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Why fractures are so problematic for older people

An X-ray image of an arm with a double fracture. (iStock)

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When kids or young adults break a bone, they might have weeks or months of recovery to get through. But they can usually expect to get back to their prefracture level of functioning.

For older adults, the stakes of a fracture can be much higher.

In one study published this year, researchers found that frail older women who broke hips were unlikely to fully recover their prefracture quality of life, even after as many as 10 years.

Another study, published in 2016 in the Journal of General Internal Medicine, followed 733 adults with an average age of 84 for 2½ years after a hip fracture. In that time, only 31 percent recovered their prefracture ability to go about their daily activities.

Many people who break hips are already frail, notes Victoria Tang, a geriatrician and assistant professor of medicine at the University of California at San Francisco, who was the lead author on the 2016 study. And having trouble with activities such as bathing, eating and walking before breaking a bone is linked with a smaller chance of making a full recovery afterward, her study found.

Plus, older adults simply don’t heal as fast as younger people do in general, says Tim Platts-Mills, vice-chair of research for the department of emergency medicine at the University of North Carolina at Chapel Hill.

Fortunately, you can take steps both before and after a fracture to make the process of healing smoother.

Guarding against fractures

It’s best to start improving your strength and balance long before you take a fall, Tang says. “It’s like putting money in your bank.”

Building muscle and bone strength can help you not only to reduce the risk of falling but also to recover more easily from a fracture. Here’s what to do.

Exercise. Research shows that getting a variety of types of exercise can help reduce the risk of falls.

In one analysis published in 2017 in the International Journal of Epidemiology, scientists reviewed 15 randomized controlled trials and found that exercise programs significantly reduced older adults’ risk of falling. The programs evaluated in the study included a mixture of techniques, such as strength training, walking, balance and flexibility exercises, and tai chi. The National Institute on Aging recommends older adults incorporate aerobic, strength, balance and flexibility exercises.

Both strength training, such as weightlifting or working with a resistance band, and aerobic, weight-bearing exercise, such as walking and running, also provide an additional benefit: They can help you build bone strength.

Stay ahead of osteoporosis. Bones lose density and strength as they age, which leads to a greater risk of fractures — and that’s especially true for women after menopause. That’s why the U.S. Preventive Services Task Force recommends that all women 65 and older (and younger women at risk for osteoporosis because of a history of hip fracture, smoking, heavy alcohol consumption or low body weight) receive a bone density screening. (Men should ask their doctors whether they’re candidates for screening.)

If the test reveals you have osteoporosis or the less severe form of low bone density, osteopenia, your doctor can recommend steps you can take to improve your bone health. If your bone loss is mild, these might include exercise, as described above, as well as eating a healthy diet with plenty of whole grains, veggies, fruits and foods rich in calcium. For more severe bone loss, doctors may also recommend medications, such as bisphosphonates or anabolics, for some patients.

Take fall prevention measures. Simple steps such as removing trip hazards throughout your living space can make your home a safer place. These can include getting rid of area rugs and keeping your floor tidy and free of shoes, clothes, books, electrical cords and other items. Getting your vision checked regularly can help, too.

Drug side effects and interactions can lead to symptoms, such as dizziness, that increase your risk of falling. So once a year, ask your doctor to review all prescription and over-the-counter medications and vitamins or supplements you’re taking.

Dealing with a broken bone

Even if you do break a bone, remember that plenty of older adults do make a full recovery and get back to their normal lives.

Still, knowing the most effective strategies is important. Here’s what to do:

Take quick action. Some fractures are emergencies — including skull, neck, back, hip, pelvis and upper leg fractures — and warrant a call to 911. You should also call emergency services if you or an injured person is losing consciousness, has severe bleeding, a bone has pierced the skin, or if an area of skin below the injured joint has turned blue, clammy, cold or pale.

If you fall or are otherwise injured but aren’t sure whether you’ve broken a bone, you should call your doctor to ask what steps you should take next.

Many fractures don’t require surgery. Hip fractures, however, usually do need surgical treatment. In those cases, it’s best to have the surgery performed soon.

Get active and eat well. Just as physical activity is key for preventing fractures in the first place, it’s also a critical part of recovering from them. So follow your doctor’s instructions on the level and types of activity that are appropriate for you. This will probably include some form of physical therapy starting a week or two after your initial fracture, once the bone has begun to heal, Platts-Mills says.

Eating a nutritious diet is also critical. And ask your doctor whether you might benefit from taking a supplement of vitamin D — this bone-building vitamin can be difficult to get from diet alone, and depending on the weather, you may not be able to get enough from sunlight.

Stop smoking. A 2013 review in the journal Bone and Joint Research that analyzed 13 other studies concluded that smoking delayed fracture healing.

Reach out for help.After a fracture, you’ll probably need help with daily activities such as housework. Ask friends or family whether they can help you get around, as well as with meals, medications and follow-up appointments.

 Copyright 2019, Consumer Reports Inc.

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