In honor of Women’s History month, we are addressing osteoporosis. According to the National Osteoporosis Foundation “one in two women and up to one in four men will break a bone in their lifetime due to osteoporosis. For women, the incidence is greater than that of a heart attack, stroke and breast cancer combined.”

Diagnosing Osteoporosis

The story of how osteoporosis is diagnosed is incredibly common. Typically, a patient arrives at Proliance Hand, Wrist and Elbow Physicians with a broken wrist after a recent fall onto an outstretched hand. When asked how she fell, the patient reports, “It’s so silly really, I just stumbled and put my arm out to stop the fall. It’s not like I was running after my grandkids or even playing football!” The hand specialist then replies, “I have good news and bad news. The good news is we can treat the fracture; the bad news is I am concerned you may have osteoporosis.”

What is Osteoporosis anyway?

Osteoporosis is a disease of the bone that occurs when the density and/or mass decreases causing the bone to become brittle and fragile. The term osteoporosis literally means “porous bone,” indicating that the bones begin to appear more porous or hollow; the hollower the bone the more likely it is to break. This disease is often described as silent in nature, meaning there are no obvious signs that bone density is being lost until the person sustains their first fragility fracture or a fracture sustained from a low-energy trauma such as a fall from a standing height. Osteoporosis is a primary cause of fragility fractures which are most common in the hip, spine and wrist.

Why does the wrist fracture matter?

A wrist fracture can be the first warning sign that the bones of the body may be weakening. They are the second most common fragility fracture and the most common upper extremity fracture of women over the age of 50. Studies show that a person over the age of 65 who has sustained a wrist fracture is now five times more likely to have a subsequent hip fracture in the first year following their injury.

The hip fracture is the absolute game changer when it comes to mortality and morbidity rates in aging adults. These injuries are one of the most alarming fractures in all of healthcare.  Statistics on patient health and recovery following these fractures are bleak. Studies have shown that approximately 30% of people with a hip fracture that are 50 and older do not survive the first year following that fracture. Additional studies have shown that those that do recover, continue to struggle greatly with independence and return to function. In fact, 6 months following a hip fracture only 15% of patients are able to walk across a room without some form of assistance. With the profound effect fragility fractures have on patient’s long-term independence and survival rates, identifying osteoporosis as early as possible is critical in minimizing the severity of its effects.

How likely am I to have osteoporosis?

The short answer is, very likely. This disease is surprisingly common, affecting more than 54 million Americans. Many factors affect how likely we are to develop osteoporosis. Common risk factors include being female, Caucasian and/or Asian, a family history of osteoporosis or fragility fractures and being greater than 65 years in age (regardless of gender). These factors are mostly out of our control, however, there are several other factors that increase the likelihood of developing osteoporosis that are very much within our control. These factors include early onset menopause, smoking, alcohol abuse, poor diet, inactive lifestyle, vitamin D deficiency, low body mass index and frequent falling. By modifying these factors, we can greatly reduce our risk of osteoporosis and fragility fractures.

So what can I do to prevent or manage osteoporosis?

There are many ways you can impact the health of your bones. Considering the following:

  • Knowledge is key: What is the current status of your bones? The CDC recommends all women 65 and older undergo a screening for osteoporosis. The CDC also recommends women between the ages of 50-64 with certain risk factors and men greater than 65-70 with increased risk undergo screening as well.   The most common screening test is a bone mineral density scan, which are pain free and somewhat like an x-ray.  Primary care physicians (PCP) can order screenings to assess bone health and make determinations about your risk of osteoporosis.
  • Choose a healthy lifestyle: We strongly suggest smoking cessation, reducing alcohol intake and eating a well-balanced diet to maintain bone health. Physical fitness matters as well. Keeping muscles active and pulling on bones contributes to maintaining their density. This can be done through balance and flexibility exercises as well as cardiovascular and strength training routines.
  • Keep upright: Fall prevention is one of the greatest tools in preventing fragility fractures and maintaining bone health. Often this is considered a topic for elderly patients, but the truth of the matter is that anyone at any age can work on core stability and balance. As we age, participating in long term fitness classes such as Tai Chi and Moving for Better Balance can challenge and improve our balance. Furthermore, seeking consultation from a physical therapist for a balance assessment can help you resolve any weaknesses that are specific to you. Finally, making sure your home is safe by clearing floor-based tripping hazards such as throw rugs, installing grab bars in the shower and properly lighting hallways and bathrooms at night can prevent the unexpected fall. Click here for further information of the profound effects fall prevention has on our health as we age.
  • Supplements and medications: After identifying that you may be at risk for osteoporosis, the next step is to have a plan to treat the problem. Often a PCP will order laboratory testing to better understand your calcium and vitamin D levels as well as examine thyroid and hormone levels. Based on the results of that data along with the information from the bone scan, a PCP will make recommendations as to what your supplement regimen should be and if you should consider medications to aid in the rebuilding of your bone.

 How Can Proliance Hand, Wrist and Elbow Physicians Help?

A consultation with Proliance Hand, Wrist and Elbow Physicians can help determine if your hand may benefit from a comprehensive hand evaluation. Our highly trained occupational therapists are onsite at our Kirkland and Bellevue offices for your convenience to see your hand surgeon and therapist conveniently and quickly. To make an appointment please contact our staff at any of our five convenient Eastside locations.

For more information on osteoporosis and ways to combat the disease, please click on the following links:

Osteoporosis OverviewNIH Osteoporosis & Related Bone Diseases National Resource Center
Preventing Fractures, National Osteoporosis Foundation
BoneTalk: Podcast & Blog, National Osteoporosis Foundation
Genomics and Precision Health: OsteoporosisCDC
Check For Safety: A Home Fall Prevention Checklist For Older Adults, CDC

 



Kristin Rosen OTR/L, CHT, CLT is an occupational therapist who specializes in hand and upper extremity rehabilitation in addition to treatment of lymphedema. She has a strong interest in supporting women’s health in the field of orthopedics. She lives in the Seattle area with her husband and when not working she is mostly a professional chauffeur to her teen and tween children.