Osteoporosis Take-Away #2 and 3: Fracture and Fall Risk Reduction
In case you missed our workshop in May with Dr. Lance Rudolph, Dr. Jenny Ploss, and Bill Basso, we've put together a quick recap of the top 3 takeaways from our workshop.
We continue with the second and third of three important updates from our speakers in May: Fracture and Falls Risk Reduction.
2. Preventing fractures is the most important component of osteoporosis treatment and prevention. We can do this by strengthening bones and by reducing fall risk.
What factors contribute to fractures?
Osteoporosis in and of itself doesn't matter much in most cases--our bones are made up of a protein framework that is hardened by minerals (calcium and phosphate). We store these minerals in our bones for later use, and they provide structural support (by hardening and strengthening your bones) to your entire skeleton (and teeth). As you age, especially right after menopause if you're a woman, your body gets worse at putting those hardening minerals (Calcium and phosphate) back in your bones and/or takes more of those minerals out of your body for use in muscles, nerves, and blood (in fact, nearly every cell in your body has and uses phosphorus!).
The main problem with this lack of hard minerals in bone becomes a higher risk of bone fractures, or broken bones. In fact, for each 1 standard deviation (SD) decrease in bone density, there is a corresponding 1.5 - 2.5-fold increase in fracture risk (Marshall et al 1996). This only accounts, however, for HALF of the fracture risk in people over age 65. Even if you have strong bones, falls can lead to fractures, and this accounts for much of the remaining fracture risk. About 1/3 of people age 65 and older will fall each year, and that number increases until about age 80 (Tinetti 1988). Combine that with more fragile bones, and it becomes very easy to fracture.
How can we prevent fractures?
1. Improve your bone density.
You should do this under the direction of a doctor, because reasons for bone loss are varied, and there are a variety of ways to improve or maintain your bone density. The only proven way to improve bone density (rather than maintain it) after the age of 30 (unless you have been bedridden recently, in which case you can regain a higher bone density in most cases) is to use medication. But studies have shown that exercise can significantly improve results from medication, and exercise has the added benefit of reducing fall risk (see #2 below) and improving overall health and wellness.
Dr. Lance Rudolph, Research Director at the New Mexico Clinical Research and Osteoporosis Center, taught us about the medical approach to fracture risk reduction. He said there are a few key components. First, make sure you get your calcium and vitamin D levels checked. He said that most people need about 1000-12000 mg/day of Calcium, which we can get from diet and supplements. You can find average amounts of Calcium in food items here. Dr. Rudolph also said that you should be screened by your doctor or a bone health specialist for underlying conditions which may contribute to accelerated bone loss (hyperthyroidism, hyperparathyroidism, presence of abnormal antibodies, hypercalciuria, or Celiac disease, to name the main ones). Third, you should take medication if your bone density is low enough--this is the only proven way to INCREASE (rather than maintain) bone density, and can reduce your fracture risk by 50-70% in the first year (then most of the time the fracture risk reduction tapers off at that point). Consult your doctor, or you can email us if you want to ask more specific questions of Dr. Rudolph and his colleagues.
I, Dr. Jenny Ploss, Physical Therapist at Langford Sports & Physical Therapy, and Bill Basso, of OsteoStrong MidTown in Albuquerque, talked about the importance of osteogenic loading. Osteogenic loading means putting stress on your bones in a way that contributes to building bone. Bone responds to forces by building up wherever that force is applied, which is why higher impact activities and higher loads for strength training are very important for bone health. Unfortunately, many people can't tolerate the high loads and high impact needed for bone health because our joints prefer low-impact and lower loads. But you can change this. Come to a MovNat for Bone Health class to see how you can progressively prepare your joints to tolerate the loads needed for bone health. Alternatively, you can talk to your physical therapist (or one of us at Langford Sports & Physical Therapy) about preparing your joints for more demanding activitries, and/or try OsteoStrong, which uses isometric contractions to help load our bones.
2. Reduce your fall risk.
There are myriad factors contributing to fall risk. I've included a list of the most common risk factors from the CDC here:
INTRINSIC | Factors • Advanced age • Previous falls • Muscle weakness • Gait & balance problems • Poor vision • Postural hypotension • Chronic conditions including arthritis, stroke, incontinence, diabetes, Parkinson’s, dementia • Fear of falling
EXTRINSIC | Factors • Lack of stair handrails • Poor stair design • Lack of bathroom grab bars • Dim lighting or glare • Obstacles & tripping hazards • Slippery or uneven surfaces • Psychoactive medications • Improper use of assistive device
The factor that is the MOST highly correlated with your risk of falling? A PREVIOUS FALL! If you fall once, you are WAY more likely to fall again, especially in the first 6 months after that first fall. So, if you have fallen, you should be looking for a physical therapist who can screen you for your highest risk factors and help you work on those. In addition, you should talk to your doctor about possible contributions from medications and other comorbidities.
And if you haven't fallen yet? Be proactive and get balance screening by your favorite physical therapist. We have amazing PT's here at Langford Sports & Physical Therapy if you want to be sure you get the best care and guidance.
There are also balance training classes (we have them here at MoveTru) and classes specifically geared toward bone health (which should include both balance and appropriate bone loading and strengthening). We offer classes here at MoveTru twice a week, and many of our members also go to OsteoStrong once a week.
1. Image: Bone normal and degraded micro architecture. Gtirouflet. 2012. Accessed Wikipedia Commons 29 May 2018.
2. Marshall, D., Johnell, O., & Wedel, H. (1996). Meta-analysis of how well measures of bone mineral density predict occurrence of osteoporotic fractures. Bmj, 312(7041), 1254-1259.
3. Tinetti, Mary E., Mark Speechley, and Sandra F. Ginter. "Risk factors for falls among elderly persons living in the community." New England journal of medicine 319.26 (1988): 1701-1707.
4. Fact Sheet: Risk Factors for Falls. CDC 2017. https://www.cdc.gov/steadi/pdf/STEADI-FactSheet-RiskFactors-508.pdf. Accessed 29 May 2018.