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Falls Plague The Elderly

Seniors can change habits to prevent hip fractures

FRIDAY, April 5, 2002 (HealthDayNews) -- The recent death of Barbra Streisand's 93-year-old mother following a fall in her Los Angeles home highlights the importance of keeping your bones healthy and your house safe as you age.

"Hip fractures are one of the major and most severe injuries among older people," says Dr. Todd Schlifstein, an attending physician at the Rusk Institute, a rehabilitation center that is part of New York University Medical Center. "But if we maintain bone density and prevent falls, the incidence of hip fractures will be diminished and, hopefully, the severity of those falls will be diminished, too."

300,000 people suffer fractured hips every year. Ninety percent of them are over age 65, and almost 100,000 of those injured don't survive more than a year after they are hurt, he reports, mostly because of complications following surgery and the resulting immobility. These dangers include blood clots and pneumonia.

Worse, the incidence of hip fractures will only increase as the population ages, says Dr. Felicia Cosman, clinical director of the National Osteoporosis Foundation.

"We expect the number of hip fractures to triple by 2030," says Cosman, who treats osteoporosis patients regularly.

Half of all hip fractures occur after a fall, and half without any precipitating fall, Schlifstein says.

But both doctors point to osteoporosis as a leading cause for the injury. The disease causes the bones to lose density, weaken and break easily.

"Whether osteoporosis is the cause of the fall can be estimated by a person's bone density, and the way the hip broke," Schlifstein says.

During the seven years following menopause, women's rates of bone density greatly decrease as their estrogen levels drop, so that by age 65 they are at risk for osteoporosis. By age 75, however, both men and women suffer bone density loss equally so their rates of osteoporosis are the same.

For women, taking hormone replacement therapy during those seven years helps maintain bone density and prevent bone loss, Schlifstein says.

Also, older men and women can take calcium supplements and vitamin D. Cosman recommends to her patients 1,200 milligrams of calcium and between 600 and 800 milligrams of vitamin D daily.

"Further, anyone who has osteoporosis should be on medication, which prevents further deterioration of the bone and increases bone strength," she says. Two popular medications are Foxamax and Actonel.

Exercise is also key, which should include regular weight-bearing exercise, like walking, jogging or low-impact aerobic exercise, along with strength training to build up muscles of the arms and legs, Cosman says.

"Exercise improves bone mass, muscle strength and balance, which helps prevent falls," she says.

Schlifstein makes other recommendations to help lower the risk of hip injury. Among them:

  • Have an annual eye exam, and wear the proper glasses. Falls occur when people aren't wearing their glasses, or have glaucoma or cataracts.
  • Check your medications. Many have mild sedatives and if you are piggybacking different drugs, you might suffer from distraction, balance problems or confusion. Ask your doctor or pharmacist to review your drug intake.
  • Half of all falls occur in the home. Remove small throw rugs, and get rid of clutter. Make sure the path from your bed to the bathroom is well lit and easy to maneuver so you can move easily if you get up in the night to go to the bathroom.
  • The bathroom is a common site for falls because of the smooth surfaces and water. Install handrails, put non-slip decals in the bathtub, and use a bathtub chair or bench when you bathe.
  • If you use a walker or a cane, make sure you know how to handle them safely, and use them regularly.
  • Wear low shoes and rubber heels. No need to risk a fall with high heels or uncomfortable shoes.

    What To Do: Statistics about osteoporosis can be found at The National Osteoporosis Foundation. Information about how seriously hip fractures affect health is at the Centers for Disease Control and Prevention.

SOURCES: Todd Schlifstein, M.D., attending physician, Rusk Institute, New York University Medical Center; clinical instructor, New York University School of Medicine, New York City; Felicia Cosman, M.D., clinical director, National Osteoporosis Foundation, Washington, D.C., and associate professor, medicine, Columbia University College of Physicians and Surgeons, New York City
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