OSTEOPOROSIS CASE STUDY: BETTIE CILLIERS (SOUTH AFRICA)

Whether you are already diagnosed with osteoporosis or you are unaware you are at risk, a fracture may well become a reality – sometimes caused by a simple misadventure that in a younger, stronger boned person would not cause a problem.

Rehabilitating a fracture, especially if your bones are already compromised by osteoporosis can be a tricky business.  Such was the case with Bettie Cilliers (82) living an independent life in her own home in a retirement village in Durbanville, South Africa, when she broke her arm after slapping a cricket with a towel against the wall. The debilitating injury caused her arm to slide out of its socket and ruptured her shoulder muscles.

She was diagnosed with osteoporosis. She had never received a diagnosis before, yet the silent disease already settled in her bones long before. An operation followed with four months of intensive physiotherapy, as well as carers who helped her to bathe, get dressed and cooked her dinner. Bettie has 4 children, 3 of whom are living in South Africa and took turns to look after their mom during her rehabilitation.

Up to that point she was still driving and enjoyed spending time with friends and family.  Life returned to normal, or that is what she thought. A year later she was getting out of the car when she stumbled and landed on the paving causing another severe fracture to the same upper arm. This time the orthopaedic surgeon had to insert screws and a plate, she was admitted to a step-down facility for rehabilitation and later had to spend time in the frail care centre of the retirement village where she lives.

Bettie developed an infection in the wound and on inspecting her x-rays her doctor found that the plate and screws inserted in her arm had moved, since her bone was  very fragile. A second plate was inserted at that stage. The whole procedure repeated itself and she was again admitted to the frail care centre and had to receive intensive physiotherapy.  One morning while sitting on her bed she fell and again broke the bone on the same arm. A third plate was inserted, followed by months of occupational therapy and physiotherapy.

 

Caption:  An X-ray showing the screws and plates inserted into Bettie’s arm

Throughout this time her children had been extremely supportive but also realised that their mother was a fall risk and that she could no longer live on her own. They had to sell her home and settled her in a flat that became available in the main retirement centre.  They also appointed a full time caregiver to look after her.  She is no longer receiving full time care, but is receiving adequate monitoring and care by the retirement village staff.

The long-term result of these fractures meant that Bettie would only always have 25% use of her arm.  Her surgeon also indicated that if she falls again and injures her arm, there would be severe implications.  Some major life changes took place. Her car was sold as she would never be able to drive it again. Any clutter and loose carpets in her apartment were removed. When she wants to go for a walk, she needs to take along a panic button and concentrate only on her walking to prevent her from falling. She has extra grab rails in her bathroom and her privacy has been severely impacted since staff need to monitor her day and night. She also regularly visits the retirement village gym to strengthen her muscles.

Bettie admits that awareness of osteoporosis is important, since she had no indication that she had the disease until she fell. Subsequent to her ordeal her children have gone for bone density scans and understand the importance of taking Vit D3 and doing weight-bearing exercises.  Her children admit that it was difficult to see their mom give up her independence and felt responsible for her even though they could not be with her the entire time. They also feel guilty that they did not pick up any signs that she had this disease. Living more mindfully and being body aware is one of the lessons she had to learn, such as getting up slowly, turning around slowly and remaining aware of her body’s position in space the whole time.

 

Caption:  Bettie with her daughter Mitzi who helped to take care of her

It is clear that we should create more awareness about the disease. The fact that it is known as the ‘silent’ disease is not helpful. Education should begin in the school years as to the prevalence and danger of the condition – and that it is not necessarily a decline associated only with old age.

Fragility fractures impose a tremendous burden on our older people, their families and carers, and our economy. A broad range of osteoporosis treatments, available in an array of dosing regiments, have been shown to significantly reduce the risk of hip fractures, vertebral fractures and other clinically apparent fractures.

Visit www.osteoporosis.org.za for more information and help us to create noise.