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Preventing Hip Fractures: A Key to Healthy Aging
In fact, one third of those that suffer a hip fracture will die in the next year. In ten years, only 8.5% of patients that suffered a hip fracture will still be alive. In comparison, approximately 39.8% of the general population will be alive. These statistics are very frightening. And, during my time as an orthopedic resident assisting in hip surgeries, I saw firsthand how a high mortality rate results from a broken hip.
In fact, for a lot of elderly patients, a hip fracture is not the true problem. The fracture is actually a result of frailty. The fracture is the last event in a decade-long process. The good news is we can begin today to reduce the likelihood of our own frailty resulting in a hip fracture later in our lives.
Why Does Bone Loss Occur?
Bone is a living tissue. Your body is constantly breaking down and reforming bone throughout your entire life. Think of it as a road that is continually being repaired. During your youth and young adulthood, the repair and breakdown processes of bone are equal. Therefore, the bone remains strong. However, as you age, the breakdown process exceeds the repair process. Consequently, your bones become weak and brittle.
Bone Loss Begins Much Earlier Than Many People Believe
As children and adolescents, bones continue to grow in size and strength. At some point, the bone growth ceases, and you achieve peak bone mass, which is the greatest amount of bone you will ever possess. Peak bone mass typically occurs in your 20's, although it can occur slightly earlier in women than in men.
Once you reach peak bone mass, the bone loss process commences. Although bone loss occurs gradually at first, it tends to increase in intensity around age 40.
Does Bone Loss Result in Bones Shrinking?
Bone loss generally refers to the decrease in bone density. The bone density decreases because the internal structure of the bone becomes less dense. It is similar to termites eating away at wooden beams. The wooden beams appear to remain intact from the exterior; however, internally, the beams weaken and ultimately become susceptible to collapsing under stress.
Why Do More Women Experience Bone Loss Following Menopause?
Following menopause, the bone loss process accelerates due to hormone-related changes. Many women experience a bone loss rate of 3-5% per year for several years. Considering a woman's total lifetime bone loss, the cumulative effect is a significant reduction in bone strength.
Considering the increasing number of individuals reaching an advanced age, this is a widespread problem. Approximately 200 million people worldwide have osteoporosis, which indicates a reduction in bone density sufficient to significantly increase the risk of fracturing. Among individuals over 65 years of age in the United States, approximately 27% of women and about 6% of men have osteoporosis.
Although it is easy to assume that this is simply a concern for older adults, the choices you make in your 20s, 30s, and 40s greatly affect your likelihood of experiencing a fracture later in your life.
Why Are Hip Fractures Particularly Hazardous?
Older adults who fracture a hip frequently fail to completely recover.
Approximately half of the patients who fractured a hip regain the ability to function as they had prior to the fracture. Many lose their independence and mobility. Frequently, overall health deteriorates rapidly following a major fracture.
The mortality statistics reflect the reality of the situation.
Therefore, the importance of preventing fractures cannot be overstated. The earlier you begin, the greater the potential for success.
The Best Way To Reduce Your Risk Of Osteoporosis Is Through Regular Exercise
Bone is responsive to its environment. Like muscle, it adapts to the loads applied to it.
If the load you apply to your body does not require strong bones, your body will not maintain them at the same level. The signals for bone formation will be reduced, and breakdown may be increased. Conversely, if you apply regular stress to your bones, your body will receive a signal that bone strength is required, and it will respond accordingly by strengthening the bone.
Clinical trials demonstrate a significant improvement in bone architecture following participation in a structured exercise program. A meta-analysis concluded that regular exercise can help prevent or reverse almost 1% of bone loss per year in women. While that may seem insignificant, over the course of years and decades, it can represent a substantial difference.
Not All Types of Exercise Strengthen Bone Equally
While exercise is beneficial for bone health, the type of exercise is important. Specifically, the most beneficial types of exercise are those that provide higher loads through two forms of stress:
External Loads
These result from impact, such as running and jumping. The forces transmitted through your legs create bone-building signals.
Internal Loads
These result from resistance training, where the stress placed upon your bones comes from your muscles pulling against your bones when you lift weights.
The most effective method for strengthening your bones is a combination of external and internal loads. Running, jumping, and resistance training all contribute to strengthening your bones because they challenge your bones beyond what they are accustomed to. Additionally, these activities promote muscle growth and improve your balance, thereby reducing your risk of falling in the first place.
Are Calcium Supplements Helpful?
Since calcium is a critical element of bone, it is logical that many people turn to supplements. However, the effectiveness of calcium supplements in preventing fractures is inconclusive. Some studies indicate benefit; however, when researchers filter studies to include only high-quality randomized controlled trials, the majority of studies conclude that calcium supplements do not significantly reduce the risk of fractures. Furthermore, excessive consumption of calcium has associated risks.
For most individuals, the best approach is to emphasize dietary approaches to calcium supplementation. Treat supplements as a supplementary resource rather than the cornerstone of your approach to bone health. Bone health is primarily influenced by mechanical loading, or exercise.
Nutrients That Help Promote Bone Health
Many individuals combine bone-promoting habits with nutrients that support the process. Examples include vitamin D, vitamin K2, and magnesium. Vitamin D facilitates the absorption of calcium from your diet. Vitamin K2 promotes the deposition of calcium into your bones. Magnesium is involved in the promotion of bone development through various mechanisms.
The key understanding here is that these nutrients are supporting resources. They do not replace the primary influence, which is exercise. If you consume magnesium as part of your daily regimen, consider learning about common magnesium mistakes to avoid.
Do Not Engage in Smoking and Excessive Alcohol Consumption
There are two habits that significantly increase your risk of developing osteoporosis:
- Smoking
- Excessive alcohol consumption
Both of these habits are detrimental to achieving optimal bone health. Therefore, it is wise to address these habits early in your life.
Osteoporosis Remains Hidden Until It Is No Longer Concealed By Your Body
One of the most difficult aspects of osteoporosis is that most individuals do not recognize they have osteoporosis until they fall and fracture a bone.
That is why screening is essential for individuals who fit into certain categories.
The most commonly utilized screening tool for osteoporosis is a DEXA (dual-energy x-ray absorptiometry) scan, which evaluates bone mineral density. Healthcare providers also evaluate your risk of fractures using your age, sex, and other risk factors.
Who Should Be Screened For Osteoporosis Using a DEXA Scan?
Based on the most current recommendations from the U.S. Preventive Services Task Force:
- All women aged 65 and above should undergo a DEXA scan.
- Women under 65 who are postmenopausal and are at increased risk should also undergo a DEXA scan. Increased risk factors include low body weight, type 2 diabetes, a family history of hip fractures, smoking, and excessive alcohol consumption.
For men, the Task Force states that there is insufficient evidence to establish a universal recommendation for DEXA scans. Therefore, each man should be evaluated individually by his healthcare provider to determine whether he would benefit from a DEXA scan based on his risk profile.
Early detection of weakened bones via a DEXA scan enables the implementation of prevention strategies sooner.
What Happens If a DEXA Scan Indicates You Have Osteoporosis?
Together with your diet and exercise, the most commonly prescribed medical treatment for osteoporosis includes a group of medications referred to as bisphosphonates. Bisphosphonates inhibit bone resorption. A meta-analysis demonstrated that these medications resulted in a 35% reduction in the incidence of hip fractures over 24 to 48 months.
However, bisphosphonates can pose a risk, albeit a rare one, particularly with prolonged use, including atypical fractures and issues related to jaw healing.
Therefore, treatment decisions regarding bisphosphonates should be made cautiously, weighing the potential benefits and risks for each individual.
The Bottom Line
Hip fractures are often a result of years of decline, not a random event. Bone loss begins much earlier than most people believe. Peak bone mass is achieved in your 20's.
If you wish to protect your future mobility and independence, begin early with the habits that will provide the greatest benefits:
- Resistance Training and Impact Exercises
- Strong Balance and Muscle Strength
- Whole Food Diet that Supports Bone Development
- Prevention of Smoking and Excessive Alcohol Use
- Screening when Appropriate
Bone health is not something that you will be able to "fix" after you fracture a bone. Instead, bone health is something that you develop over decades.