen
shoulder, knee pain, fractures & dislocations, joint replacement surgeries, rehab
for Cardiac, Neuro and Respiratory conditions, Sports injuries, osteoporosis etc.
The organization is ISO 9001:2008 certified and are dedicated to delivering
the highest standard of patient care and provide highly advanced Physiotherapy
and Rehab service.
Their approach to recovery is quite unique. The institute believes in actively
involving the patient in designing their own treatment. That is why their main
focus on educating patients and their family about physical condition, its causes
and effects. The institute aims not only at recovery but also on training the
patients and their caretakers to maintain the activity levels of the patient even
after the treatment is over and guide them on how to prevent injury or
recurrence of a specific condition in future.

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• https://www.algaecal.com/expert-insights/emotional-wellness-
osteoporosis/
• https://www.osteoporosis.ca/multimedia/pdf/publications/Living%20Well
%20with%20Osteoporosis%20booklet_EN.pdf.pdf
• https://healthtalk.org/osteoporosis/feelings-and-thoughts-about-
osteoporosis
• https://www.orthopaedicinstitute.com/new/how-osteoporosis-can-affect-
your-emotional-health
• http://link.springer.com/article/10.1023/A:1023017013225
• https://healthtalk.org/osteoporosis/impact-on-home-life-due-to-
osteoporosis
• https://www.24hrcares.com/osteoporosis/home-care/
• https://www.mayoclinic.org/diseases-conditions/osteoporosis/symptoms-
causes/syc-
20351968#:~:text=Having%20a%20parent%20or%20sibling,draw%20fro
m%20as%20they%20age
• https://www.osteoporosis.ca/multimedia/pdf/publications/Living%20Well
%20with%20Osteoporosis%20booklet_EN.pdf.pdf
• https://www.nof.org/patients/treatment/overall-health/

• https://www.thehindu.com/news/cities/puducherry/addressing-the-
acute-need-of-geriatrics/article8039498.ec

• https://www.arthfound.org/oesteroporosis.php

• https://www.helpageindia.org/bone-health-with-ageing/

• https://bonehealthindia.weebly.com/

• https://reliva.in/osteoporosis/

• https://www.mayoclinic.org/diseases-
conditions/osteoarthritis/symptoms-causes/syc-20351925

• https://mydoctorfinder.com/healthy-blogs/view-article/6-causes-of-
osteoporosis

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