Fragility fractures, osteoporosis and you

Almost all of us know of someone who has fallen and broken a bone. What many people don’t know is that normal bones are very strong and should not break from minor trauma, such as a fall from standing height. When a bone breaks from such an injury, it is called a fragility fracture. The fracture is caused by weakness of the bone, not by the injury itself. Osteoporosis is the most common cause of weak bones that can lead to fragility fractures.

Why would a bone become weak?

Bone mass and strength are built during childhood and adolescence, peak in young adulthood, then begin to decline. In women, the decline in estrogen levels that occurs at menopause increases the rate of bone loss. Men also lose bone strength as they age, but usually not as quickly.

Bone strength is affected by many factors, including age, gender, ethnic background, certain chronic diseases, medications and lifestyle factors. Osteoporosis is the medical name for the condition when bone strength is so weak that fracture is highly likely.

Why are fragility fractures important?

Fragility fractures are common; there are over 2 million broken bones each year in the U.S., or about 5,500 fragility fractures every day. The National Bone Health Alliance display “Cast Mountain” which recently visited Christiana Hospital, represents this daily toll of fragility fractures. All these broken bones cause pain and disability for patients and greatly increase health care costs.

The most severe type of fragility fracture is a hip fracture. A significant number of patients with a hip fracture die within the following year, and many more never regain independent living.

Another reason fragility fractures are important is that a broken bone in anyone over the age of 50 is a warning that indicates greatly increased risk for more broken bones. For example, a patient who has had a wrist fracture is about twice as likely to have a broken hip. Almost half of patients who have a hip fracture have had a previous fragility fracture.

How can I learn my risk?

Knowing your fracture risk is crucial. How likely you are to have a fracture depends on what risk factors you have. These factors include diseases you have, medicines you take, and some lifestyle factors. Some chronic diseases (insulin-dependent diabetes, rheumatoid arthritis, chronic liver disease, intestinal malabsorption, etc.) and medicines also affect risk. Ask your health care provider whether you are at risk for osteoporosis and fractures and whether you should get a DXA scan to measure your bone density.

What is a DXA scan?

A bone density study (also called a bone mineral density, bone densitometry study or a DXA scan) measures the mineral content of your bones to assess your risk for fracture. By having this test, you will help your doctor assess your condition and, if needed, recommend ways to reduce your risk of fracture. A bone density scan is painless and safe. A bone densitometry or DXA machine emits a narrow beam of radiation to measure the density of your bones. The radiation exposure is minimal, and there are no side effects. Scans of your lower back and hip are typically taken. The scan takes about 15 to 30 minutes. T-scores are used to diagnose osteoporosis and indicate the likelihood of fracture.

Do you know your T-score? If not, ask your doctor.

Are there ways to reduce fracture risk?

Yes! Some risk factors (age, gender, race, chronic disease, hip fracture in a parent, etc.) cannot be changed, but there are many worthwhile steps you can take:

  • Eat a balanced diet with adequate calcium.
  • Take adequate vitamin D (your doctor can measure your vitamin D level).
  • Avoid smoking. Use alcohol only in moderation.
  • Engage in weight-bearing exercise.
  • Eliminate fall hazards in your home.
  • Ask your health care provider if you should consider medication for osteoporosis.

The bottom line

Osteoporosis is sometimes called the “silent killer,” but there are ways to estimate your chance of broken bones, and ways to reduce your risk. The key is awareness. Talk with your health care provider and learn more about this important issue.