Download More Than Just a Slip on the Ice

More Than Just a Slip on the Ice
By: Kenneth G. Swan, Jr., MD
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% 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
1000mg 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 2-3 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. 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, NJ; to make an appointment, call 855-5-MOTION.