More than just a slip on the ice

By Kenneth G. Swan, Jr., M.D.

Black ice.That is what caused the elderly woman to fall and break her hip. However, this woman had a less apparent risk factor than her slippery sidewalk: osteoporosis. According to the International Osteoporosis Foundation, approximately 9 million osteoporotic fractures happen every year, worldwide.

Though my patient slipped on black ice, a simple fall in the kitchen or bathroom is a more typical scenario.A frightening, painful experience often ensues. Regardless of the place or mechanism of injury, the broken hip almost always requires hospitalization, surgery and often a prolonged stay at an inpatient nursing facility. Complications can arise, and a significant percentage of patients (up to 30 percent, according to some studies) do not survive the year ahead. Fortunately, there are things we can do to prevent, diagnose and treat osteoporosis.

Osteoporosis is a weakening in the quality of the bones that occurs with increasing age White females, of European or Asian descent and smaller stature, are at highest risk. However, elderly men are at risk as well.Any race can develop osteoporosis. Cigarette smoking, alcohol abuse, certain medications (such as corticosteroids) place people at risk, as do diabetes and chronic kidney disease. In addition, those people whose parents had a low-energy fracture related to osteoporosis are at high risk for having the same problem themselves.

 

Frail, elderly patients may suffer more falls because of balance and visual changes, and their bones may not tolerate the force of a simple fall. The hip commonly breaks and usually will not heal without surgery. Depending upon the specific characteristics of the break, the fractured bone may be repaired or replaced. This all-too-common scenario does not have to be inevitable, though. If you are under age 50, you can help prevent osteoporosis: diet, exercise and smoking cessation can go a long way for many parts of your body, including the skeleton. Your bones need vitamin D and calcium. Remember the number 1000.A well-balanced diet, with ample amounts of dairy and produce, will help get you to the recommended daily allowance of calcium and vitamin D. Milk and orange juice are fortified with both nowadays. Supplementing your diet now with at least 1000 mg of calcium and 1000 I.U. of vitamin D each day will help you reach your daily needs.

Your muscles and bones like regular weight-bearing exercise. Building muscle strength and stressing your bones at a young age helps create a more robust skeleton for the future. Regular walking or running, or working out with weights, are good forms of weight bearing activities.

For those age 50 and older, you need to consider regular screenings for osteoporosis. A DEXA scan is a non-invasive test that measures bone density. Bone is quantified as normal, osteopenic or osteoporotic. Bone density should be checked every two to three years. People in this age group should be taking calcium and vitamin D supplements (remember 1000!) and exercising. Studies show that regular exercise, including weight training and classes such as tai chi, can help prevent falls and fractures by improving strength and balance.

If your DEXA scan reveals osteoporosis, or significant osteopenia in the presence of other risk factors (such as a prior fragility fracture or family history of osteoporotic-related fracture) then you may be a candidate for prescription medication treatment to prevent a serious fracture. Discuss this with your primary physician or gynecologist at your next appointment.

Once a broken bone has occurred, action should be taken both to treat that fracture and to prevent the next one.A simple wrist fracture that needs a cast should be cause for concern of an impending, more serious hip fracture.This fact should not be ignored, and treatment with one of the osteoporosis medications (for example Fosamax or Boniva) should be strongly considered.

Osteoporosis medications can have some side effects, some of which can be serious. However, these medications work well with minimal downside in the majority of patients.They improve bone density and are an appropriate treatment option in patients at risk for a hip or spine fracture.

People are living longer these days. Yet an injury or a hospitalization can really slow them down. Prevention is the best medicine. Consider this in your lifestyle choices, as well as at your next doctor’s visit. In the meantime, watch out for that black ice!

Board certified orthopedic surgeon Dr. Kenneth Swan Jr. is a member of the Human Motion Institute at Raritan Bay Medical Center, a comprehensive musculoskeletal program dedicated to returning patients to normal activities quickly and safely, with help from a nurse navigator who guides patients and their families through surgical care. Dr. Swan has offices in Perth Amboy and Wall Township; to make an appointment, call 855-5-MOTION.