Strategies to Reduce Your Risk of Fractures
If I am diagnosed with osteoporosis, what should I do next?
You may feel concerned or even frightened after being diagnosed with osteoporosis. However, the good news is that, armed with information and the support of your doctor, you can significantly improve your bone health and reduce your risk of future fractures with a combination of medication, diet, exercise, and lifestyle modifications.
Some of my friends take medication for osteoporosis. Should I consider this?
Yes. Several medications are available to prevent and treat osteoporosis, including: bisphosphonates; estrogen agonists/antagonists (also called selective estrogen receptor modulators or SERMS); parathyroid hormone; estrogen therapy; hormone therapy; and a recently approved RANK ligand (RANKL) inhibitor. Your doctor can help you understand the benefits and risks of each of these medications and select one that is right for you.
In men, reduced levels of testosterone may be linked to the development of osteoporosis. Men with abnormally low levels of testosterone may be prescribed testosterone replacement therapy to help prevent or slow bone loss.
What else can I do to protect my bones?
In addition to taking your medication, some of the most important things you can do are to follow a diet rich in calcium and vitamin D, maintain an adequate daily intake of protein, monitor your sodium intake, and get plenty of exercise.
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Calcium is needed to maintain healthy, strong bones throughout your life. Unfortunately, most Americans do not get enough calcium from their diets. Dairy products such as milk, cheese, and yogurt are excellent sources of calcium, and some nondairy foods such as broccoli, almonds, and sardines can provide smaller amounts. In addition, many foods that you may already enjoy—juices, breads, and cereals—can now be found fortified with calcium.
Calcium supplements can ensure that you get enough calcium each day, especially in people with a proven milk allergy. The Institute of Medicine recommends a daily calcium intake of 1,000 mg (milligrams) for men and women up to age 50, increasing to 1,200 mg for women over age 50 and men over age 70.
Calcium supplements are available without a prescription in a wide range of preparations and strengths. Many people ask which calcium supplement they should take. The “best” supplement is the one that meets your needs based on tolerance, convenience, cost, and availability. In general, you should choose calcium supplements that are known brand names with proven reliability. Also, you will absorb calcium better if you take it several times a day in smaller amounts of 500 mg or less each time.
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Vitamin D plays a significant role in helping your body absorb calcium. The relationship between calcium and vitamin D is similar to that of a locked door and a key. Vitamin D is the key that unlocks the door, allowing calcium to enter your bloodstream. As we age, our bodies become less able to absorb calcium, which makes getting enough vitamin D even more important. The recommended daily intake for vitamin D is 600 IU (international units) up to age 70. Men and women over age 70 should increase their uptake to 800 IU daily. Many people get this amount by consuming vitamin D-fortified foods such as milk. In addition, many calcium supplements are fortified with vitamin D.
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Sodium, a main component of table salt, affects our need for calcium by increasing the amount of it we excrete in urine. As a result, people with diets high in sodium, or table salt, appear to need more calcium than people with low-sodium diets to ensure that, on balance, they retain enough calcium for their bones.
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Protein in excess amounts also increases the amount of calcium we excrete in urine, but it provides benefits for bone health as well. For example, protein is needed for fracture healing. In addition, studies have shown that elderly people with a hip fracture who do not have enough protein in their diets are more likely to experience loss of independence, institutionalization, and even death after their fracture. The recommended daily intake for protein is 56 grams for men and 46 grams for women.
I've always been active, but I don't want to risk breaking another bone. Maybe I need to spend more time "on the sidelines" from now on.
It is perfectly understandable that you want to avoid another fracture. No one who has broken a bone wants to revisit that pain and loss of independence. However, living your life “on the sidelines” is not an effective way to protect your bones. Remaining physically active reduces your risk of heart disease, colon cancer, and type 2 diabetes. It may also protect you against prostate and breast cancer, high blood pressure, obesity, and mood disorders such as depression and anxiety. If that isn’t enough to convince you to stay active, consider this: exercise is one of the best ways to preserve your bone density and prevent falls as you age.
What type of exercise is best to reduce my risk of another fracture?
Exercise can reduce your risk of fracturing in two ways—by helping you build and maintain bone density and by enhancing your balance, flexibility, and strength, all of which reduce your chance of falling.
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Building and maintaining bone density. Bone is a living tissue that responds to exercise by becoming stronger. Just as a muscle gets stronger and bigger with use, a bone becomes stronger and denser when it is called upon to bear weight. Two types of exercise are important for building and maintaining bone density: weight-bearing and resistance. Weight-bearing exercises are those in which your bones and muscles work against gravity. Examples include walking, climbing stairs, dancing, and playing tennis. Resistance exercises are those that use muscular strength to improve muscle mass and strengthen bone. The best example of a resistance exercise is weight training, with either free weights or weight machines.
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Reducing the risk of falling. You can significantly reduce your risk of falling by engaging in activities that enhance your balance, flexibility, and strength.
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Balance is the ability to maintain your body’s stability while moving or standing still. You can improve your balance with activities such as tai chi and yoga.
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Flexibility refers to the range of motion of a muscle or group of muscles. You can improve your flexibility through tai chi, swimming, yoga, and gentle stretching exercises.
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Strength refers to your body’s ability to develop and maintain strong muscles. Lifting weights will increase your strength.
How can I exercise safely if I have osteoporosis?
If you have osteoporosis, it is important for you to get plenty of exercise. However, you will need to choose your activities carefully. Be sure to avoid activities with a high risk of falling, such as skiing or skating; those that have too much impact, such as jogging and jumping rope; and those that cause you to twist or bend, such as golf.
Unfortunately, some people become so afraid of breaking another bone that they become more sedentary, which leads to further loss of bone and muscle. Rest assured, however, that by practicing proper posture and learning the correct way to move, you can protect your bones while remaining physically active. Every activity can be adapted to meet your age, ability, lifestyle, and strength. Your doctor or a physical therapist can help you design a safe and effective exercise program. In the meantime, here are some general guidelines for safe movement:
Don't:
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wear shoes with slippery soles
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slouch when standing, walking, or sitting at a desk
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move too quickly
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engage in sports or activities that require twisting the spine or bending forward from the waist, such as conventional sit-ups, toe touches, or swinging a golf club.
Do:
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pay attention to proper posture. This includes lifting your breastbone, keeping your head erect and eyes forward, keeping your shoulders back, lightly “pinching” your shoulder blades, and tightening your abdominal muscles and buttocks.
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make sure to use a handrail when climbing stairs
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bend from the hips and knees and never from the waist, especially when lifting.
My fracture happened after I tripped on a rug in my own home. How can I prevent another fall?
Falls are a major source of fractures. The likelihood that you will fall depends on both personal and environmental factors.
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Personal factors. A fall may occur because your reflexes have slowed over time, making them less able to react quickly to a sudden shift in body position. Loss of muscle mass may occur as you age, which can diminish your strength. Changes in vision and hearing can also affect your balance, as can the use of alcohol and certain medications. People with chronic illnesses that affect their circulation, sensation, mobility, or mental alertness are more likely to fall. To reduce your risk of falling, keep this personal safety checklist in mind:
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Personal safety checklist
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Stay active to maintain muscle strength, balance, and flexibility.
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Have your vision and hearing checked regularly and corrected as needed.
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Discuss your medications with your doctor to see if one of them (or their combination) might lead to falls.
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Environmental factors. At any age, people can make changes in their environment to reduce their risk of falling and breaking a bone. The following safety checklists provide a few tips that should help:
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Indoor safety checklist
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Use night lights throughout your home.
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Keep all rooms free from clutter, especially the floors.
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Keep floor surfaces smooth but not slippery. When entering rooms, be aware of differences in floor levels and thresholds.
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Wear supportive, low-heeled shoes even at home. Avoid walking around in socks, stockings, or floppy slippers.
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Check that all carpets and area rugs have skid-proof backing or are tacked to the floor, including carpeting on stairs.
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Keep electrical cords and telephone lines out of walkways.
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Be sure that all stairways are well lit and that stairs have handrails on both sides. Consider placing fluorescent tape on the edges of top and bottom steps.
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Install grab bars on bathroom walls beside tubs, showers, and toilets. If you are unstable on your feet, consider using a plastic chair with a back and nonskid leg tips in the shower.
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Use a rubber bathmat in the shower or tub.
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Keep a flashlight with extra batteries beside your bed.
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Add ceiling fixtures to rooms lit only by lamps, or install lamps that can be turned on by a switch near the entrance to the room.
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Use at least 100-watt light bulbs in your home.
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Outdoor safety checklist
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In bad weather, consider using a cane or walker for extra stability.
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In winter, wear warm boots with rubber soles for added traction.
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Look carefully at floor surfaces in public buildings. Many floors are made of highly polished marble or tile that can be very slippery. When floors have plastic or carpet runners in place, try to stay on them whenever possible.
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Use a shoulder bag, fanny pack, or backpack to leave hands free.
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Stop at curbs to check height before stepping up or down. Be cautious at curbs that have been cut away to allow access for bikes or wheelchairs. The incline may lead to a fall.
What is hip padding? Should I consider it?
Research has shown that hip protectors can decrease the risk of hip fracture among people who are at high risk for falls. Most hip protectors are washable undergarments that fit over the hips. On each side of the garment is a thin layer of lightweight foam plastic. Hip protectors are typically worn by people who have an unstable stride or posture and by people who tend to fall down (with the main impact near the hip) rather than the more typical fall forward (with the main impact on the hands or knees).
However, studies have found that up to one-third of people refused to wear hip protectors or wore them for only limited periods.
Is there anything else I can do?
If you are a smoker, now would be a good time to quit. Tobacco is toxic to your bones, putting you at higher risk for low bone mass and osteoporosis. Excessive alcohol intake also may be damaging to your bones, and people who drink heavily tend to have more bone loss and fractures due to poor nutrition and an increased risk of falling.
