Which bones am I more likely to break

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For all women with or without osteoporosis who are 50 years or older, the lifetime risk of fracturing any bone is about 40%, though most fractures occurring after age 50 are related to osteoporosis. For all U.S. adults, the lifetime risk of fracturing a bone is greater than the combined risk of developing breast, uterine, or ovarian cancers. If you are a woman, the risk of fracturing your hip, your spine, or your wrist is between 15% and 18% each. If you are a white elderly woman who either has hyperthyroidism (overactive thyroid), cannot get out of a chair without using your arms, or has a resting pulse rate of over 80 beats per minute, the risk for fracturing your hip is about 70%. If your only risk factor is that your mother broke her hip, then your risk is about 80%. But it's only about 50% if you fractured any of your bones since the age of 50. Even without any of these specific risk factors, age increases your risk for fracture by about 40% every 5 years. Your risk for hip fracture increases with more risk factors, so making changes to reduce your risk, such as increasing exercise, getting enough Vitamin D and calcium, and quitting smoking is important.

All together, there are more fractures related to osteoporosis than the combined number of heart attacks, strokes, and new diagnoses of breast cancer among women each year. The combined 250,000 hip fractures,

250,000 wrist fractures, 750,000 spinal fractures, and 250,000 other fractures amounts to 1.5 million fractures related to osteoporosis per year. So, if you are going to break a bone, you are about 3 times more likely to break a bone in your spine than you are in your hip. And you are just as likely to break your wrist as your hip.

Marie's comment:

My grandmother had osteoporosis. Well, actually, I don't think she was ever officially diagnosed with it, but she must have had it because she had so many broken bones. I remember when she visited us at our house when she was about 85 or 86 and she had such terrible back pain, she couldn't even get dressed by herself. She told us she had fallen onto her bottom and back when she was at home and reached up into her closet to get something off the top shelf. She didn't fall that far or hard, but she said her back had been hurting ever since. We took her to the doctor and they did x-rays that showed she had 4 or 5 fractures in her spine bones. She was admitted to the hospital and was progressing slowly, and then she came home to our house and recuperated there for another 2 or 3 weeks. She eventually went back to her home (after about 2 months all together), but within 2 weeks she fell again, this time in the bathtub and was admitted to the hospital. This time she cracked her pelvis and was eventually admitted to a nursing home. After she had been in the nursing home for 6 years or so, she broke her thigh bone while trying to get out of bed. Her leg got caught up in the side rail on the bed, and when she turned, it just broke. She wasn't ever treated for osteoporosis, except for taking calcium. And she wasn't at such high risk. She was a good-sized women, not fat or anything, but not frail. And she was active her whole life. But, after she cracked her pelvis she never left that nursing home. She died there.

Fragility fracture

Term used to describe fractures that occur with very little trauma or force and from a height that is usually not great enough to cause broken bones, usually indicating that the bone is weak. Also called osteoporotic fractures.

74.1 am 45 years old. I recently stumbled on a rug. I fell against the wall. I broke my wrist and my clinician is now concerned that I have osteoporosis. She called my fracture a "fragility fracture." What is that, and what does it have to do with osteoporosis?

Fragility fracture is a term used by clinicians to describe fractures that occur without much force and from a height usually not great enough to cause broken bones. They are also called osteoporotic fractures. The term is used to help clinicians evaluate the state of their patient's bones. A history or presence of one or more fragility fractures also helps clinicians in the decisions to send you for BMD testing and treat you for osteoporosis (see Questions 20-21). The degree of osteoporosis is also diagnosed by the presence or history of fragility fractures. Severe osteoporosis is diagnosed when BMD indicates a T-score more than 2.5 standard deviations below the mean with a history or presence of one or more fragility fractures. However, you don't have to have osteoporosis to have a fragility fracture. In fact, according to the NORA (National Osteoporosis Risk Assessment) study, 50% of fragility fractures occur in individuals with osteopenia. Interestingly enough, you can even have a fragility fracture while still having normal BMD.

One of the problems with fragility fractures is that sometimes they occur, not because you have osteoporosis or low bone mass as measured by BMD testing, but because your bones have poor bone quality. This means that while your bone density tests may indicate that you have normal bone density, the "architecture" of the bones may be weak. Machines used to measure BMD cannot "see" inside the bone to evaluate its structure and, therefore, a DXA machine cannot measure your bone quality. Because BMD testing does not measure bone quality, your risk of getting a fragility fracture may still be high despite a normal T-score.

Because most of the research has been conducted on women over the age of 65, there are not enough data yet to provide useful information on younger women and men. So, even though younger women are not expected to be at high risk for fracture, your clinician is right to be concerned simply based on the low level of force of your fall. Some clinicians believe that the angle of breaking a bone determines whether the bone has enough strength to withstand force. This would be likened to a breakable dish that when dropped at one angle may shatter, but from another angle it remains unharmed. Your bone strength could actually be quite weak even though your bones appear to be normal on BMD testing.

Fragility fractures can happen when you fall or bang against something, but most often they occur spontaneously in your back (see Question 83). Sometimes you will experience significant pain with a vertebral fracture and other times it will be "silent," meaning that a fracture occurs but you are not even aware of it.

If you experience a fragility fracture, your clinician will send you for a DXA test. You also will be evaluated for possible causes, such as using medication that weakens bones or having an illness that interferes with bone development or quality (see Questions 16 and 17). If possible secondary causes for the fragility fracture are ruled out, you should be referred to a specialist to discuss treatment for osteoporosis. This presents an opportunity for beginning medications for osteoporosis to increase bone density and to decrease further fracture risk, even though the quality of your bones may cause you to fracture a bone more easily. You should also receive counseling about your calcium and Vitamin D intake, exercise, and any lifestyle changes that may improve the health of your bones. Once you have sustained one fracture, you are at high risk for having another, so it's important to evaluate your surroundings for the things that could put you at risk for falling. Question 79 discusses ways to reduce your risk of falls. You would also want to make sure that you are not bending forward or twisting your spine, since both actions could cause vertebral fractures. Figure 10 in Question 45 shows exercises to avoid.

75. If I fracture a bone, will it change my treatment? Will a broken bone take longer to heal? Will a broken bone be repaired or casted differently?

To heal a broken bone can be challenging at any age, but if you have osteoporosis, you are more likely to be in your middle years or older. Healing does happen more slowly as we age. It is more important than ever that you have a healthy diet and get the proper nutrients for healing. Your diet should be a healthy one, including adequate but not excessive protein. You should also be especially careful to get the appropriate amounts of vitamins and minerals, particularly calcium and Vitamins A, C, and D, all of which contribute to healthy bone development and healing whether you have a fracture or not. You should stay on your osteoporosis medication unless told otherwise by your clinician, but it's also a good idea to ask if there are any medications you should discontinue while you are healing.

Depending on which bone you break, the repair and treatment may be a little different:

Hip. Because you will be less mobile for a period of time (see Question 77 and 78), it is important for you to stop certain medications that can put you at risk for blood clots, such as Evista (raloxifene) and MHT (estrogen or estrogen and progesterone). Casts are not applied to broken hips the way they are for other broken bones. Broken hips can take a very long time to heal, and complete healing may never take place. Many factors contribute to the healing process, not the least of which is the person's physical condition prior to the broken hip. The caretakers, who themselves may be quite elderly, may not be able to provide the intensive care that is often needed for recovery. And the isolation associated with immobility can lead to severe depression, which has a huge impact on healing.

Wrist. Fracturing a bone in your forearm, usually near your wrist, does not cause the same problems of disability and even death that are attributed to hip fractures. However, wrist fractures can cause persistent pain, functional and nerve problems, bone deformities, and arthritis. Although a wrist fracture is less likely to cause problems with walking and being mobile, it can still restrict you from getting out of the house, especially if you need to drive. It can also prevent you from doing activities of daily living, such as bathing and meal preparation. You will likely have a cast applied to your forearm, which includes the area below the elbow down to the thumb and fingers. Typically, a simple fracture requires a cast for 4 to 6 weeks, but depending on your ability to heal, you may have a cast longer.

Vertebral fractures. Fractures of the spine can be painful or they can be "silent," meaning that they are present but not necessarily painful (see Question 83). These types of fractures cannot be put in a cast. However, some clinicians might still recommend that you wear a metal brace that prevents your spine from twisting or bending. There is controversy about whether a brace provides sufficient pain relief to warrant its use and whether the immobility provided by the brace causes more harm than good, so braces are recommended infrequently. Vertebral fractures can cause considerable disability and distress. In addition to staying on your currently prescribed medication, Miacalcin NS or Fortical may be added to ease some of the pain associated with your spine fractures, and it may work with your current medication to increase your bone density even further. This type of fracture can take many weeks to heal. Unfortunately, the very fact of having one osteoporotic spinal fracture significantly increases your risk of having another within one year's time.

Roxanne's comment:

Although my ankle fracture occurred about 5 months ago, I think it's going to take me a full year to recover. I never would have guessed that this type of fracture could take so long to heal. I still have some pain and quite a lot of swelling, although I'm able to get around on my own. My orthopedist said that I should expect to have arthritis in the ankle and to go back to the elliptical machine instead of walking as my form of exercise. I have started taking estrogen again for my menopause symptoms, although I had stopped it during my recovery because I was fairly immobile.

When I first fractured my ankle, the surgeon came out with crutches, expecting me to use them. He obviously didn't know I was a klutz and would have broken the other ankle if I actually continued to use them. I constantly felt like I was going to fall. Crutches and walkers are the equivalent of walking on your hands! So, instead ofseeing a wheelchair as a sign of failure, I saw it as my only option to get around. I went everywhere in it. That wheelchair allowed me to go back to work and to do almost everything I was used to doing before the accident. I used nothing but a wheelchair at home too. I was home alone during the day for about a month, and I was petrified of falling while using crutches or a walker. The wheelchair was the single most important reason I was able to stay active and mobile. And it saved me both financially and socially because I was able to return to work probably about 6 weeks sooner than I would have had I stayed on crutches. I tell everyone that a wheelchair is not a sign of weakness or failure!

Recovering from a fracture like this has been an enlightening experience for me. I look for handrails and handicapped access everywhere I go now. I never realized how seriously breaking a bone could impact your life. I'm very conscious now of not putting myself in situations where I could fall. Although I was wearing low-heeled, rubber-soled shoes when I fell, I recommend wearing high-top sneakers and cowboy boots for their ankle support!

76. My clinician told me not to take up skiing or ice-skating now that I have bone loss. Why is that, and are there other activities I should avoid?

High-impact winter sports are discouraged for people who have any degree of bone loss unless you have always been a skier or skater. The learning curve for these types of sports involves many falls, which is the reason to avoid them. The impact from the falls further increases your risk for a fracture. Even professional skiers and skaters fall sometimes. It has nothing to do with stamina or willingness to learn. It has to do with the likelihood of falling. Any sport that involves a high possibility for falls should be avoided.

And it's not just winter sports. For example, if you've never run the 100-meter high hurdles or done horseback riding, now is not the time to start! Similarly, you should avoid sports that are high impact, where there is a strong possibility that you will have rough contact or be knocked over by another player. So, sports such as football, soccer, field hockey, softball, and kick-boxing are best avoided if you have osteoporosis.

Midlife and beyond, particularly if you are retired, present many opportunities to try new things and explore your interests. It's great to take up the challenge of learning and trying new things! Remaining physically active is very important, but stick to new activities that have low impact and low risk for falls.

If you have been told that you have osteoporosis or if you have a history of spinal fractures, it is particularly important to avoid forward bending or twisting of your spine. You should be careful to avoid toe touches, sit-ups, and some movements in yoga and Tai chi (see Questions 44-45). If you have been told that you have osteopenia (T-score >-2.5), you can still do exercises that involve forward bending or twisting of the spine as long as the bone loss is not in your spine (see Figure 10 in Question 45).

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