Density is not the sole measure that protects bones on the one hand or predisposes them to fracture on the other. As Dr. Susan Love, clinical professor of surgery at the University of California, Los Angeles, reminded us recently, “…bone density is only one aspect of bone health. It just happens to be the one we can measure.”
Quantifiable or otherwise, additional physical qualities that bones possess include their size, shape, and architecture. Bone architecture can be defined as the pattern of trabeculae (partitions) in the bone and associated structures. Along with density, these aspects of bones govern the ability to sustain the loads to which we subject the bones. Just as architects and engineers must design buildings to code to safely sustain environmental forces, Mother Nature has spent millennia perfecting her design specs for our bones.
What all designers understand is that form follows function. The theory of bone architecture that defines how bone in a healthy body will adapt to loads is known as Wolff’s law, and was developed over 100 years ago by the German bone anatomist and surgeon, Julius Wolff. This law states, “Every change in the form and the function of a bone, or in its function alone, is followed by certain definite changes in its internal architecture and secondary alterations in its external conformation.”
This simply means that the architecture of bone directly relates to its function. The bones in our extremities, for example, must support most of our weight and carry heavy loads, so they are longer, harder, and denser than those that must frequently expand and contract, like our rib cages do with our breathing, and our spines, which are articulated and pliant.
Bones are categorized as a type of connective tissue. Bone architecture can also be divided into two major types, trabecular and cortical
- Trabecular, or cancellous bone has a lower density and lower strength than cortical bone. This is the interior, spongy type of bone that has lots of partitions and lacunae(holes), and thus, a great deal more surface area than cortical bone. Trabecular bone is where most of the blood vessels, as well as the nerves, of bones are located. The outer layer of trabecular bone is where bone marrow can be found. It is less calcified (only 15-25%) than cortical bone, and makes up only one-fifth of our total bone tissue by volume.
- Cortical bone is the extremely hard, dense type of bone tissue forming the surface of bones. It is sometimes referred to as compact bone. Comprising four-fifths of our total bone in volume, cortical bone is 80-90% calcified. The primary functions it serves are support and protection. Orthopaedic scientists in The Netherlands have actually monitored the three-dimensional development of cortical bone using micro-CT technology. These images show how the pores of trabecular structures gradually fill in to form the compact cortical bone. They also confirm that trabecular and cortical bone share the same regulatory mechanisms for adapting to mechanical loads.
Yet anatomically and physiologically, these two bone types are distinctive. The fact that the spongiform trabecular bones have a much higher amount of surface area per volume means that they undergo a much higher rate of turnover than cortical bone. This marked difference in the anatomy and physiology of cortical and trabecular bone tissues is reflected in their susceptibility to fracture. It makes sense that trabecular bone’s larger surface area and higher rate of metabolic activity predispose it to fracture more easily. When conditions for bone turnover are sub-optimal, the incidence of spinal and rib fractures increases with age because the bones of the spine and ribs have a higher percentage of trabecular bone.
For more on the demographics of bone fracture, check out bone specialist Dr. Susan Ott’s graphs, which show the rates of fracture for different bone types, geographic regions, different races, and both genders across the lifespan.
Please click here for information on types of fractures — what different kinds of bone fractures can happen?.
There are probably almost as many ways of categorizing bone fractures as there are bones in the body (206!) — pretibial fractures, hip fractures, wrist or colles fractures, and spinal or vertebral fractures, just to name a few — but only a few bones are prone to osteoporotic fractures. Not surprisingly, all the various risk factors discussed above are associated with one or more specific type of fracture: instability is associated with falls to the side and greater occurrence of hip fractures; a tendency to walk more briskly is associated with people who fall forward and break their colles; and compression fractures of the spine — indeed all fractures — become more common in those whose capacity to continually mineralize trabecular bone becomes increasingly compromised with age.
In terms of mechanics, however, the two major types of fractures are stress fractures and compression fractures. Here’s an overview, with a little more emphasis on compression fractures, since they are far more common in older individuals with osteopenia and osteoporosis.
A stress fracture is really a crack within the bone. It is a partial fracture, or microfracture, rather than a complete fracture. Stress fractures most often result from overuse or repetitive stress on the bone. They often result from any increased amount or intensity of activity that occurs too rapidly to give the bone a chance to adjust.
Every day bone cells work to strengthen the bone, or allow the bone to become less strong, depending upon the forces at play in and on the body. The body is programmed to make new bone daily to replace the bone that has been broken down by the stresses of everyday activity. Ideally, the body produces as much new bone as it breaks down. In many cases, however, bone breakdown comes to exceed new bone formation. This can weaken the bone and lead to the microfractures known as stress fractures.
In many cases, stress fractures occur because an individual has increased her or his activity too quickly and the stress put upon the bone is too fast for the body to adapt. If the bone is not accustomed to the new loading, and if it is unable to strengthen itself quickly enough, stress fractures can develop. About half of all stress fractures occur in association with athletic activity. More than 50% of all stress fractures occur in the lower leg, the most common of these being tibial stress.
In contrast to stress fractures, a compression fracture is a complete bone break that disrupts the bone tissue and collapses the affected bone. The spinal vertebral body is the most common site of compression fractures. As the most common fractures associated with osteoporosis, vertebral compression fractures typically occur in the elderly osteoporotic spine; however, they can also occur as a result of severe trauma in the non-osteoporotic individual.
Some compression fractures are painful, while others go unnoticed. In the healthy body, these fractures will usually heal on their own within 8-12 weeks. The estimated rate of spinal fractures in Caucasian women has always seemed to me to be a bit high, but we don’t know the exact rate, since two-thirds of them go unnoticed. Recent data from the US Study of Osteoporotic Fractures suggest that some 18% of all US Caucasian women develop spinal fractures visible on x-ray between the ages of 68 to 84. For persons of African and Asian ancestry, the rates are lower.
Compression fractures of the spine result as a bone in the spine collapses. The fracture causes the vertebral body to lose height and form a wedge shape; this type of fracture is sometimes referred to as a wedge fracture.
But the occurrence of one spinal fracture does tend to be associated with further fractures. Carefully designed and conducted studies have shown us that the likelihood of incurring additional vertebral fractures is increased once you have already experienced one, even if you do not have low bone density. In fact, research suggests that around 20% of older women who experience a spinal fracture will experience another such fracture within a year. This has important health consequences because over time, accumulated compression fractures can lead to a noticeable loss of height and, if extreme, multiple spinal-vertebral fractures can cause significant pain, the development of a dowager’s hump, and problems with breathing, balance, and mobility. Which is why, as with so many health concerns, early identification and intervention are key!
Osteoporotic spinal fractures — under-diagnosed, under-treated
Even the standard chest x-ray — ordered for a number of clinical indications — can be a useful tool for identifying vertebral fractures that might be due to osteoporosis. It’s unfortunate that spinal fractures are so often overlooked — or ignored — by radiologists. Studies done in the last decade reveal this to be the case in chest x-rays reviewed for moderate or severe fractures. When x-rays were reviewed, only around half of the spinal fractures that were clearly visible in retrospect had been mentioned on the radiologists’ formal reports! More disappointing are data showing that even when radiologists do report fractures noted on x-ray, fewer than half those patients receive appropriate treatment.
If this is our standard of care today, we have a long way to go. It goes without saying that if osteoporosis is undiagnosed, it is highly unlikely to be treated. Which is why, if you want to build healthy bones and live a long and fulfilled life, you also want to take good care of yourself. If you are over 50 and undergo chest x-ray for any reason, for example, we encourage you to speak up and request your providers to check for spinal fractures. Even more, if you are concerned about the possibility of vertebral fractures or deformities you can ask your doctor to do a vertebral morphometry scan at the same time they do the DEXA bone density test. This scan, done on the same bone density machine, will scan the spinal bones for small deformities as well as full fractures.
Overall, at the Center for Better Bones, we advise anyone who has experienced a low-trauma fracture of any kind to be especially diligent about self-care, for any osteoporotic fracture indicates vulnerability to further fractures. (For more in-depth information, refer to my article on spinal vertebral fractures and my article on fracture risk assessment, How can we tell who will fracture?)
Topics covered in this article:
Imagine a scenario in which your elderly aunt walks across her living room and, in a moment of distraction, trips on the carpet, falls, and breaks her hip. Or your 60-year-old friend stumbles on the sidewalk while walking her dog and breaks her wrist as she reflexively throws out her hands to avoid hitting the pavement. People trip and fall all the time without breaking bones; why do these simple accidents have such serious consequences? Bone that breaks from minor trauma is weak bone, and for decades, what scientists and clinicians have sought to understand is why this happens.
But osteoporotic fractures aren’t just a result of weak bone — they’re a combination of two components. The first is the weakened bone vulnerable to fracture from low-impact trauma, such as a fall or sudden turn, and the second is the trauma itself. For decades, efforts to prevent osteoporotic fractures have focused on the weakened bone component — trying to build bone strength by building bone density, so bone would be less vulnerable to breakage. Today, however, there is a growing awareness that simply having weak bones doesn’t necessarily mean fractures are inevitable. Factors that increase the risk of falling (such as poor balance and coordination, muscle weakness, and factors related to lifestyle) have a strong bearing on a person’s risk of fracture. Thus, fall prevention is becoming a cornerstone of fracture prevention efforts.
A new way of looking at bone fractures
Finnish bone specialist Dr. Teppo Järvinen nicely summarizes this new perspective, saying “The mainstay of current strategies to prevent fractures is to screen for osteoporosis by bone densitometry and then treat people with low bone density with anti-resorptive or other bone-specific drugs. However, the strongest single risk factor for fracture is falling, and not osteoporosis.”
This proposed shift in focus from bone density to falls merits serious attention, as we now know bone density does not predict fractures. Furthermore, the majority of people who experience an “osteoporotic” bone fracture do not have an “osteoporotic” bone density — they have either just osteopenia or normal bone density.
On the other hand, for the vast majority of people, osteoporotic bone fractures occur as a result of a fall. Ninety percent of hip fractures are caused by falls, as are at least 50% of vertebral fractures and most wrist and forearm fractures. And falls among people 65 years and older are very common, affecting one in three Americans in this age group. Moreover, approximately 30% of all women and 20% of all men older than 50 will fall each year. While less than one fall in 10 results in an identifiable fracture (it’s not known how many small or hairline fractures might go undiagnosed), 20% of all fall incidents require medical attention. Seeing osteoporotic fractures in this light highlights the notion that fall prevention is indeed fracture prevention.
So how do we prevent falls? In reviewing the growing scientific literature on falls, four major fall intervention areas stand out. These are:
- Building muscle strength
- Balance enhancement
- Protective gear use
- Environmental modifications
Please click here for information on a recipe for strong muscles.
At the Center for Better Bones, we believe that the state of health is the norm in the natural world, rather than the exception. In the functional medicine model, allostasis, or “dynamic stability through change” is regarded as the default condition. In observing all the creatures in the animal kingdom around us, we can see that lifelong bone health is a birthright with which Mother Nature has blessed us, for we too, are given ample bone to last our whole lives through.
This leads us to wonder what physiological conditions are causing bone health to deteriorate long before the ends of so many people’s lives today. What robs our bones of their innate capacity to repair themselves so that fracture can be avoided?
To answer this question, we can look first to the physiology of bone, and then to the physics
You may recall from high school science class that physiology is all about function. But there is much more to physiology than function alone. More formally, the American Heritage Scientific Dictionary defines physiology as:
The scientific study of an organism’s vital functions, including:
- growth and development
- the absorption and processing of nutrients
- the synthesis and distribution of proteins and other organic molecules
- the functioning of… tissues, organs, and other anatomic structures
If the skeleton is the organ under consideration here, and our bones the tissues, the physiology of bones can be defined as the study of their “normal mechanical, physical, and biochemical processes.”
As explained in the above section on risks for fracture, bone mineral density (BMD) is an obvious and important determinant. From the physiological standpoint, however — the aspect that involves the growth and development of bone with respect to its function — the demineralization of bone is the metabolic process most integral to tipping bone toward health or disease. A high rate of bone protein matrix breakdown — that is, a high bone resorption rate — will leave bones bereft of collagen. Collagen is the living elastic tissue that imparts flexibility and resilience to bone, the qualities necessary to withstand the stress and strain they encounter as we go about our everyday lives. Slowing the demineralization process becomes particularly critical for skeletal health with advancing years.
At the cellular level, bone demineralization is the result of a complex interplay of messenger molecules, key nutrient availability, enzymes, cleavers, and countless other physiological variables. Bone can be visualized as a living protein sponge matrix upon which mineral crystals are embedded. As we lose bone, this living protein matrix is broken down by osteoclasts and excreted from our bodies in our urine. The amount of bone protein fragments found in the urine is a direct reflection of rate of bone resorption taking place in our bodies. A number of urine tests are available that detect these urinary indices of skeletal turnover. They are as useful, and in some cases more useful, than bone density tests in evaluating the rate of bone breakdown, and offer an alternative tool for predicting fractures, independent of bone density. Indeed, the combination of high rate of bone resorption together with low bone density is particularly predictive of fracture risk.
Now, this is just the short version — there is much more about the biochemical processes that build bone and then break it down in an ongoing, give-and-take process that never ceases until the day we die.
Please click here for information on the physics — what physical conditions in the bones predispose them to fracture?.
A novel Swedish study interviewed 84% of all Swedish twins aged 55 and older and asked them one simple question, “Do you have impaired balance?” Over time it was shown that those twins with self-reported impaired balance had three times the risk of hip fracture as the co-twin with normal balance. Overall, one-third of all hip fractures were attributed to impaired balance.
Proper postural balance while walking is a complex function. It involves somatosensory, visual, vestibular, and musculoskeletal components. Balance problems, along with the fear of falling and decreased mobility, are primary causes of institutionalization among the elderly. These concerns, in fact, account for 50% of nursing home admissions. Gait problems and balance problems such as increased amount of sway can develop slowly and can perhaps go unnoticed.
There is evidence that much of the decline in postural balance typically associated with aging is in fact not a result of aging at all, but rather the result of physical inactivity associated with a sedentary lifestyle. Studies clearly show that with therapeutic physical activity programs, postural balance can be enhanced and any aging decline in balance averted. An increase in quadriceps strength and a significant decrease in postural sway in older adults were reported following just 10 weeks of moderate aerobic and strength training exercises. In another study of postmenopausal women, significant reduction in lateral body sway and increases in both lower body muscular strength and lean leg mass were reported following 9 months of progressive walking while wearing a weighted vest. T’ai chi chuan is another healthful way to increase balance and reduce falls. Among men and women 70 years or older, those who undertook a 15-week, moderate t’ai chi practice experienced a 50% reduction in falls.
Nutrition habits can also affect balance. Skipping meals will cause blood sugar levels to fluctuate abnormally. This can lead to drastic decreases in energy, clarity of thought, and muscle control. An excess of stimulants such as coffee and soda also upset blood sugar levels, decreasing the brain’s ability to consciously control the muscles. Regular meals, snacks, and minimal stimulant use provide consistent energy, steady blood sugar levels, and indirectly sustain good balance. Alcohol and illicit drug use also impair balance, increasing the risk of fall.
Balance is also affected by poor vision. Many factors such as wearing the wrong prescription lenses, glaucoma, or cataracts limit vision. Since changes in eyesight often happen gradually, you may not notice a decrease in your visual accuracy. Poor depth perception and poor low-frequency contrast sensitivity (night vision) have both been found to increase a person’s risk of fracture from a fall.
Finally, many medications and mood-altering drugs can cause dizziness or lack of coordination and thus increase the risk of falling. For example, the use of long-half-life, mood-altering psychotrophic drugs like Valium® and Librium® have been associated with a 70–80% increased risk of hip fracture.
Medicines that may increase the risk of falling include:
- Various heart medications
- Muscle relaxants
- Sedatives or sleeping pills
- Drugs that lower blood pressure
If you are currently taking any medications that cause dizziness or lack of coordination, speak with your doctor. Perhaps there is an alternative medication available, or it might be possible to lower the dose of your current medication.
The top 13 environmental modifications to reduce the risk of falls
- Use nightlights or motion-sensitive lighting throughout home.
- Install adequate lighting in stairwells, doorways, and along walkways.
- Install grab bars and railings.
- Remove area rugs.
- Eliminate clutter: put books on shelves, clothes in a hamper, towels on a rack, and shoes in the closet.
- Keep wires behind furniture.
- Highlight edges of steps with bright paint or tape.
- Maintain proper furniture height.
- Have minimal transitions on flooring surfaces.
- Use non-slip mats on the floor of your bathtub and shower.
- Wear shoes both inside and outside the house. Avoid going barefoot or wearing slippers. Choose shoes with rough or patterned rubber soles (not smooth).
- Keep a flashlight next to your bed.
- Add skid-resistant material to steps and stairs.
Using protective gear
Hip fractures are undoubtedly the most serious and life threatening of all osteoporotic fractures. In the US and many other Western countries, one in six Caucasian women over 50 will suffer a hip fracture as will 6% of all Caucasian men over 50. The fact that most occur as a result of falling sideways and not from compression has given birth to hip protective gear for the frail.
While there are several types of hip protectors, a Finnish study of 1,801 ambulatory but frail elderly tested whether protective oval shaped pads worn inside pockets on a stretchy undergarment helped to prevent hip fractures. The pads reduced the impact of a sideways fall, thus significantly reducing hip fractures. In this study there was a 60% reduction in hip fractures among those study participants assigned to the use of these anatomically designed external hip protectors. Even more, the authors concluded from their trial that the risk of hip fracture can be decreased by more than 80% if the protector is worn at the time of a fall.
A significant reduction in falls has been found with the elimination of hazardous factors in the environment. Most notably, it has been suggested that if uncarpeted wooden floors were replaced with carpeted surfaces in nursing homes, the risk of hip fracture would be reduced by nearly 80%. Even simple environmental modifications can go a long way in reducing needless falls and fractures.
Think about strength, think about balance
The origin of any osteoporotic fracture is multi-faceted and so is its prevention. Taking precautions to avoid needless falls and minimizing the impact of falls at any age are clearly powerful fracture-reducing interventions. Fortunately today we have access to a wide range of life-supporting interventions that allow us to regain balance and strength, even as we age. New branches of physical therapy, chiropractic and exercise therapy, and nutrition, as well as the ancient sciences of t’ai chi, qi gong, and yoga can indeed help bring us back “into balance” at any age.
As any cat would tell you, our feline friends have much to teach us.
While this includes the importance of keeping a steady supply of catnip and feather toys handy, we can also gain insight into our own health.
A self-described “cat-lady” colleague recently sent me an article detailing how a cat’s purr can be connected to improved bone density. Curiosity got to me and I decided to take a closer look.
Why do cats purr and how is it connected to bone health?
Most of us believe a purring cat is a happy cat. But it seems that purring can also be a sign of stress or injury, leading researchers to suspect that cats purr for self-healing. Examining further, researchers discovered cats may even be increasing their bone health through the constant low pressure vibrations that come with purring.
It seems that purring frequencies are often right on target to improve bone density and possibly even fracture healing. During a “purr analysis” of frequency ranges done at the Cincinnati Zoo, the dominant frequency for three species of domestic and wild cats’ purrs was 25 Hz or 50 hertz. In studies using vibration platforms to build bone, researchers suggest 30-50 hertz seems to resonate with bone to stimulate bone growth.
Of course, we humans are already looking at how this knowledge can benefit us! I find it fascinating that we may be able to develop better support for astronauts in zero gravity based on the bone building effect for an animal which might get very little physical activity.
More healing power from pets
Pippa and Sarah bring me to a final thought about cats and bone health. One of my intentions for 2014 was to exploring the healing powers of happiness and love. I do know that the love and companionship of any kind of pet is one way to help many of us cultivate the kindness and caring that can enhance every aspect of our health. Take good care of them and they will take good care of you. To you and your furry (or not-so-furry) friends, I wish you good health!
Lyons, L. (2006, April 3) Why do cats purr? Scientific American. Retrieved from http://www.scientificamerican.com/article/why-do-cats-purr/
Von Muggenthaler, E. (2006, September 18-20) The Felid Purr: A bio-mechanical healing mechanism. Presented at the 12th International Conference on Low Frequency Noise and Voice and its Control. http://www.animalvoice.com (accessed 03.17.2014)
Dear Mr. McGee,
I’m a bit of a basketball fan, and even though I must confess I most enjoy watching the often thrilling (and often top ranking) Syracuse University team, I’m following the news of your fractured leg and that you’re out the remainder of the season.
I spend my days counseling people about bone health and keeping up with the activities they love. And while most of them don’t make it into the NBA Playoffs or have a reality show with their former WNBA star mother, they are just as anxious to recover as you are. In fact, many of them are looking for ways to speed their fracture healing and so I thought you might be interested in the advice I give them.
Tips to heal your fracture more quickly
1. Take a comprehensive multivitamin and mineral supplement. By weight, bone is roughly 70% mineral content and healing any fracture requires extra minerals be available to do the repair work at the fracture site. Many of us just don’t get enough of the needed vitamins and minerals on a daily basis. I tell my clients to consume at least two cups of fresh vegetables for lunch and dinner. High antioxidant intake is particularly important for fracture healing. With fracture a great deal of oxidative damage occurs, and nutrient antioxidants help prevent excessive bone breakdown from inflammation.
2. Think super nutrition. With a fracture, your body needs to gather your protein building-blocks to synthesize new structural bone protein matrix. Adding even modest amounts of extra protein to the diet can help reduce complications, shorten the healing phase, and minimize further bone loss in the area as the fracture heals — by as much as half. Adding more calories is a good idea too, as fracture healing requires a lot of energy. For example, an active adult may require 2,500 calories a day, but a bedridden, injured patient with multiple fractures may demand 6,000 calories per day for proper healing.
3. Block pain without aspirin and ibuprofen. These two anti-inflammatory drugs can actually slow down fracture healing as they work to block pain. That’s because inflammation plays a key role in the cleaning and re-building process of healing a fracture. Ibuprofen and aspirin inhibit this necessary inflammation and therefore delay healing. A better choice for pain relief would be acetaminophen, or better yet, give natural supplements a try — such as vitamin C, quercetin, and omega-3 fatty acids.
For many of my patients, I also recommend mild exercise. I’m pretty sure you’ve got this one covered! As you can see, you really can take a much more active role in your healing than you may have realized.
Best wishes for your own good health (including a quick recovery),
Susan E. Brown, PhD
One of the greatest disappearing acts I know is the idea that hormone replacement therapy (HRT) helps reduce long-term bone fracture risk.
That’s because while much has been made of the positive effects of hormone therapy on bone, the truth is that any improvements are short-term only and stop once the hormone therapy itself is stopped.
Recently, Spanish researchers once again proved this when they found HRT use in early menopause offered no protection from spinal fractures.
HRT may actually increase spinal fracture risk
What’s more, the researchers revealed even more about the negative aspects of HRT for our bones. Looking back 20 years, they discovered women who had taken hormone therapy in early menopause actually experienced more spinal fractures as they aged than did women who never used HRT.
This is yet another reason why I highly recommend you do not rely on past use of hormone replacement therapy when it comes to protecting your bones against fracture.
The real way to reduce long-term bone fracture risk
For bone strength that isn’t simply an illusion, I encourage you to develop a comprehensive natural, life-long approach to building and maintaining bone strength—one which works with nature to create lifelong healthy bones.
For at-home guidance on exercise, nutrition and lifestyle changes, and supplements that provide long-term positive results, my Better Bones Health Programs are a good place to start. If you are looking for more information about HRT in general, I suggest you explore the Hormone Replacement Therapy section of Women’s Health Network.
Castelo-Branco, C., J. Davila, M. F. Perelló, A. Peguero, C. Ros, M. J. Martínez-Serrano, and J. Balasch. 2014. Long-term effect of hormone therapy on bone in early menopause: Vertebral fractures after 20 years. Climacteric. DOI: 10.3109/13697137.2013.871511.
Even as the temperature plunges in January and February, I highly endorse getting outside as much as possible. Whether you choose a short walk or a longer snow-shoeing trek, you’ll find the connection to nature is a wonderful lift for the spirit.
However, I understand wintery weather brings concerns about fracturing as the result of slipping, sliding and falling on icy sidewalks and streets. (You may remember a few years back I shared my experience about falling while collecting firewood.)
Fall prevention for bone fracture prevention is critical
According to Finnish bone specialist Dr. Teppo Järvinen (who I suspect may know a bit about winter weather too), the strongest single risk factor for fracture is falling, and not osteoporosis. I’ve written an entire article about how to prevent fractures.
Here are some extra tips for fall prevention in winter
• Keep your balance with a walking stick or even a ski pole on slippery surfaces.
• Wear the right footwear – the best options are sturdy, flat-soled shoes or boots with heavy rubber soles.
• Keep sand or kitty litter handy to put on icy surfaces. I keep some in my car too.
• Make a practice of paying close attention while walking. How often do you talk on the phone while walking? Wait to make the call later. You’ll focus more on arriving safely, and keep your hands free in case you do lose your balance.
• Give yourself extra time to get to your destination so you don’t have to be in a hurry.
• Remove snow immediately. I noticed that this morning’s snow had hidden the icy patches in my driveway. It’s best to remove snow or ice immediately, especially in well-traveled areas such as your steps.
One final reason for getting out and enjoying winter is that exercise can also help reduce your chance of falling by strengthening your legs and your muscles. Exercise like t’ai chi can also increase strength and improve balance too, making falls much less likely!
The Center for Better Bones and the Better Bones Foundation
Dr. Susan E. Brown, PhD
605 Franklin Park Drive
East Syracuse, NY 13057
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