New perspectives on why older people are at risk for broken bones — and on how to reduce those risks — are overturning traditional wisdom about preventing and treating bone loss.
For decades, research focused on post-menopausal osteoporosis and, by extension, Caucasian women, the group most at risk for that brittle-bone disease. But it overlooked a large segment of the population that is also vulnerable to the debilitating and even deadly consequences of fractures. Up to a quarter of hip-fracture victims are men, for example, and their one-year survival rate is significantly lower than that of women with the same injury.
Researchers “put blinders on and focused almost exclusively on compensating for the loss of estrogen at menopause,” says Stavros Manolagas, a professor at the University of Arkansas for Medical Sciences in Little Rock. “But men also lose bone and, for most of their lives, at about the same rate as women.”
Even bone mineral density testing, long considered the standard measure for determining fracture risk, has proved to be a less central determinant of bone strength than researchers once thought. Studies have revealed that half of osteoporosis-related fractures occur in people whose bone-density readings would have ruled out the disease.
Women should have their bone density measured and fracture risk assessed at age 65; men at 70, or sooner if they have risk factors for osteoporosis, such as a family history of the disease or if they smoke, have a poor diet or are very thin. If you and your doctor have made treatment decisions based solely on bone-density readings, your condition should be reassessed, and you should discuss all of the available options, including medication and other steps you can take to protect your bones against fractures.
This new understanding reveals that it’s not enough to focus just on bone density. These steps can help to reduce your risk of breaking a bone:
Strong muscles provide solid support, reducing stress on bones, improving balance and reducing the risk of falls. Incorporate resistance exercises such as weight training and push-ups into your fitness routine.
Drugs that can weaken your frame include proton pump inhibitors such as Prevacid and Prilosec; estrogen blockers such as Depo-Provera; and selective serotonin reuptake inhibitors such as Prozac and Paxil. If you’re at high risk for fractures, talk with your doctor about alternatives, and regularly review your need for medication.
More than a third of U.S. adults older than 65 fall each year, and it’s the leading cause of injury-related death among that group. While the actual falls might not be the direct cause of death, health complications that result can lead to it.
One proven way to reduce falls is to exercise. Activities such as tai chi that promote strength and balance are beneficial. Review all prescription and over-the-counter medication with your doctor to see if any can cause dizziness or affect balance. Have your vision checked. And check your home: Install handrails in showers, tubs and stairways, and eliminate such hazards as poor lighting, throw rugs and loose cords.
For a variety of reasons, conditions such as diabetes, heart disease and rheumatoid arthritis affect bones. For example, people who have had a heart attack are much more likely to break a bone than those who haven’t, according to an analysis of 30 years of data published in a June 2011 issue of Circulation.
Recent research linking a class of bone-building drugs called bisphosphonates to an increased risk of fractures in the femur, or thigh bone, has discouraged some potential users. But so far that side effect appears limited to women who have taken the drug for more than five years, and even in that group it remains relatively rare.
1. Maintain a healthy weight. Being too thin has been linked to a higher risk of osteoporosis and fractures.
2. Exercise. Choose weight-bearing activities such as hiking or tennis, or use an elliptical machine or treadmill.
3. Don’t smoke. Chemicals in cigarette smoke are bad for bone cells and make it harder for the body to make new bone.
4. Get enough calcium and Vitamin D. The recommended daily intake of calcium is 1,000 milligrams for women 50 and younger and for men younger than 71; 1,200 milligrams for those who are older. Aim for 600 international units of Vitamin D daily, 800 if you’re older than 70.
5. Go easy on alcohol, caffeine, protein and sodium. When consumed in excess, they are thought to interfere with the body’s ability to retain calcium and form new bone.