Let’s say you’re a 50-something woman, or maybe a 70-something man, and you break a leg or hip when you fall down a six-foot ladder. It would be a misfortune, for sure, but probably neither you nor your doctor would be surprised at the severity of the injury, given the nature of the accident.
And your doctor probably wouldn’t warn you after the fall that weakened bones might have contributed to your fracture, or that you might be at risk of breaking another bone the next time you have a minor accident, like tripping over your dog.
So once the fracture has been immobilized with a cast or surgically repaired, your doctor will likely not do anything else to prevent the possibility of a new fracture.
Doctors are trained to think that only bones that break after minimal or no trauma are evidence of brittle bones. And that such fractures are the only ones that warrant an assessment of the patient’s bone health, as well as treatment and counseling to prevent further fractures. Furthermore, professional recommendations reinforce this thinking and lead physicians to discharge patients after correction of a high-trauma fracture.
However, there is now growing evidence that for postmenopausal women and older men, a broken bone from any type of trauma – whether severe (car accident) or not (fall on the sidewalk) – bone fragility is likely to be the culprit.
In a commentary published in JAMA Internal Medicine last year, physicians Anne L. Schafer and Dolores M. Shoback of the Veterans Health System in San Francisco, US, suggested that fractures after severe or minimal trauma represent “a distinction without difference” for middle-aged and elderly people.
No matter how the accident occurred, current evidence indicates that when an elderly person breaks a bone, a more in-depth assessment of that person’s overall bone health and advice on how to maintain it should follow as an integral part of treatment.
An important finding shows that only 9% of Medicare patients, the US government’s health insurance, who suffered a hip or spine fracture were tested for bone loss and received treatment to prevent further fractures.
Within three years, 20% of them had another fracture. It probably goes without saying that “an ounce of prevention is worth a pound of cure,” but doctors are often reluctant (and patients are often reluctant) to go beyond repairing the initial injury.
Older women who suffer a fracture need a bone exam
The comment in JAMA Internal Medicine was in response to a major study published in the same issue of the journal in July 2021.
The study cataloged the incidence of subsequent fractures among 7,142 postmenopausal women, many of them between the ages of 50 and 60, who suffered a first fracture, and compared the risk of having a second fracture with 66,874 of their peers who did not have an initial fracture. . The researchers followed the women for about eight years on average.
Among those who suffered the initial fracture from minimal trauma, which is considered a hallmark of weakened bones, the risk of having another fracture increased by 52%. Among women whose first fracture occurred after a traumatic accident, such as falling from a ladder, the risk of a second fracture was 25% higher than expected based on women who had no initial fracture.
The study authors concluded from their statistical analysis that both “initial non-traumatic and traumatic fractures” were “similarly associated with risk of subsequent fracture.”
Contrary to current guidelines, the authors wrote that “the results of our study are clinically important because, in contrast to a non-traumatic fracture, a fracture considered traumatic generally does not prompt further evaluation of osteoporosis or advice about increased fracture risk.” subsequent”.
However, they added, “high-trauma and low-trauma fractures show similar associations with low bone mineral density.”
According to studies, even younger postmenopausal women who have suffered a severe fracture are at increased risk for osteoporosis, said Dr. Sundeep Khosla, a bone specialist at the Mayo Clinic in Rochester, Minnesota (USA).
“There is very strong evidence that postmenopausal women who experience a fracture, regardless of the degree of trauma, should have their bone density assessed,” he told me. “A fracture sustained in a fall from standing height confers almost as high a risk of a second fracture as if the first fracture resulted from a fall from a ladder.”
Elderly men are also at high risk for a second fracture.
Men also face an often overlooked risk of second fractures, especially since their first fractures are more likely to result from a traumatic event like a car accident, and are not recognized as a harbinger of future fractures, Schafer said in an interview.
Dr. Carolyn J. Crandall, an internal medicine physician at the David Geffen School at the University of California at Los Angeles who led the JAMA Internal Medicine study, said recent studies have documented that older men who suffered a high-trauma fracture were often as likely to have lower bone densities than men with low-trauma fractures, as well as being at risk of further fractures.
“Older men may be at a special disadvantage if we rule out their high-trauma fractures,” Schafer said. “Men lose bone with age and develop osteoporosis, although usually later in life than women. They have been forgotten. Men who have fractured bones in the past should not be ruled out.”
How to test and treat brittle bones
What, then, is the message for elderly men and middle-aged and older women? And for your doctors?
For starters, the question doctors often ask – “How did this fracture happen?” – is not relevant. What counts, Khosla said, is the health of the patient’s bones, and that is determined by a bone density test that measures the mineral content of the bones of the spine, hips, and sometimes the forearm. The test is painless, non-invasive and quick, and its results are best interpreted by an osteoporosis specialist.
If the exam shows abnormally weak bones, doctors often prescribe drugs to slow, stop, or reverse the process. Treatment should also include lifestyle counseling regarding diet and exercise, Khosla said.
“Being physically active helps maintain strength, balance and agility, and lessens the chance of falling and breaking a bone.” Weight lifting and muscle strengthening exercises are important throughout life.
Equally important, eat a well-balanced diet rich in vegetables, fruits and whole grains, as well as calcium and vitamin D. Avoid smoking and limit your consumption of alcohol and caffeine.
Finally, check your home and surroundings for tripping hazards and eliminate them. Loose rugs, shoes and other items left halfway, lack of handrails and poor lighting especially on stairs all tend to cause falls that can break bones.
Translated by Luiz Roberto M. Gonçalves
Chad-98Weaver, a distinguished author at NewsBulletin247, excels in the craft of article writing. With a keen eye for detail and a penchant for storytelling, Chad delivers informative and engaging content that resonates with readers across various subjects. His contributions are a testament to his dedication and expertise in the field of journalism.
