The risk of bone fractures from even small types of trauma increases dramatically as we age. A major contributing factor is osteoporosis or thinning of the bones. The most common bones that are broken are the hip and spine. Unfortunately, older adults’ overall health tends to decline exponentially when they suffer from one of these fractures. An increased risk of death within the next two years is associated with these fractures in the geriatric population, defined as age over 65 with serious health issues.
Fractures can occur if the bone density or strength is less than normal and then subjected to trauma, such as a slip and fall injury. If bone density is severely compromised, fractures can occur with little to no excessive force. In extreme cases, a hard sneeze can cause a fracture.
Bone density is evaluated using a low level x-ray test called a DeXA scan. With this test, a normal score is T -1.0 to 1.0. Osteopenia (lower than normal bone strength) occurs at a T score between -2.5 and -1.0, and osteoporosis (extremely low bone strength) is a T score of -2.5 or lower. The lower the T score, the higher the risk of bone fracture. Postmenopausal women, Asians and Caucasians have an increased risk of osteoporosis. Overall, one in four people, age 80 and older, has osteoporosis.
Diet, exercise and lifestyle changes can prevent or slow down the development of osteoporosis. Calcium and vitamin D are essential vitamins and minerals for bone formation. Diets that include green leafy vegetables, fish, soy, dairy, and fortified orange juice and rice are high in Calcium. Vitamin D can be found in fish, milk, egg yolks, fortified orange juice and rice. Avoidance of tobacco and excess alcohol also reduces the chances of bone thinning. Exercise, especially weight bearing, increases bone strength and density. Also, the more bone density a person has in their younger years carries through to their older years and decreases the risk of osteoporosis.
Vertebral fractures are especially painful and if left untreated can lead to chronic pain and deformity which can affect other body functions. When the back bone is fractured, even the simplest movements cause extreme pain. This is because the edges of the fracture are moving with each breath and change in position. Some people find that the only comfortable position is lying in bed, motionless. This, of course, is not healthy and leads to more problems such as pneumonia, deconditioning and weakness, and blood clots, to name a few.
A fracture of the spine can take six months to a year to heal naturally. For over 20 years, a non-invasive procedure called a Percutaneous Balloon Kyphoplasty, or PBK, has been available that can immediately fix the fracture and alleviate pain. It involves injecting cement into the fracture line through a small needle. Once the cement is injected, it immediately becomes hard and forms an “inner cast” for the spine. The cement cast also prevents the bone from collapsing. If the vertebra collapses, it causes a humpback type of deformity of the spine that can make it hard for people to stand up straight or take a deep breath. After having the PBK procedure, most patients are back to their previous activities of daily living within two to four weeks, with minimal to no pain.
Once you’ve had one vertebral fracture, your risk of having another one is five times greater, regardless of the treatment. This is why it is extremely important to start a plan that includes safe weight bearing exercise, balance and core strength re-education and bone hardening medications to lower your risk of repeat fractures.