After a Fracture: The First 48 Hours

“Many physicians may not be aware of exactly how much vitamin D,” an older person needs, says Dr. Denise Houston, a nutrition epidemiologist at the Wake Forest University Baptist Medical Center.  “We’re probably not taking it at these levels. It does need to be pushed in this group.”

Dr. Houston was the lead researcher on a recent study in the medical journal Gerontology demonstrating the connection between Vitamin D deficiency and insufficiency and poor physical performance. Her team conducted a battery of tests on older individuals, such as walking briskly for a short distance and getting in and out of a chair. Grip strength and balance were also measured. The results indicated that Vitamin D deficiency was correlated with poor balance and lower muscle strength. Even a more subtle “insufficiency” was correlated with lower handgrip strength.

While medications may be ultimately become part of a multifaceted reaction to an osteoporosis diagnosis, a patient probably shouldn’t expect the doctor to prescribe such treatment, such as bisphosphonates, in the days after a fracture. Most physicians will usually wait for a patient to stabilize before introducing a new drug.

Granted, finding the energy and motivation to confront osteoporosis can be no easy task for someone dealing with a painful fracture such as that of the hip, wrist or vertebrae. If the fracture has rendered the person temporarily bedridden, the patient is also at risk of complications, including pneumonia and blood clots, which would need to be treated immediately. Yet facing such health challenges should be no reason to neglect one’s condition of osteoporosis, since being weakened by bed rest may be one of the factors that contribute to a subsequent fall, which in the worst case could result in further fracture.

A study in the April 25, 2007 issue of the Journal of the American Medical Association found that even previously healthy older people, when confined to bed rest for two weeks (as might well be the case for someone suffering from a hip fracture, for example), lost a large amount of skeletal muscle, particularly from the lower extremities. In fact, they lost more lean tissue in 10 days than young individuals after 28 days. This is a good reason to get up and around again as soon as the doctor gives the go-ahead, but can also be a reason to be extra careful.

Sometime after a fracture, a physician may prescribe physical therapy to restore the previous function of the body part. Those who suffered wrist fractures, for example, might need help practicing normal hand movements in order to do chores at home. This is due both to the fracture itself and the resulting muscle atrophy while the limb was immobilized. While it is essential to follow the doctor’s instructions in this regard, the effects of other bone-strengthening exercise regimens after a fracture have been debated. According to a July 2006 study in the Archives of Physical and Medical Rehabilitation, healthier individuals with a single fracture may benefit, while more frail individuals with a history of fracture may actually put themselves at risk of further injury. One should consult with a physician before beginning any exercise program and always proceed with caution.