My First Fracture, and What to Know About Osteoporosis
A childhood fall on the ice taught me about broken bones. Here's what osteoporosis is, who's at risk, how it's assessed, and how to protect your bones.
I can still remember the day I experienced my first real injury. I was about twelve years old and it was another ordinary early morning at the ice rink. I was running late for practice for an upcoming show and quickly got on the ice and started skating. It usually took me twenty minutes to warm up on the ice, but that morning I had no time. My music came on suddenly and I started to skate my program. As I came to the end of my performance, I prepared for my final move, a split on the ice. I attempted the split but heard a startling 'cracking noise' and immediately felt immense pain. I remember the sound and feeling of my bone breaking like it was yesterday. I was not able to move and needed assistance off the ice. After hours at the hospital, I was diagnosed with a hairline pelvic fracture, which kept me off the ice for several months during my last year of elementary school.
What is osteoporosis? My injury was a consequence of trauma, but many individuals suffer non-traumatic fractures from osteoporosis. Osteoporosis is a disorder of low bone mass that causes bones to become thin, weak, and brittle. It is not acutely life-threatening, but it can lead to debilitating fractures of the hip, spine, and wrist, along with various complications. Some of these fractures result from low trauma such as coughing, sneezing, or tripping after losing balance, and they can significantly impact daily activities and quality of life.
Risk factors. These include age, family history, a previous fracture, race, vitamin D deficiency, low body mass index, excessive alcohol intake, and smoking. Certain medications like steroids, antacids, and antidepressants can increase fracture risk. People with rheumatoid arthritis, lupus, seizures, inflammatory bowel disease, or thyroid disorders are at higher risk for bone loss, especially if their treatment affects bone quality. Electrolyte and vitamin deficiencies, as seen in anorexia, also raise risk.
Assessing fracture risk. As a rheumatologist, it is imperative to assess an individual's risk for osteoporosis and fracture. This is done by (a) obtaining a thorough personal and family history, (b) performing bone density testing (DXA), (c) checking blood work for calcium, vitamin D, parathyroid, and thyroid levels, and (d) using an online tool called FRAX to estimate an UNTREATED individual's ten-year probability of a hip or major osteoporotic fracture.
Lifestyle change #1: Stop smoking today! Get on some type of nicotine replacement with the advice of your doctor as soon as you can. Nicotine can generate free radicals that destroy bone cells and increase cortisol levels that accelerate bone deterioration.
Lifestyle change #2: Limit excessive alcohol (more than 2 to 3 ounces a day). Alcohol interacts with bone-forming cells and can affect the liver and pancreas, which play a role in calcium and vitamin D absorption.
Lifestyle change #3: Engage in balance and flexibility training and strengthening (weight-bearing) exercises to stimulate bone formation. Swimming, walking, yoga, and Tai Chi are encouraged.
Lifestyle change #4: Get adequate calcium and vitamin D into your diet! It may be time to substitute the half-and-half in your coffee with soy or almond milk. Good sources of calcium include milk, yogurt, nuts (almonds), cheese, dark green vegetables, orange juice, sardines, and soy milk. Vitamin D sources include cod liver oil, fish oil, eggs, fortified dairy products, and over-the-counter supplements.
What about medications? Sometimes women and men develop worsening bone density despite good lifestyle changes and may need medication to increase bone density and strength. Some medications help build bone mass, others prevent further bone loss, and others affect how the different cells in bone remodeling interact. Estrogen has also been used to help protect the skeleton by promoting calcium absorption and preventing the death of bone-forming cells. Current options include bisphosphonates, denosumab, teriparatide, abaloparatide, raloxifene, and romosozumab.
Every person is different and must discuss the options with their physician, weighing their comfort with each drug's side effect profile before making a final decision. Keep in mind that not treating osteoporosis can be risky and may lead to disability, and no therapy is permanent.
I hope that with more education about this public health concern, people will empower themselves to take measures to improve their bone health! References: National Osteoporosis Foundation (nof.org); American College of Rheumatology (rheumatology.org).
Dr. Maggie Cadet, MD