Volume 18, No. 3, Summer 2010
By Jean Talbert, M.D.
Over 300,000 hip fractures occur in this country each year, most often among the elderly as a result of a fall at home. Caucasian postmenopausal women are at the greatest risk.
One in seven will sustain a hip fracture during her lifetime and the rate increases to 50 percent by age 90. Most of these require surgery and hospitalization.
More ominous, one in four remains in a nursing home for at least one year after a fracture and 20 percent die within 12 months. For those who survive, hip fractures can lead to such long-term problems as loss of independence, depression, additional surgery and chronic pain.
Osteopenia, the loss of bone mass, is a significant risk factor for hip or vertebral fracture. Peak bone density occurs about age 30, from which point the normal aging process causes bone to be reabsorbed faster than it is made. With osteoporosis, the bone minerals are so depleted that the structure becomes fragile and easily susceptible to fracture. Once osteoporosis has developed, bone strength and architecture are very difficult to regain. Prevention is the key.
Risk factors for osteoporosis include a family history, previous fracture, advancing age, low body weight, long-term steroid use, inadequate calcium and vitamin D intake, smoking and high intake of alcohol. Women typically experience their greatest bone loss in the first few years after menopause when estrogen levels decrease.
Behavioral changes can correct some risk factors but we can’t stop the aging process or change family history.
Optimizing peak bone density needs to begin in childhood and adolescence. Adequate calcium and vitamin D intake, minimizing consumption of carbonated soft drinks, and regular exercise can help significantly. Eating disorders such as anorexia, cigarette smoking and alcohol abuse in adolescence and early adulthood significantly limit the body’s ability to build bone.
Calcium and vitamin D intake is important to keep bones strong as women approach menopause. The current recommendations are 1200mg per day of calcium through diet or supplements and 800 IU of Vitamin D. Vitamin D is found in fatty fish such as salmon, eggs, vitamin fortified milk or orange juice. Vitamin D is also made in the skin with exposure to sunlight. Regular weight bearing exercise such as walking, jogging, and resistance training can also help to maintain bone strength throughout life.
Fall prevention at home is also crucial, especially for the older population. Regular exercise helps to improve balance, while frequent review of medications, regular eye exams and removal of fall hazards in the home can minimize risks.
There are very accurate and safe ways to test bone density and screening is recommended for all women after age 65 and younger women with risk factors. There are drugs that stabilize bone, slow loss or even increase bone density. Generally safe, they can have side effects.
Osteoporosis is a common condition associated with high morbidity and mortality so preventive measures such as good nutrition and regular exercise should be started in adolescence and continued throughout life. When risk factors are present, early screening may identify bone loss early enough to prevent the disabling effects of this disease.
(Dr. Talbert is a board certified OB/GYN specialist practicing with Cape Obstetrics, Midwifery & Gynecology in Falmouth and Sandwich, 508-457-0088.)