Osteoporosis and Fragility Fractures: What You Need to Know
A 2017 study revealed that 82 percent of postmenopausal women don't know that a bone fracture or break, caused by falling from a standing position or less, is a sign of osteoporosis. The study was commissioned by Radius Health, Healthy Women, and the National Osteoporosis Foundation (NOF). To address this and other misconceptions, we spoke with NOF's Clinical Director, Andrea Singer, M.D., associate professor of medicine and obstetrics and gynecology at Georgetown University Medical Center.
Osteoporosis may be a bigger problem thank you think
It's not typical cocktail party chit-chat, but maybe it should be. According to the NOF, one in two women and one in four men over 50 will experience an osteoporosis-related fracture. They're also called fragility fractures or low-impact fractures, and they’re usually in the hip, spine, or wrist. Hip fractures cause the most problems and, in one in five patients, can result in nursing-home care. Twenty-four percent of hip fracture patients age 50 and over die in the year following a fracture.
Fragility fractures are about energy transfer
"There's a big disconnect between breaking a bone, and the underlying condition of osteoporosis that may cause the break," says Dr. Singer. "Patients with normal bones won't usually break anything in the same situation. For someone with osteoporosis, it doesn't matter how hard the surface. It's about the energy transfer on weakened bones. Osteoporosis is a systemic skeletal disease that causes changes in the underling structure of the bone, making it more fragile and more likely to break."
Fractures are breaks and vice versa
Earlier research has shown that most people believe there's a difference between a fracture and a break. "We use these terms interchangeably, but the public doesn't always use those words," says Dr. Singer. "If you break or fracture something — it's the same thing — that may signify that osteoporosis is the underlying cause. A 'care gap' can occur, so you should ask for a correct diagnostic workup to determine if you have osteoporosis and to receive appropriate treatment."
Risk factors you can't control
Certain factors increase osteoporosis risk, thus increasing risk of fragility fractures, Dr. Singer says. Some you can't control: being a woman over 50, being post-menopausal, Caucasian or Asian, or having low body weight, which correlates with small stature and being thin. Family history is a risk, and conditions such as rheumatoid arthritis, malabsorption diseases such as celiac disease, inflammatory bowel disease such as Crohn's disease, some thyroid disorders, and type 1 and type 2 diabetes.
What you can do to reduce your risk
To help yourself, you can ensure sufficient intake of calcium and vitamin D, eat more fruits and vegetables, be more active overall, especially with more weight-bearing exercise, which is also called strength training, she says. You definitely want to avoid smoking, drinking too much alcohol, or losing excessive weight rapidly — more than "normal," which is why it's especially important to seek help for an eating disorder such as anorexia nervosa.
The perfect storm can form for falls
Other research cites frailty as a predictor of bone fractures, as a 2017 study in BMC Musculoskeletal Disorders conveys. "More evidence is needed to examine whether interventions in the pre-frail older adults can prevent osteoporotic fractures," say the authors. Dr. Singer says frailty includes not only bone loss, but loss of muscle mass and strength, or sarcopenia. "These factors, along with poor nutrition or side effects from certain medications, can lead to increased risk for falls."
Start reducing your risk now
"We want to focus on healthy aging and consider the 'whole person' and every aspect we can to maintain bone health," says Dr. Singer. "It's always harder to recover from bone loss than to prevent it in the first place. Once you have an osteoporotic fracture, you and your health care provider should discuss overall management strategies and medications available to prevent future fractures. This disease doesn't go away and requires lifelong management, to avoid losing mobility and independence."
The latest medications to boost bone health
Your doctor may explain about different categories such as antiresorptive drugs that include bisphosphonates, denosumab, hormone therapies, and anabolics such as parathyroid hormone and parathyroid hormone-related protein, says the NOF. Medications aim to even out the processes of resorption — breakdown and removal — and formation or generation of new bone. Tell your doctor about side effects, and be open to trying different medications.
This test is best to predict osteoporosis risk
For women over 50, a painless, non-invasive bone mineral (think "calcium") density test is the best way to assess osteoporosis risk. In keeping with the name, osteoporosis, imaging will show areas of your bones that have deteriorated and now show low bone mass. The NOF and most doctors, including Dr. Singer, recommend a dual-energy X-ray absorptiometry scan — also called a DXA scan or DEXA scan. You'll be given a resulting T-score, which predicts future fracture risk.
The calcium conundrum
You've seen reports about calcium and wondered: "Should I? And how much?" Dr. Singer was an author of a December 2016 medical guideline published in the Annals of Internal Medicine. It says that calcium with or without vitamin D, from food or supplements, has no relationship, good or bad, with risk for cardiovascular (heart) and cerebrovascular (brain) disease, mortality, or all-cause mortality in generally healthy adults. Recommended daily intake should be no more than 2000 to 2500 milligrams.