Osteoporosis – How Can Fractures Be Prevented?

Winter is upon us and along with holiday cheer comes the beautiful yet hazardous snow and ice. Osteoporosis is the most common type of bone disease, characterized by a decrease in bone density, which can lead to fracture.

Bone is living tissue. Existing bone is constantly being replaced by new bone. Osteoporosis (OP) occurs when the body fails to form enough new bone or when too much bone is reabsorbed by the body, or both. OP is silent until you have a fracture. Fractures are most likely to occur in the hip, spine and wrist. About half of all women over the age of 50 will have a fracture in one of these during their lifetime due to OP.

The lifetime risk of hip fracture is 6 percent for men and three times as common in women. Approximately 90 percent of hip fractures in the elderly occur from a simple fall from the standing position. One in five hip fractures results in death within a year of injury and one in three adults who lived independently before their hip fracture remains in a nursing home for at least a year. These are frightening statistics. So, how can we prevent hip fractures?

— Most importantly, prevent falls. Patients can reduce their risk of falling by exercising regularly. It is important that the exercises focus on increasing leg strength and improving balance. Tai Chi programs have proven benefit as has consultation with a physical therapist.
— Have your doctor review your medications and consider stopping the ones that can cause dizziness or drowsiness.
— See your ophthalmologist at least once a year and consider getting a pair of eyeglasses with single vision distance lenses for some activities such as walking outside.
— Make homes safer by reducing tripping hazards, adding grab bars inside and outside the tub or shower and next to the toilet, adding railings on both sides of stairways, and improving the lighting in their homes.
— Get adequate calcium and vitamin D from food and/or from supplements.
— Have a DEXA (bone density scan) and consult with your rheumatologist if you need medication for osteoporosis.

There has been a lot of controversy this year about calcium. Recent studies have raised concern about an increased cardiovascular risk with the use of calcium supplements, but the findings are inconsistent and inconclusive. Two large prospective studies showed that the use of calcium was associated with an increased risk of cardiovascular events (CV) or death, but a large Canadian prospective study and the extended follow-up of the Women Health Initiative (WHI) trial showed no significant association between use of calcium supplements and CV events. In addition, neither the Framingham Heart Study nor the WHI trial showed a relationship between the use of calcium supplements and the coronary calcium score, a sign that calcium is depositing in heart vessels.

Adequate calcium is important for skeletal health at all ages. Inadequate calcium intake in adults is common especially in the elderly and is associated with increased bone loss and fracture. The recommended dose for women ages 9 to 50 years of age and men 19 to 70 years of age is 1000 mg per day; women older than 50 and men older than 70 require 1200mg per day.

Vitamin D helps with intestinal absorption of calcium. Vitamin D stores decline with age, especially in the winter. Controlled trials have demonstrated that vitamin D and calcium supplementation can reduce the risk of falls and fractures in the elderly. Although the optimal Vitamin D level to maintain skeletal health is not firmly established, levels 30 to 55 ng/mL, are supported by observational studies. In addition, Vitamin D may have several other putative benefits, including beneficial effects on the immune and cardiovascular systems.

Make sure your New Year’s resolution includes exercise, getting enough calcium and vitamin D and eating a well-balanced diet.