Those scary statistics — banishing fear of fracture with a dose of common sense
by Dr. Susan Brown, PhD
Many of the women we see at the Center for Better Bones come to us because they’re scared. They’ve been told that they’ve either already lost bone or that they’re at high risk for bone loss, and they fear that they will become “one out of every two women … over 50 [who] will have an osteoporosis-related fracture in their lifetime.” These women picture themselves with a broken hip, wheelchair-bound, or bed-ridden for weeks and months, unable to walk or drive or even care for themselves. I talk to women who are afraid to do even simple tasks like lifting groceries or doing yoga stretches for fear of fracture. I don’t blame them — who wouldn’t be frightened by all the fear-based information out there, warning us that debilitation and loss of independence are just a coin-toss away?
What about spinal fractures?
Where does this “1 in 2” number come from? It largely derives from what are called “silent” vertebral or spinal fractures — currently estimated at about 500,000 per year, but likely higher since many go undiagnosed (the majority are found by accident, on an x-ray looking for something else).
Many women who experience such spinal fractures do not report pain — or even realize they’ve had a fracture.a And most recover and continue to go unnoticed without any intervention at all.
Such fractures do become meaningful, though, when they are associated with pain and deformity. Multiple vertebral fractures can start to deform the spine, cause a loss of height and the so-called “dowager’s hump.”
But don’t be fooled — a stooped appearance does not necessarily mean multiple spinal fractures.b Chances are better a dowager’s hump is due to loss of muscle strength and weakened posture, rather than osteoporotic fractures.
I’m happy to be able to dispel these bone health myths — the chances of a debilitating bone injury are considerably less than 50-50 for most women. In fact, these statistics that sound so scary leave out a lot of information that women need to know if they’re to get an accurate sense of how likely such an injury really is for them.
Let’s look more closely at some commonly cited osteoporosis statistics, so you can gain a better sense of your real risk, then empower yourself to begin today to create stronger, healthier bones.
Statistic #1: One out of two women over 50 will suffer an osteoporosis-related fracture in her lifetime.
The above statistic is commonly cited by the National Osteoporosis Foundation and manufacturers of osteoporosis drugs. Many credible US scientists, however, do estimate that 40% of Caucasian women will experience an osteoporosis-related fracture during the remainder of their lifetime. Meanwhile, the International Osteoporosis Foundation states that 1 in 3 women over 50 will experience an osteoporotic fracture during the remainder of her lifetime. Whether the real figure is 30%, 40% or 50%, one has to ask, “What does this statistic really mean?” Does every second or even third woman in her 50’s land in the hospital with a broken hip or other serious osteoporotic fracture? Of course not. Here are some important details to keep in mind:
- These statistics relate to any and all fractures. Importantly, they include spinal fractures, which are by far the most common but generally less debilitating than other fracture locations, such as breaking a hip or wrist. Spinal fractures often go undetected and resolve on their own (see above).
- When it comes to hip fractures, the Surgeon General estimates that only 17% of women over 50 will fracture her hip in her lifetime — a far cry from 50%. Casting this in a more positive light, 83% of American women over 50 will NOT experience a hip fracture! In consideration of those who can see the light better from the shadows, the average age of hip fracture in the US is about 82, whereas the average life expectancy for a woman in the US is around 80 — I think we can all do the math!
- A small group of individuals with multiple risk factors are the ones who are more likely to fracture a hip. Risk of a serious osteoporotic fracture can increase dramatically with a co-existing illness, such as Alzheimer’s or a parathyroid imbalance; a nutrient deficiency, such as vitamin K or D; or if a patient is taking corticosteroid drugs like prednisone. But even people with medical complications can improve their risk profile by addressing some of their risk factors or taking other steps to support healthy bones. In Japan, for example, researchers dramatically reduced fracture risk among Alzheimer’s patients simply by exposing them to sunlight for enhanced vitamin D production.
- Here in the US, information on osteoporosis generally comes from studies done on white women, so we need to put these study findings in context. Statistically speaking, rates vary markedly among women of different ethnic groups: white women have the highest risk, Hispanic women somewhat less than whites, Native Americans slightly less than Hispanics, black women only half as much as white women, and Asian Americans about a third as much as white women.
Low bone density doesn’t always lead to fracture
In the absence of other risk factors, having low, or even very low bone density doesn’t tell us a particular woman is going to fracture a bone.
Here are some other factors to take into account when assessing risk of fracture:
- vitamin D status
- evidence of prior fractures
- corticosteroid drug use
- vitamin K status
- muscle strength
- lack of physical activity
- urine pH (acidity vs. alkalinity)
- low mineral intake and an acidifying diet
The majority of osteoporotic fractures aren’t the devastating event most people envision, but they are a cautionary sign to pay greater attention to our bone health — if we wish to avoid joining the unfortunate minority who do experience a serious hip, pelvic, multiple spinal, or wrist fracture. Such flags do warrant concern — but not panic. More importantly, if you are in one of the high-risk groups, this knowledge can become an opportunity for action rather than something fearsome. Even when you can’t change some of the factors that increase your risk, you can take steps to offset them and improve your bone health — without resorting to drugs (see my article about lifestyle changes for better bones).
Statistic #2: In women ages 50 to 59, 58% have low bone mass, and this percentage increases as we age
Whenever I see a measurement described as “low” or “high,” the first question I ask is, Compared to what standard? If all women had exactly the same build and body type, then the standard would be obvious — but that’s clearly not the case. There are thin women and heavy-set women, tall women and short women, and some women who naturally have denser bones than others.
When you have your bone mineral density (BMD) tested, your results are reported in two numbers, the T-score and the Z-score. The T-score is calculated by comparing your bones to those of the average young woman at peak bone density — late 20’s to very early 30’s. Women of different body types, racial backgrounds, exercise habits, and so forth will naturally vary from this artificial “norm” of bone density, particularly as they age — bone loss across the lifespan is perfectly normal. The Z-score is different — it compares you to someone of your own age, gender, weight, and racial origin. But when I talk with women, many tell me they were told by their busy healthcare providers (or via form letter) that they had “bone loss” or “low bone mass,” or “osteopenia,” with no explanation given about the difference between the two different values or their significance.
What’s more, neither score offers much information about whether your bones are capable of supporting you without breaking. Thin bone can still do the job without fracturing, as long as it’s strong and healthy — it’s only when bone is both thin and of poor quality that a person is at increased risk of a low-impact fracture. Asian American women illustrate this point: as a group they have significantly lower bone density than other ethnic groups, yet they fracture less, even less than African American women.
This is not to say that low bone density is not of concern; it is one of many important fracture risk factors, but by itself it has marginal predictive value. The good news is, having bones that are thinner, even considerably thinner, than the standard is not, in and of itself, good reason to start on drug therapies — no matter what the bone drug advertisements would have us believe.
Statistic #3: Osteoporosis causes 1.5 million fractures every year in the US
Osteoporosis is commonly said to be a condition of having thin bone, and while thin bone might be more prone to fracture, as explained above, bone does not fracture by virtue of being thin alone. It fractures for one of two reasons: 1) the bone quality is so compromised that the usual activities of day-to-day living are too much for the bone to withstand; or 2) the bone is strong enough for daily activity but not strong enough to withstand a fall or other acute force upon the bone. The second situation is by far more common than the first.
Most people with low bone density who break bones do so because of a fall or some other minor trauma to the bone. The vast majority of osteoporosis-related fractures are not life-threatening or even seriously debilitating, much less fatal. Many such fractures, as I mentioned, are spinal fractures that have gone unnoticed by the women experiencing them. So while the number of fractures sounds large, as though it’s very easy to become one in a million and a half, it has been shown that even in people with very low bone density, the risk of fracture can be greatly reduced by taking simple steps to prevent falls. Some of these measures include:
- exercise training to restore balance and build muscle strength
- removing or firmly securing area rugs
- improving lighting
- adding grab bars in bathrooms
Studies have shown that such simple measures can greatly reduce falls — and thereby lower the risk of even minor fractures. Ultimately, if you have osteoporosis, you’re more likely to be able to avoid fracturing a bone if you make choices that can help you avoid falling — choices that are actually pretty easy to implement!
What to make of these frightening statistics?
Many of my patients at the Center for Better Bones are relieved when they hear that they should take these statistics with a big grain of salt. But some of them also want to know why these frightening statistics are still bandied about, when they don’t truly reflect most people’s risk. The answer is that there are people, organizations, and companies that have a vested interest in promoting osteoporosis as a serious, debilitating disease because spreading fear is an easy way to get people to pay attention. Sometimes this is done with the best of intentions — a physician, for instance, may cite these statistics to get the attention of a patient who really is at risk of osteoporosis in an effort to help this patient make changes toward better health. Or groups like the National Osteoporosis Foundation may use the statistic to make the point that osteoporosis is a public health concern of great significance so that more research and public awareness may be generated.
Unfortunately, all too often the rationale for these statistics isn’t so benign — osteoporosis drugs are a big business, and it’s a lot easier to market a drug like Fosamax or Boniva to people who are frightened about their risk of fracture. It’s in the drug companies’ best interests to make osteoporosis seem as big and frightening as possible, and statistics like “1 in 2” help them to do just that.
But whatever the intentions behind the fear-based messaging, what’s missing is the personal perspective — a way to figure out just where you stand with respect to these statistics. When you gain perspective on your own bone health, you learn that you can do a lot to put yourself into the low-risk fracture category — without taking a prescription drug.
Your bones are in your capable hands
At the Center for Better Bones, our primary goal is to help our clients get a realistic sense of what their risk factors are, and then help them to reduce their risk. We’ve been doing that without drugs for over 25 years. We take the position that statistics aren’t very useful when it comes to the health of an individual person — everyone is unique, and the risk factors that will (or won’t!) affect their bone health have to be taken into consideration case by case.
What’s more, worrying or stressing out about how your bones stack up against the numbers isn’t going to do them any good — quite the opposite! So here’s a statistic that better represents the state of your bone health right now: 100% of women age 50 and older have the ability to make decisions about the food they eat, the exercise they get, and the bone-building nutrients they take. You have the tools to build stronger bones on your own, and you can start today! To learn more about the risk factors that you can change, and how to get started, take our Bone Health Profile. It’s an easy first step, and it’s free.
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Original Publication Date: 01/01/2009
Last Modified: 07/10/2012
Principal Author: Dr. Susan E. Brown, PhD