Winter can be a treacherous time of year, with cold and ice and this year, snow, writes Dr Miriam F. Delaney. A fall on slippy ground resulting in a fractured (broken) wrist or hip is termed a fragility fracture. This occurs as a result of weakened bone, usually from osteoporosis but sometimes from other conditions such as low levels of vitamin D in the body.
Osteoporosis is when bone becomes weakened with ageing. The lattice-like structure of the bone is susceptible to fracture. One in two women over the age of 50 will suffer a fracture from osteoporosis, as will one in four men.
Wrist fractures occur earliest, often from age 60, then spine fractures and, finally, hip fractures. We know that one in three men will die in the first year after a hip fracture, one in three will never regain independence, and only 30pc regain their pre-fracture independence.
These are stark figures - but the good news is that you can prevent the risk of this happening to you.
Bones are alive and continue to grow until age 20. Our best (peak) bone density is achieved by age 30, but after this, we start to lose bone at a slow (1pc) but steady rate which accelerates at the time of menopause in women and after 50-60 in men. At this age, we cannot impact our bone store (peak bone density) since it is a product of our genetics, and health, diet and exercise as a child. But we can plan to optimise our bone health for the later years of our life.
An investment in bone health at the age of 50 aims to improve the quality and quantity of bone, and focus on muscle strength, posture and balance to reduce the onset of osteoporosis and reduce the risk of fractures.
Bones are alive
Calcium, vitamin D, magnesium and many other elements are essential for making and maintaining healthy bone. Ensuring adequate daily dietary intake of calcium and vitamin D is recommended for everyone, young and old. Recommended daily amounts (RDA) are usually met in most healthy diets.
Calcium: Adults need to ingest 1,000 mg of calcium daily. This should be spread over the course of the day, since we can only absorb 500mg of calcium at one time. Calcium-rich foods such as cheese and milk are the best source. If calcium tablets are to be taken, they should be taken with food, up to 500mg at a time.
Vitamin D: Calcium absorption is dependent on normal blood levels of vitamin D, which is found in our diet in foods such as fortified milk and tinned tuna, and in sunlight. Sunlight exposure between the April and October allows the skin to make vitamin D. This means full body exposure without sunscreen for 20 minutes a day. For many, this is not an option, so they depend upon diet or a supplement to maintain vitamin D levels. Some medications reduce levels and some disorders reduce absorption from the diet. As a result, many need dietary supplementation. The RDA is 400 to 800 iu daily.
Risk factor: Some risk factors we inherit such as gender, race or mother having a hip fracture before age 50. These cannot be changed. However, a personal history of smoking, excessive alcohol intake or inactivity are modifiable risk factors and these can be offset to decrease risk of fracture in the future.
Too fit to fracture: With ageing, inactivity, illness and certain medications there is weakening of and loss of muscle which compounds bone loss. Exercise is an essential part of bone health. Weight bearing exercises stimulate bone to repair and remain strong.
In our Bone Health and Osteoporosis Program at the Bons Secours Hospital in Galway, we recommend a specific exercise training programme run by a team of experts. The physiotherapy programme includes specific exercises that focus on strength training, weight bearing, posture, balance and aerobic exercise.
When to be assessed?
Postmenopausal women of >65 years and men >70 years should be assessed for fracture risk using a bone density scan. People with other risk factors should be assessed earlier.
If no medication is required to prevent or treat fractures:
• Calcium and vitamin D intake is ensured by diet or supplement
• Advice is given to reduce risk factors that can be modified
• Weight bearing exercises, posture, balance and strength training
• Fall prevention strategies
Follow up may be one to two years for those on treatment. Otherwise, five to 10 years may be appropriate, unless additional risk factors develop.
The key message is that fractures can be prevented. So for 2018, let our New Year resolution be healthy bones, healthy nation.