Only 15 percent of fractures among older adults may be due to having low bone density. Without a fall, even fragile hips don’t fracture. A combination of resistance exercise to improve lower limb muscle strength and balance training can beat out drugs for preventing osteoporotic bone fractures.
What about calcium supplements? See my videos Are Calcium Supplements Safe? (https://nutritionfacts.org/video/are-calcium-supplements-safe/) and Are Calcium Supplements Effective? (https://nutritionfacts.org/video/are-calcium-supplements-effective/).
What about drinking milk? See my video Is Milk Good for Our Bones? (https://nutritionfacts.org/video/is-milk-good-for-our-bones/).
For more on how to live your longest, healthiest life, preorder my new book How Not to Age (https://nutritionfacts.org/book/how-not-to-age/). (As always, all proceeds I receive from all of my books (https://nutritionfacts.org/books/) are donated to charity.)
“Fall Prevention Is the Most Important Thing
for Preventing Osteoporosis Bone Fractures”
¶
0:08.38
Bone mineral density screening
may be a billion-dollar industry,
0:12.42
but only 15 percent
of low trauma fractures
0:15.06
are due to osteoporosis in older women
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(meaning from a fall
no more than from standing height)
0:20.56
Only 15 percent of fractures
are due to having low bone density.
0:24.36
Between the ages of 60 and 80,
0:26.53
hip fracture risk increases 13-fold
in men and women,
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whereas the age-related decline
in bone mineral density
0:32.28
accounted for only
a twofold increased risk.
0:34.56
So, the contribution
of declining bone density
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to the exponential increase
in hip fracture risk with age
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is relatively small.
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The vast majority of our age-related rise
in hip fracture risk
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appears to have nothing to do
with the measured density of our bones.
0:49.50
So, what’s the main contributor?
0:51.60
Fall risk. Without a fall, even
fragile hips don’t fracture.
0:57.42
Falls are the primary cause of fractures—
including vertebral fractures.
1:02.34
The disparity between men and women
in hip fracture rates
1:04.98
is primarily not because
men have stronger bones,
1:07.20
but because women fall more often.
1:09.36
Doctors just asking the simple question,
“Do you have impaired balance?”
1:13.98
can predict about 40 percent
of all hip fractures,
1:16.74
more than a bone scan diagnosis
of osteoporosis.
1:19.98
Even a weak osteoporotic bone
is strong enough to survive
1:24.06
normal life activities
without the excessive loading
1:27.06
that comes from a fall impact
or, in the case of the spine,
1:29.70
bending with your back to lift something
rather than your knees.
1:32.94
The primacy of falls
in fracture risk explains
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a number of apparent
osteoporosis paradoxes.
1:39.66
For example, despite the fact
that about 75 percent of your bone mass
1:43.80
may be determined by your genes,
the heritability of bone fractures
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appears negligible at older ages
1:50.10
(because the propensity to fall
is much less inherited).
1:54.24
It also explains
the poor predictive value
1:56.76
of bone density screening
for fractures.
1:58.80
Adding bone mineral density measures
to a hip fracture risk score
2:02.40
based just on age, sex, height,
weight, the use of a walking aid,
2:06.42
and cigarette smoking, did little
to improve its predictive power.
2:11.16
A provocative editorial published
in the Journal of Internal Medicine
2:14.82
entitled “Osteoporosis:
The Emperor Has No Clothes”
2:18.50
suggested that it would be safer
and more effective
2:21.06
to focus on fall prevention
rather than pharmaceutical intervention.
2:27.06
Even though only about 5 percent
of falls result in a fracture,
2:30.30
falls are very common
among the aged, due in part
2:33.78
to age-related muscle weakness
and loss of balance.
2:36.48
More than a third of those aged 65
and older fall each year,
2:40.05
and after a hip fracture,
fewer than 50 percent
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regain their pre-fracture function
2:44.88
in terms of walking ability
and independence.
2:46.86
What can we do to prevent injurious falls?
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Based on dozens
of randomized controlled trials,
2:53.46
the single intervention
most strongly associated
2:56.28
with a reduction in fall rates: exercise.
3:00.37
So, exercise
doesn’t just boost bone density,
3:03.66
more importantly, it also reduces
the number of falls over time
3:07.80
by 23 percent and the number
of fallers by 15 percent.
3:10.86
So, if you followed
1,000 people around age 75 for a year,
3:14.94
and 480 fell a total of 850 times
without exercise,
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adding exercise
would be expected to result
3:21.84
in 72 fewer fallers
and 195 fewer falls.
3:26.52
Tai Chi appears to reduce falls
by 19 percent,
3:30.09
balance and functional exercises
(like sit to stand)
3:32.76
may reduce falls by 24 percent,
3:34.71
and multiple exercises—
typically balance and functional exercise
3:38.10
plus strength training—
may reduce falls by 34 percent.
3:42.36
The reduced falls rate
then translates into fewer fractures.
3:46.92
A recent meta-analysis found
that exercise interventions—
3:49.56
mostly using a combination
of resistance exercise
3:52.20
to improve lower limb muscle strength
and balance training—
3:55.14
cut fracture rates nearly in half.
3:58.80
One year-long trial
that combined strength training
4:01.14
with step and jumping aerobics
and focused on balance and agility
4:04.74
resulted in 74 percent fewer fractures
over the 5-year period
4:08.82
after the study ended.
4:10.32
Furthermore, more than 70 percent
of the women in the combo exercise group
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went those five years
without a single injurious fall,
4:16.80
compared to less than half
of those in the control group.
4:20.46
Trials on hip protectors,
which cushion a sideways fall on the hip
4:25.26
with plastic shields or foam pads
sewn into special underwear,
4:29.22
are often plagued with poor compliance.
4:32.10
Studies have not found them to be useful
for reducing hip fracture rates
4:35.34
among those living at home,
but trials in nursing homes
4:38.22
or residential care facilities
do show a small reduction in risk,
4:41.52
translating into about 11 fewer people
out of a thousand
4:44.88
suffering hip fractures
due to wearing hip protection.
4:48.36
There are also common-sense
measures one can employ.
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Quality improvement trials involving
interventions like patient education
4:56.10
have shown a 10 percent reduction
in fall rates.
4:58.68
For example, keep things within reach
so you don’t need to use step stools,
5:02.64
use non-slip mats in the bath and shower,
add grab bars in the bathroom,
5:07.74
keep floors clutter free,
remove small throw rugs
5:12.06
or use double-sided tape
to keep them from slipping,
5:14.52
and make sure all staircases
have handrails and adequate lighting.
5:18.00
You could also avoid taking walks
during inclement weather,
5:21.60
and for those who walk leashed dogs,
consider choosing smaller breeds
5:25.92
or ensuring proper training
to prevent them from lunging.
5:28.74
Otherwise, the main ways
to prevent fractures
5:32.10
may not have changed much over the decades
since the classic paper entitled
5:36.78
“Strategies for Prevention
of Osteoporosis and Hip Fracture.”
5:39.72
The main ways to prevent these fractures
are to “stop smoking,
5:43.56
be active and eat well.”
