Fall Prevention Is the Most Important Thing for Preventing Osteoporosis Bone Fractures

Below is an approximation of this video’s audio content material. To see any graphs, charts, graphics, photographs, and quotes to which Dr. Greger could also be referring, watch the above video.

Bone mineral density screening could also be a billion-dollar business, however solely 15 p.c of low-trauma fractures (which means from a fall not more than from standing height) are attributable to osteoporosis in older women. Only 15 p.c of fractures are attributable to having low bone density. Between the ages of 60 and 80, hip fracture threat will increase 13-fold in males and women, whereas the age-related decline in bone mineral density accounted for solely a twofold elevated threat. So, the contribution of declining bone density to the exponential improve in hip fracture threat with age is comparatively small. The overwhelming majority of our age-related rise in hip fracture threat seems to don’t have anything to do with the measured density of our bones.

So, what’s the principal contributor? Fall threat. Without a fall, even fragile hips don’t fracture. Falls are the main reason for fractures—together with vertebral fractures. The disparity between males and women in hip fracture charges is primarily not as a result of males have stronger bones, however as a result of women fall extra typically. Doctors simply asking the easy query, “Do you have impaired balance?” can predict about 40 p.c of all hip fractures––greater than a bone scan prognosis of osteoporosis. Even a weak osteoporotic bone is powerful sufficient to outlive regular life actions with out the extreme loading that comes from a fall affect or, in the case of the backbone, bending along with your again to carry one thing reasonably than your knees.

The primacy of falls in fracture threat explains a variety of obvious osteoporosis paradoxes. For instance, regardless of the proven fact that about 75 p.c of your bone mass could also be decided by your genes, the heritability of bone fractures seems negligible at older ages (as a result of the propensity to fall is way much less inherited).

It additionally explains the poor predictive worth of bone density screening for fractures. Adding bone mineral density measures to a hip fracture threat rating based mostly simply on age, intercourse, height, weight, the use of a strolling support, and cigarette smoking standing did little to enhance its predictive energy. A provocative editorial revealed in the Journal of Internal Medicine entitled “Osteoporosis: The Emperor Has No Clothes” advised that it could be safer and simpler to give attention to fall prevention reasonably than pharmaceutical intervention.

Even although solely about 5 p.c of falls end in a fracture, falls are quite common amongst the aged, due partially to age-related muscle weak spot and loss of stability. More than a 3rd of these aged 65 or older fall annually. After a hip fracture, fewer than 50 p.c regain their pre-fracture operate by way of strolling capability and independence. What can we do to stop injurious falls?  Based on dozens of randomized managed trials, the single intervention most strongly related to a discount in fall charges: exercise.

So, exercise doesn’t simply increase bone density. More importantly, it additionally reduces the variety of falls over time by 23 p.c, and the variety of fallers by 15 p.c. So, for those who adopted 1,000 folks round age 75 for a yr, and 480 fell a complete of 850 occasions with out exercise, including exercise could be anticipated to end in 72 fewer fallers and 195 fewer falls.

Tai Chi seems to cut back falls by 19 p.c, stability and purposeful exercises (like sit to face) might scale back falls by 24 p.c, and a number of exercises—usually stability and purposeful exercise plus strength training—might scale back falls by 34 p.c.

The decreased falls price then interprets into fewer fractures. A latest meta-analysis discovered that exercise interventions—principally utilizing a mix of resistance exercise to enhance decrease limb muscle strength and stability training—lower fracture charges almost in half. One year-long trial that mixed strength training with step and leaping aerobics, and targeted on stability and agility, resulted in 74 p.c fewer fractures over the five-year interval after the examine ended. Furthermore, greater than 70 p.c of the women in the combo exercise group went these 5 years with no single injurious fall––in comparison with lower than half of these in the management group.

Trials on hip protectors, which cushion a sideways fall on the hip with plastic shields or foam pads sewn into particular underwear, are sometimes plagued with poor compliance. Studies haven’t discovered them to be helpful for lowering hip fracture charges amongst these residing at dwelling, however trials in nursing houses or residential care services do present a small discount in threat––translating into about 11 fewer folks out of a thousand struggling hip fractures attributable to carrying hip safety.

There are additionally commonsense measures one can make use of. Quality enchancment trials involving interventions like affected person training have proven a 10 p.c discount in fall charges. For instance, maintain issues inside attain so that you don’t want to make use of step stools. Use non-slip mats in the tub and bathe. Add seize bars in the lavatory. Keep flooring litter free. Remove small throw rugs, or use double-sided tape to maintain them from slipping. And be sure all staircases have handrails and enough lighting. You might additionally keep away from taking walks throughout inclement climate, and for those that stroll leashed canine, contemplate selecting smaller breeds, or making certain correct training to stop them from lunging. Otherwise, the principal methods to stop fractures might not have modified a lot over the many years since the traditional paper entitled “Strategies for Prevention of Osteoporosis and Hip Fracture.” The principal methods to stop these fractures are to “stop smoking, be active and eat well.”

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