Prior columns defined Vitamin D’s role in osteoporosis and why you should care about your bone health. This column reviews risk factors that may predispose you to hip fracture and offers recommendations to reduce that risk.
Some risk factors in women are not modifiable: menopause, thin stature, age and genetics (mom having osteoporosis increases your chances of osteoporosis), parent with hip fracture, rheumatoid arthritis, long term steroid use. Modifiable risk factors include increased intake of calcium/vitamin D, not smoking, and consuming less than 3 alcoholic beverages daily. Weight-bearing and strength-training exercises are beneficial to bone development and maintenance.
Patients often discuss with their physicians medicines that intend to reduce the risk of hip fractures, but overlook the significant risk reduction from fall prevention strategies.
Among women aged 75 years and older, muscle strengthening and balance exercises have been shown to reduce the risk of falls and fall-related injuries by 75%. Falls are a precipitating factor in 90% of all fractures, including hip fracture. In the US and Canada approximately 1/3 of women older than 60 fall at least once a year. The incidence of falls increases with age, rising to a 50% annual risk in women over 80 years. Poor vision, hearing, balance and muscle weakness become critical determinants of fall risk.
A risk for falling is a prior fall, and having 2 or more falls in the last year significantly increases the risk for future falls. This, however, is preventable. If you or a loved one is falling, then seeing your family doctor, neurologist or geriatrician is important to evaluate balance and gait, lower extremity strength, sensation and coordination, visual impairment, cognitive impairment, footwear and foot problems. Medications like anti-depressants, anti-psychotics, anti-epileptics and anti-hypertensives can also contribute to fall risk.
An often overlooked area of risk is the home. A review of your home can include adjusting or eliminating safety hazards in the following areas:
Lighting: provide ample lighting, easy-to-locate light switches, night lights to illuminate pathways, lights on at all stairways
Obstructions: remove clutter and low-lying objects, remove raised door sills to ensure smooth transitions
Floors and carpets: provide nonskid rugs on slippery floors, use nonskid floor wax and repair worn, buckled, or curled carpet
Furniture: arrange furniture to ensure clear pathways, remove or avoid low chairs and armless chairs, adjust bed height if too high or low
Storage: install shelves and cupboards at an accessible height, keep frequently used items at waist height
Bathroom: install grab bars in tub, shower and near the toilet, use chair in shower and tub, install nonskid strips/decals in tub and shower, elevate low toilet seat or install safety frame
Stairways and Halls: install handrails on both sides of stairs, remove or take down throw rugs and runners, repair loose and broken steps, install nonskid treads on steps
Helpful websites for fall prevention are:
Center for Disease Control
http://www.cdc.gov/injury/STEADI
National osteoporosis foundation
American Bone Health
http://americanbonehealth.org/what-you-should-know/exercise-right-to-prevent-fractures/
Geriatric Bone Health/Physical Therapy
http://geriatricspt.org/index.cfm
UCSF
http://ptrehab.ucsf.edu/stand-tall
Join us on Saturday October 1st from 10:00 – 11:00 AM for an office open house and brief presentation on perimenopause and menopausal genito-urinary sexual health. I will review the North American Menopausal Society’s (NAMS) recommended strategies to keep that “spark alive”. Coffee and pastries will be served. For more information, visit our Facebook page at Timothy A Leach MD.
