Fragile Bones – Don’t Let it Happen to You
By Dr. John C. Redfern, Colorado Springs Orthopaedic Group, Colorado Springs LIVING WELL Magazine
Many people live their entire life without a broken bone until they reach their elder years. Then, suddenly, they are dealing with a broken hip after a simple fall at their home. This is a story heard too many times in the emergency room and orthopaedic surgery office. Almost always, the broken bone is due to osteoporosis or “brittle bone disease.” Osteoporosis is a bone disease where the bone looses mass and strength. While it is normal for bone to weaken with age, some people advance more quickly than others, and these are the folks who may be at risk for a fragility fracture.
Osteoporosis affects about 34 million Americans and is expected to increase almost 50% by the year 2020. Eighty percent of those with osteoporosis are women, and approximately 1 in 2 women and 1 in 8 men over 50 years of age will have an osteoporotic fracture in their lifetime. Half of those who sustain an osteoporotic hip fracture are unable to walk without a cane or walker, and almost 25% have an increased risk of dying within a year following their hip fracture. Overall, osteoporosis is estimated to cost U.S. healthcare $14 billion annually or roughly $38 million per day!
So what can you do? First, be aware of the risk factors that may increase your chances of having osteoporosis. Certain risk factors are not in your control: increasing age, family history, female gender, certain medications, and ethnicity. Latinos have the highest risk closely followed by Caucasians and Asians. African Americans are fairly low risk. Other risk factors may be more modifiable: smoking, postmenopausal state, testosterone deficiency, inactive lifestyle, excessive alcohol consumption, and poor nutritional intake. Additional risk factors other than those listed above for sustaining a fragility fracture are: impaired vision despite correction, dementia, history of falls, and overall poor health/frailty. If you have one or more of these risk factors, it may behoove you to be tested for osteoporosis.
Osteoporosis can easily be determined with a simple bone mineral density test also known as a DEXA scan. This test is recommended to those with a history of a fragility fracture, all women over 64 years old, all men over 50 years old with risk factors, and postmenopausal women less than 65 years old with risk factors. Your primary care physician typically orders this test, and if it indicates you are at risk, there are steps you can take to decrease your chance of sustaining a fragility fracture.
Multiple treatment options for osteoporosis exist. It can be as simple as taking a vitamin D and calcium supplement. Vitamin D deficiency is easily determined by a simple blood test. Incorporation of an exercise routine can help build stronger bones and increase balance/muscle control. House modifications can be implemented to help prevents falls: handrails on stairs and in the bathroom, remove clutter from floors, wear supportive low-heeled house shoes, use bright light bulbs in all rooms, place a rubber mat in the shower/tub, keep a flashlight at bedside, keep walkways free of cords/wires, use skid-proof backing on rugs, keep a week supply of prescription medicines on hand, and maintain daily contact with a family member/neighbor/monitoring company. Lastly, prescription medications may be recommended to help increase your bone strength.
Prescription bone strengthening medications are generally termed bisphosphonates. These are bone-building medications that prevent bone resorption and are important in avoiding debilitating fractures. The bisphosphonates have gained attention in the press recently for some rare side effects and as with any medication, this should be discussed with your prescribing physician prior to instituting this therapy. As always, the patient must weigh the significant risks of fracture and its consequences versus a rare side effect before deciding to take this medication.
When all else fails, and you have arrived in the emergency room with a hip fracture, your options are very limited. Hip fractures are typically treated with a hip replacement or holding the broken bones together with a metal plate or rod. The key to treating hip fractures is to avoid having one in the first place. Hopefully, implementing some of the above strategies will help prevent you from an unexpected visit by the orthopaedic surgeon in the emergency room.
John C. Redfern, MD, is a shoulder & sports medicine specialist with Colorado Springs Orthopaedic Group and may be reached at 719-632-7669 or 719-574-8383.