Preventing Falls and Fractures
How can I prevent fractures?
If osteoporosis has started to thin your bones, even a simple fall or twist can have devastating consequences. According to the National Osteoporosis Foundation, 10 million people have osteoporosis, and almost 34 million more have low bone mass, which places them at risk for fractures.
Indeed, one out of two women over 50 -- and one out of four men -- will suffer osteoporosis-related fractures in their lifetime. Most of the breaks occur in the spine, wrist, and -- worst of all -- the hip. About twenty percent of older people who break their hips fail to regain the independence they had before the injury, and about one out of four die within one year of the break.
The good news is that it's not too late to protect yourself. Even if you already have thin bones or have already suffered a fracture, you can take the following steps to prevent future breaks.
- Get your bones tested. One of the keys to avoiding fractures is understanding your risk. A simple bone density scan can gauge the strength of your bones and help your doctor plan a strategy for protecting them. The National Osteoporosis Foundation recommends bone density scans for all women 65 and over, all postmenopausal women at high risk for osteoporosis, and all men and women over the age of 50 who have already fractured a bone.
- Compare prices. The $300 price tag for a typical X-ray scan once kept many women away from testing, but that barrier has fallen. Medicare began covering tests in 1998, allowing most women 65 and over to get screened at little cost. Cuts in Medicare reimbursements in 2007, however, have led to concerns that many people at risk may not be getting tested. Many doctors have portable ultrasound scanners that gauge bone strength in mere seconds, at a fraction of the cost of an X-ray. The scanners can detect women at risk for osteoporosis, but only a follow-up test with standard (and more sensitive) X-rays can seal the diagnosis.
- Get your calcium and vitamin D. These two nutrients are like bricks and mortar for your bones, and they're powerful protection against fractures. In a three-year study of 389 people over the age of 65, researchers at Tufts University found that supplements of calcium (500 milligrams per day) and vitamin D (700 international units per day) cut the risk of broken bones roughly in half. These nutrients are also found in dairy products, dark green leafy vegetables (which contain calcium but not vitamin D), and fortified cereals.
- Exercise. Much research has recently focused on aging and exercise due to an unusual partnership between the National Institute on Aging and the National Aeronautics and Space Administration (NASA) to determine the effects of weightlessness on the human body. Without the effect of gravity, astronauts' muscles and bones begin to deteriorate while they're in space -- a process similar to what happens to us during aging if we lead a sedentary lifestyle. Fortunately, "weight-bearing" exercises can help prevent this: Walking, running, stair climbing, dancing, and weight lifting will improve your bone density while giving you extra strength, agility, and balance to prevent falls. For still further benefits of balance training, consider the arts of yoga or T'ai Chi, which strengthen leg muscles; some YMCAs and senior centers offer classes at little or no cost. Swimming and cycling are good exercises as well, but you need an exercise that bears your weight to build denser bones. If safety and secure footing are concerns, you might consider mall walking.
- Consider medications. If your bones are already fragile or you're at high risk of osteoporosis, today's doctors have an impressive arsenal of tools for protecting your bones. Be sure to ask about side effects, especially serious ones, before making your decision.
- Accident-proof yourself. Falls cause a majority of all fractures in older people, so keeping upright is the best protection you can give your bones. Ask your doctor if any of your medications might throw off your balance, and, if necessary, ask for an alternative. Drink alcohol in moderation, as it can make you unsteady and increase your risk of falling. For extra protection, wear sturdy shoes with rubber soles, remove tripping hazards from your floor (loose wires, cords, throw rugs, and so on), and cover loose cable wires and electrical cords. Also, make sure all stairways have secure handrails and nonskid treads, keep your house well-lit, and place rubber mats or nonskid tape in the kitchen near the stove and sink. You may also want to rearrange your furniture and remove pointed edges for clear and safe pathways.
- Inspect your bathroom. Install grab bars and nonskid strips (or rubber mats) in bathtubs and shower stalls. Replace a "spring rod" with a screw-in shower curtain rod. If you start to fall, this rod will offer more support (don't grab at the towel rack -- it may come off in your hand!)
- Protect your eyes. Have your vision checked to be sure your eyeglasses are the right prescription and that you don't have glaucoma or cataracts, which limit vision.
- Keep it simple. If you have trouble walking, you might want to put a night commode chair next to your bed for nighttime needs. Also, raise or lower the bed to make getting in and out easier.
Also, be aware that at least half of the falls among seniors take place outdoors, according to the U.S. Centers for Disease Control and Prevention. Those who fall outdoors tend to be healthier than those who fall indoors, but are tripped by curbs and bumps in sidewalks or parking lots. Pay close attention to your environment and uneven or slippery surfaces, which can give even the healthiest person a nasty spill.
--Chris Woolston, MS, is a health and medical writer with a master's degree in biology. His reporting on occupational health earned him an award from the northern California Society of Professional Journalists. Beth Witrogen McLeod is the author of Caregiving: The Spiritual Journey of Love, Loss, and Renewal (John Wiley & Sons, 1999), which was nominated for a Pulitzer Prize. Gerontologist and author Kelly Ferrin also contributed to this report.
Mayo Clinic. Bone Density Test: Measure Your Risk of Osteoporosis. 2008 Feb.
National Osteoporosis Foundation. Fast Facts. http://www.nof.org/osteoporosis/diseasefacts.htm
Centers for Disease Control. Falls and Hip Fractures Among Older Adults. September 2006. http://www.cdc.gov/ncipc/factsheets/falls.htm
National Osteoporosis Foundation. Proposed Bill to Protect Patient Access to Osteoporosis Testing by Reversing Cuts in Medicare Reimbursement. Press Release. Nov. 2007
National Osteoporosis Foundation. BMD Testing. www.nof.org/osteoporosis/bonemass.htm