Hip Fractures in the Elderly
Falls are common, often dreaded events in the lives of older
people. Aside from the obvious injuries and even death that might result,
falling can cause wide-ranging consequences, including loss of independence,
mental decline, and decreased activity and mobility.
Falls are the leading cause of fatal and non-fatal injuries to
older people in the United States. Each year, more than 11 million people over
age 65 fall that's one of every three senior citizens.
The treatment of injuries and the complications associated with
falls costs more than $20 billion each year. Already a serious national health
concern, increases in falls and injuries among older people could reach epidemic
levels as the population ages.
Fortunately, research has shown that the majority of falls are
preventable. Many medical risk factors for falling can be controlled. Simple
common sense precautions can reduce, if not eliminate, this serious threat to
the health and well-being of older persons.
Older women, especially Caucasian women, are at highest
risk. The number of falls and the severity of injury increase with age and in
seniors who, for whatever reason, experience loss of physical conditioning,
mobility, and balance. Users of many prescription and over-the-counter medicines
(polypharmacy) fall more often. Alcohol use often contributes to falling
problems. Those with medical conditions affecting balance and walking ability,
such as Parkinson's disease and stroke, also are vulnerable.
Where do falls occur?
Although you might expect falls to occur with risky
activities, such as walking outdoors or in bad weather, most falls (more than
60%) happen in the home. Falls in the community account for 30%percent, and only
10% of falls occur in institutions such as nursing homes. Remember that falls
can happen at any time, in any place, and to anyone, even when the person is
engaging in ordinary activities.
Preventing falls is important at any age, but it is
especially important for those who have osteoporosis, because their bones are
more fragile and easily broken. Each year, about one-third of individuals 65
years and older will fall, and some will be disabled by the broken bones that
can follow. In many cases, a fall can be precipitated by medicines such as
sedatives, muscle relaxants, and blood pressure drugs that can cause dizziness,
lightheadedness, or loss of balance. When two or more medicines are used in
combination, these side effects might be aggravated. Falls also result from
diminished hearing, vision, muscle strength, coordination, and reflexes, as well
as from diseases that affect balance.
What to do to reduce your risk of falls
- Regular follow-up visits Get proper medical evaluation and
treatment for conditions causing physical changes. Do not assume you are
just "getting older."
- Floors Remove all loose wires, cords, and throw rugs. Minimize
clutter. Make sure rugs are anchored and smooth. Keep furniture in its usual
- Bathroom Install grab bars and non-skid tape in the tub or shower.
- Lighting Make sure halls, stairways, and entrances are well-lit.
Install a night light in your bathroom. Turn lights on if you get up in the
middle of the night.
- Kitchen Install non-skid rubber mats near the sink and stove.
Clean spills immediately.
- Stairs Make sure treads, rails, and rugs are secure.
- Other precautions Wear sturdy, rubber-soled shoes. Keep your
intake of alcoholic beverages to a minimum. Ask your health care provider
whether any of your medicines might cause you to fall. Avoid risky
behaviors. Do not become unduly fearful about falling, as fear will only
encourage inactivity and immobility.
- Take action Inactivity is dangerous. Exercise improves strength,
balance, coordination, and flexibility, which can help you avoid falling in
the first place.
What is osteoporosis (brittle bones)?
Osteoporosis is a debilitating disease that can be prevented
and treated. Osteoporosis causes bones to become fragile and, therefore, more
likely to break. If not prevented, or if left untreated, osteoporosis can
progress painlessly until a bone breaks. These broken bones, also known as
fractures, occur typically in the hip, spine, and wrist.
Any bone can be affected, but of special concern are fractures
of the hip and spine. A hip fracture almost always requires hospitalization and
major surgery. It can impair a person's ability to walk unassisted and might
cause prolonged or permanent disability or even death. Spinal or vertebral
fractures also have serious consequences, including loss of height, severe back
pain, and deformity.
Millions of Americans are at risk of developing osteoporosis.
Although women are four times more likely than are men to develop the disease,
men also suffer from osteoporosis.
Who is at risk for osteoporosis?
There are many factors that determine who might develop osteoporosis. The
first step in prevention is to determine whether you are at risk. The risk
- Age The older you are, the greater your risk of osteoporosis. Your
bones become weaker and less dense as you age.
- Gender Your chances of developing osteoporosis are greater if you
are a woman. Women have less bone tissue and lose bone more rapidly than do
men because of the changes involved in menopause.
- Race Caucasian and Asian women are more likely to develop
osteoporosis. However, African American and Hispanic women are at a
significant risk for developing the disease.
- Bone structure and body weight Small-boned and thin women are at
- Menopause/menstrual history Normal or early menopause (brought
about naturally or because of surgery) increases your risk of developing
osteoporosis. In addition, women who stop menstruating before menopause
because of conditions such as anorexia or bulimia, or because of excessive
physical exercise, also might lose bone tissue and develop osteoporosis.
- Lifestyle By smoking, drinking too much alcohol, consuming an
inadequate amount of calcium, or getting little or no weight-bearing
exercise, you increase your chances of developing osteoporosis.
- Medicines and disease Osteoporosis is associated with certain
medicines (such as cortisone-like drugs) and is a recognized complication of
a number of medical conditions, including endocrine disorders (having an
overactive thyroid gland), rheumatoid arthritis, and immobilization.
- Family history Susceptibility to fractures might be, in part,
hereditary. Young women whose mothers have a history of vertebral fractures
also seem to have reduced bone mass.
Understanding bone and bone health
It is important to understand that bone is not a hard and
lifeless structure. It is, in fact, complex, living tissue. Our bones provide
structural support for muscles, protect vital organs, and store the calcium
essential for bone density and strength.
Because bones are constantly changing, they can heal and might
be affected by diet and exercise. Until about age 35, you build and store bone
efficiently. Then, as part of the natural aging process, your bones begin to
break down faster than new bone can be formed. In women, bone loss accelerates
after menopause, when the ovaries stop producing estrogen the hormone that
protects against bone loss.
Assessing your bone health
To determine if you have osteoporosis or might be at risk
for the disease, your doctor will ask you a variety of questions about your
lifestyle and medical history. Your doctor will want to know if anyone in your
family has suffered from osteoporosis or if they have fractured bones.
Based on a comprehensive medical assessment, your doctor might
recommend that you have your bone mass measured. A bone mass measurement is the
only way to tell if you have osteoporosis. Specialized tests called bone density
tests can measure bone density in various sites of the body. If the test is
conducted at intervals of a year or more, it can detect osteoporosis before a
fracture occurs, predict your chances of having a fracture in the future,
determine your rate of bone loss, and/or monitor the effects of treatment.
What if I have osteoporosis?
Although there is no cure for osteoporosis, there are steps
you can take to slow its progress. (Keep in mind that these suggestions are made
in the context of possibly preventing hip fractures in the elderly.)
Experts recommend 1,500 mg of calcium a day for women. Calcium
should be taken with Vitamin D (1,000 IU per day). Although exercise is good for
someone with osteoporosis, it should not put any sudden or excessive strain on
your bones. Care should be taken when lifting heavy objects, such as bags of
groceries, young children, etc.
If you have osteoporosis, it's important to minimize your
chances of breaking a bone. Take steps to prevent falls. As extra insurance
against fractures, your health care provider can recommend specific exercises to
strengthen and support your back.
Guide to osteoporosis prevention
- All women should receive counseling on their risk factors for
osteoporosis. Osteoporosis is a silent risk factor for fractures, just as
hypertension (high blood pressure) is for stroke.
- All post-menopausal women who suffer a fracture should be tested for
osteoporosis using the bone mineral density method. This test will determine
the severity of the disease.
- All post-menopausal women age 65 and older should receive a bone mineral
density test regardless of additional risk factors. Women in this group
should maintain an adequate intake of dietary calcium (at least 1,500 mg per
day, using supplements if necessary) and Vitamin D (1,000 IU per day).
- All people at risk for osteoporosis should perform weight-bearing
exercises and muscle-strengthening exercises to reduce the risk of falls and
- Avoid tobacco, and drink alcohol in moderation.
- All post-menopausal women who suffer vertebral (spine) or hip fractures
should be considered as candidates for treatment of osteoporosis.
- Women with no other risk factors whose bone mineral density T-scores are
below -2.0 should begin therapy to reduce the risk of fractures. Women whose
bone mineral density T-scores are below -1.5 and who have other risk factors
should begin therapy to reduce the risk of fractures.
- Pharmacologic (medicine) treatment options for osteoporosis prevention
or treatment are estrogen replacement therapy, Evistaฎ, Fosamaxฎ,
Actonelฎ, and Miacalcinฎ nasal spray.
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