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Dr. Susan E. Brown

Spinal vertebral fractures among US Caucasian women: new statistics and new insights

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Osteoporosis researchers in the past estimated that 35 to 50% of all Caucasian postmenopausal women experience spinal vertebral fractures. This figure always seemed high to me, and for some time I have been looking for “solid” statistics on these rather elusive spinal vertebral fractures. I call spinal vertebral fractures elusive because two thirds of these fractures are “silent” and are not even noticed by the people experiencing them. They can, however, be seen in an x-ray exam.

Now for the first time we have solid, long-term data on spinal vertebral fracture incidence among US Caucasian postmenopausal women. Data from the US Study of Osteoporotic Fractures covers a 15-year observation period looking at nearly 2,700 Caucasian women with a mean age of 69 years old at the start of the study. Over the 15-year observation period the incidence of new spinal vertebral fractures was studied carefully using x-ray exams. What researchers found was the following:

  • Overall, 18.2% of all women in the study developed a spinal vertebral fracture visible on x-ray over the 15-year period.
  • Fourteen percent of the women who came into the study without any vertebral fracture developed such a fracture during the 15 years.
  • Only 9% of the women with normal bone density and no previous fracture came to have a vertebral fracture during this 15-year period.
  • Among women with an osteoporotic lumbar spine bone mineral density, but no existing vertebral fracture at baseline, 23.3% came to fracture a vertebra during the study. An osteoporotic bone density is defined as being 2.5 standard deviations or greater below the average bone density of young women.
  • Among women with an osteoporotic total hip bone mineral density T score (i.e. -2.5 T or more), but no existing vertebral fracture at baseline, 28.3% came to fracture a vertebra during the study.
  • Among those women who came into the study with an existing vertebral fracture, 41% of them experienced a new fracture over the 15 years. This was true even if they did not have low bone density.
  • The highest risk of fracture was among women who came into the study with osteoporotic BMD (-2.5 T or more) and also had an existing vertebral fracture at the start of the study. A full 56% of these women suffered a new vertebral fracture during the 15-year study.
  • Even women with previously undetected “silent” spinal vertebral fractures at baseline had a 4-fold increased risk of experiencing a new fracture, as compared to those who had no spinal vertebral fractures at the start of the study. This was true even if they did not have low bone density.
  • The strongest predictors of fracture were previous fracture, advancing age, and lower weight.

So what does all this mean? What are the important implications of this large, long-term study?

A US Caucasian woman’s risk of experiencing a spinal vertebral fracture has been overstated.

The results of this study suggest that earlier calculations of spinal vertebral fracture incidence have overestimated real fracture incidence. Over fifteen years, from age 68 to 84, only 18% of all US Caucasian women experienced a vertebral fracture. Overall, counting those who entered the study with an existing vertebral fracture, a little over 26% of all women had radiological evidence of a spinal fracture by age 84. This figure is significant, yet not as worrisome as the 35-50% estimate previously reported.

Many spinal fractures, at least in Caucasian women, occur before the age of seventy.

In this study, 14.7% of all women experienced a vertebral fracture before entering the study at a mean age of 68.8 years. During the 15-year study, a total of 18.2% ended up with a spinal fracture. Thus, nearly as many women fractured before their late 60’s as did after their late 60’s (between 68.8 and 83.8 years of age).

And just how important are these spinal vertebral fractures?

To put this study into perspective, we must remember that only one third of all spinal vertebral fractures are clinically recognized. Most are never detected by the person suffering the fracture or by his/her doctor. These fractures are not painful or troubling enough to notice. Multiple spinal vertebral fractures, however, can cause significant pain, height loss, the development of a dowager’s hump, and, if extreme, can compromise breathing, balance, and mobility.

Having one or more spinal vertebral fractures does in fact increase your risk for having others.

Another impressive finding from this long-term study is the increased risk of a new fracture for women who entered the study with an existing spinal vertebral fracture. For some time, it has been suggested that those who have experienced a spinal vertebral fracture are at greater risk for having another. In this study, the risk of experiencing a spinal vertebral fracture over the 15-year study was increased 5-fold if one came into the study having had a previous spinal vertebral fracture. Of those found to have any previous spinal vertebral fracture, 41% experienced a new spinal vertebral fracture over the 15 years. Even “silent,” unnoticed fractures indicated a 4-fold increased likelihood of other vertebral fractures. Other short-term studies have also shown that a prevalent vertebral fracture is associated with a 5-fold increased risk of sustaining a new vertebral fracture.

You should pay special attention, and be especially diligent, if you experience a fracture — any low-trauma fracture likely suggests you are more vulnerable to other fractures. As I have said, most vertebral body deformities go unnoticed, but you can have these assessed as part of your bone density test. As an “add-on” to your bone density test, you can ask for an imaging of the vertebrae to detect deformities and fractures. This is known as a measurement of “vertebral morphometry” and with this, you can see “silent” vertebral deformities and fractures.

Bone mineral density is an important risk factor, but still does not determine fracture risk by itself.

Lower densities increase fracture risk, but do not determine the risk. Keep in mind that most fractures occur in women who do not have osteoporosis based on BMD alone. Those who fracture generally have other factors contributing to bone weakness, including lower levels of vitamin D, the use of bone-depleting medications, lack of physical activity, little muscle strength, older age, low body weight, metabolic acid load, and the like. In this study, it was shown that the strongest predictors of fracture risk were previous fracture, advancing age, and lower weight. (For our fracture risk assessment click here.)

It is wise to look beyond osteoporosis medications for fracture prevention.

During the 15 years of this study, several osteoporosis medications became available. Many women in the study were given these medications over the years by their physicians. The use of such medications was significantly higher in women who had a fracture during the study (51%) than among those who did not fracture (42%). As the researchers report, the use of bone medications did not have a significant impact on study findings. Whether they used bone drugs or not, the women with previous fracture, lowest weight, lowest bone density and more advanced age had the highest rate of new fractures.

The likelihood of experiencing an osteoporotic fracture varies greatly from individual to individual depending on the number of risk factors one exhibits.

The more risk factors you have, the more imperative it is to develop an effective bone strengthening and fracture-prevention plan. It is our long-held position that the best approach to fracture prevention is a comprehensive, holistic nutrition and lifestyle program. For details on our Women’s Health Network Better Bones Package, click here.

Dr. Susan E. Brown

Fractures 101 — an overview of the physiology, physics, types and risks of fractures

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Nearly 30 years ago, when bone density testing machines were first being developed, we thought low bone density was what mattered most in determining a person’s risk for osteoporotic fractures. Since that time, bone density testing has become the standard of health care throughout the developed nations, where fracture rates are highest.

Common variables used to determine 10-year risk of osteoporotic fracture

  • Age
  • Gender
  • Weight and height (Body mass index <21)
  • History of previous fracture
  • Parental history of hip fracture
  • Smoking status
  • Use of glucocorticoid drugs
  • Rheumatoid arthritis
  • Secondary disorders linked to osteoporosis, such as type 1 diabetes
  • Drinking more than 3 alcoholic beverages per day

Other important factors

  • Ethnicity
  • Nationality
  • Postural instability
  • Poor vision
  • pH balance
  • Vitamin D status
  • Use of proton pump inhibitors (PPI’s)
  • Use of antidepressants

Nowadays, we know that rates of fracture tend to be higher in people with low bone density only in certain populations, and only under certain conditions. After following thousands of people over time, bone researchers have found that the majority of those who fracture do not have osteoporotic bone density, but actually have bone density that is osteopenic, or even normal!

What’s more, many people who, on testing, would be given a diagnosis of osteoporosis never go on to experience fracture. Clearly, the expectations we placed on bone densitometry technology as a straightforward means of predicting fracture risk have fallen short.

To illustrate this point, let’s take a closer look at the case of hip fractures in the elderly, since they are some of the most problematic types of fracture in older people.

Up until the mid-1990’s, it was widely held that many risk factors for hip fracture — weight loss, family history, and physical inactivity for instance — acted at least partly through their effects on bone density, whereas others — postural instability and sedative use — acted by influencing a person’s risk of falls. Then, in the 1990’s, a four-year study of nearly 10,000 Caucasian American women over the age of 65 revealed that all the above-listed factors exerted significant effects on the risk of fracture — after adjustment for base-line bone density.

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This raised the possibility that the risk of hip fracture involved factors other than bone density and the risk of falling. Just some of the factors the researchers identified were the size, shape, and architecture of bone, as well as the type and severity of falls. Plus, the authors of the study identified independent risk factors, including low body weight, physical inactivity, a maternal history of hip fracture, use of long-acting benzodiazepines, and impaired vision.

We have also realized over the intervening years how greatly risk factors interact with each other, and have learned they can become increasingly or less important as people grow older. That’s in part why certain types of fractures are more common in certain age groups. But while we understand now that there are many variables at play in the fracture prediction equation, the reality remains that the majority of hip fractures — and the most burdensome of all osteoporotic fractures — occur within the elder segment of our population.

As foreboding as that may sound, the truth is that the longer a person lives, the more likely she/he is to experience one or more osteoporotic fractures. If there is one thing we want you to know about statistics, it is that they are only a best guess — not a sentence! Obviously, reduction of geriatric fracture is a worthwhile goal, for it would both provide our elderly with a higher quality of life and substantially reduce the healthcare costs of aging.

The good news is that both these goals lie well within our reach today. Current scientific literature nicely documents the special nutrient and lifestyle needs of elderly people. Meeting these special needs could substantially reduce the incidence of fracture in older folks. For example, the recurrence of vertebral fractures can be more than halved, and the incidence of hip fractures can be decreased by over 40%, by simply administering appropriate nutritional supplementation. Additionally, muscle mass can be increased 90% or more — even among 90-year-olds — with simple strength-building exercises! Balance can be improved and falls reduced with vitamin D therapy. And the gentle movement and breathing exercises embodied in the practices of yoga,t’ai chi, and qi gong reduce fracture risk through many mechanisms. Further, simple lifestyle modifications and attention to the special nutrient needs of the elderly can significantly reduce the incidence of falling, and thus further enhance well-being and reduce fracture risk.

While the above approach offers us a practical and effective means to reduce geriatric risk of fracture, many elements of this approach could be just as readily applied to younger populations. No matter what your age, caring for yourself by getting regular exercise, eating a healthy diet, and supplementing your nutrition appropriately can significantly minimize your fracture risk.

So it’s not just your bone density, your statistical risk of falling, or your numerical age that determine the likelihood that you will fracture. With the realization that risk of osteoporotic fracture changes over time as a result of numerous variables interacting with one another — from what we eat and drink to our genetics — bone researchers have devised various algorithms to more accurately estimate an individual’s overall risk than can be obtained by bone-density tests alone. These fracture risk assessment tools are very useful, yet the science remains a young one. Every day, we develop a broader vision as, little by little, the complex interplay of numerous factors reveals itself to our understanding.

I write more about the history and science behind these tools in my article on how we can tell who will fracture. I encourage you to check out your own risk with the Better Bones Fracture Risk and Bone Health Profile tool. You can also learn more about protecting your bones through our article on fracture prevention and fall prevention.

Please click here for information on bone processes and functions and their relationship to fracture.

Dr. Susan E. Brown

New analysis looks at bone drug risks vs. benefits

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Wouldn’t it be valuable if there was one study to answer the important questions about bone drugs, including:

  • How effective are bisphosphonates?
  • How well do they actually work to prevent hip fractures?
  • What’s the possibility of harm from these bone drugs?

Now, there is one — thanks to researchers who conducted a detailed systematic analysis of clinical trials using bisphosphonate drugs to treat osteoporosis and prevent hip fractures.

Benefits vs. risks of bisphosphonates

Here are two striking numbers researchers discovered when looking at how bisphosphonates help or hurt the women who take them:

  • 175 postmenopausal women with bone fragility had to be treated for three years to prevent one single hip fracture.
  • Treating 300 people with bisphosphonate drugs for three years will result in one person being harmed from serious side effects.

What’s more, researchers noted that hip fracture rates in developed countries are declining, yet sales of bisphosphonate drugs tripled between 2001 in 2008 and are forecast to exceed $11 billion in 2015.

Also, while 80 is the average age at hip fracture, the evidence suggests no benefit from bisphosphonate bone drugs for this age group.

“Pharmacotherapy (for hip fracture prevention) can achieve at best a marginal reduction of hip fractures at the cost of unnecessary psychological harms, serious medical adverse events, and forgone opportunities to have greater impacts on the health of older people,” said Dr. Barbara Mintzes, one of the study authors.

I really appreciate that they took into account the psychological impacts of osteoporosis overdiagnosis, which is something I see often in my work.

Listen: The trouble with bisphosphonates

You can listen to Dr. Mintzes detail more about the research findings in the first 13 minutes of this interview that aired on Australian national radio titled “The trouble with bisphosphonates” here.

 

Reference:
Jarvinen, T.L., et al, Overdiagnosis of bone fragility in the quest to prevent hip fractures. BMJ 2015;350:h2088, 2015 May 26 (http://www.bmj.com/content/350/bmj.h2088)

Vitamin C Reduce Fracture Risk
Dr. Susan E. Brown

Vitamin C reduces fracture risk

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High amounts of vitamin C led to a nearly 44% reduction in risk of fracture, according to new research on the effects of vitamin C on bone health.  The study suggests that women and men with higher levels of vitamin C intake experience significantly less aging bone loss than those with lower vitamin C intakes along with the significant reduction in fracture incidence.  The 25% with the highest vitamin C intake had nearly a 44% reduction in risk of fracture.

What surprises me about this research is the “high” level of vitamin C intake was only 200 to 300 mg/day (and that is from diet and supplements together). At The Center for Better Bones we find that for complete health and detoxification, many people require much higher dose of this key vitamin — up to 1,000-3,000 mg a day. This makes sense because vitamin C plays several important roles within every cell — including dozens of important functions related to cell repair and division, energy production, toxin neutralization.

What surprises me about this research is the “high” level of vitamin C intake was only 200 to 300 mg/day (and that is from diet and supplements together). At The Center for Better Bones we find that for complete health and detoxification, many people require much higher dose of this key vitamin — up to 1,000-3,000 mg a day. This makes sense because vitamin C plays several important roles within every cell — including dozens of important functions related to cell repair and division, energy production, toxin neutralization.

I’m always uplifted when physicians take into account the nutrient factors that benefit bone. I encourage you to take a few minutes and watch my recent conversation with Dr. Sahni, from Beth Israel Deaconess Medical Center, Boston, about her research on vitamin C and broadening the scope of research about the many roles of nutrients.  I congratulate Dr. Sahni on her study!

Learn more with my interview with Dr. Sahni

 

Reference:

Author; S. Sahni. Vitamin C and Bone Health, Presentation at 9th International Symposium on Nutritional Aspects of Osteoporosis, Montreal Canada, June 17-20, 2015.

Better Bones Blog
Dr. Susan E. Brown

Making your first fracture your last fracture

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IMG_1458

For many women, a fracture is the first sign of sub-optimal bone health — and it can be pretty scary!  I understand, which is why I always remind women that they have more control than they may realize to improve their bone health and to make their first fracture their last fracture.

Phyllis, a 59-year-old client from Michigan, is one wonderful example.  In my book, she has met with great success after deciding to take heart and take action.  Here’s her story:

How Phyllis discovered her osteoporosis

In the fall of 2010, at age 57, Phyllis had her first bone density test, inspired by a wrist fracture two years earlier. To her surprise, she found out she had osteoporosis of the hip and osteopenia of the spine.

Phyllis took action with the Better Bones approach

  • Daily supplementation. Taking supplements is one of the easiest steps to increase bone health. For Phyllis, the Better Bones Builder and Omega-3 combination was the best choice.
  • Creating pH balance. Through diet and our supplements she alkalized to help preserve bone.
  • Enjoying “social exercise.” Phyllis expanded her exercise routine and came to see herself as a “social exerciser.” Not only did she feel much better with exercise, she also loved the community support and the social aspect of group exercise.

Remarkable results

  • Two years later her bone density test showed that she had gained bone — a whopping 19%, the trochanter part of the hip and nearly 7% in the total hip. The neck of the hip and the spine remained stable.
  • What’s especially remarkable is that at 59, most women would be losing about 1% of bone mass a year. Phyllis had actually either gained significant amounts of bone mass or remained stable, depending on the site analyzed.
  • Continuing success: Phyllis is maintaining her gains and her bone density as a whole remained stable — defying the natural process of aging bone loss.  She also continues to search for hidden causes of bone weakening.

Do you have a success story you can share with us?  We would love to hear it!

Does having a low bone density mean you will fracture?
Dr. Susan E. Brown

Bone health, bone fractures, and low bone density — what we know now

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When most people are told they have low bone density, their greatest concern is whether they are at risk for bone fractures. That’s because many people, even many physicians, make a direct association between low bone density and fracture. But in truth, this association is weak at best. Having low bone density doesn’t mean that you are doomed to fracture, and scientists now agree you cannot predict who will fracture looking only at their bone density.

Bone density, at best, is just one of a dozen important fracture risk factors. People with very thin bone density often never experience a fracture, while people with an “osteopenic” or even a “normal” bone density may fracture with even a low-impact fall. The fact is, “thin” bone is not the same as “weak” bone — bones may be thin yet strong, or thick yet weak, or (worst case scenario) thin and weak. The latter is the group most prone to fracture.

Sadly, the fear of fractures drives many people — even some who don’t have osteoporosis — to accept prescriptions for the supposedly bone-strengthening bisphosphonate drugs, such as Fosamax, Boniva, and Actonel. These drugs may offer some short-term benefits to people with severe bone loss, but they make unhealthy long-term changes in the body. We’ve begun to see signs that these drugs don’t so much build or strengthen bone as harden it, and that can cause even greater problems over time — including the fractures the drugs were intended to prevent!

Use of such drugs is largely unnecessary for the vast majority of people, because most people’s bones can be strengthened and made denser by simple nutritional and lifestyle changes that promote the body’s natural bone-building capabilities. When you support your bones with a combination of 20 key nutrients and an alkaline diet, and include exercise and stress reduction into your daily life, your bones can work astonishing changes, becoming stronger and more flexible. And it doesn’t matter when you start — these changes work whether you’re 39 or 89.

If you have been told you’re at risk for fracture, or if you’ve already had one, I encourage you to take our bone health profile to determine how great your risk of a new fracture might be — the results could surprise you. Then, learn just what you’re up against and how to maximize your bone health by reading our articles about bone fractures — what they are, what causes them, how to prevent them, and natural ways to promote bone fracture healing.

Our most popular resources on bone fracture

What is bone architecture?
Dr. Susan E. Brown

Physics — what physical conditions in the bones predispose them to fracture?

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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.

longboneYet 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?.

3 main types of fractures
Dr. Susan E. Brown

Types of fractures

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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.

Stress fractures

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.

Compression fractures

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?)

Better Bones Blog
Dr. Susan E. Brown

Fall prevention for bone fracture prevention

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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.

Better Bones Blog
Dr. Susan E. Brown

Where do hip fractures actually occur?

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Fracturing a hip is one of the top fears of women who are concerned about their bone health. While one in six U.S. women will experience a hip fracture, you may not realize that not all parts of the hip are created equally when it comes to fracture frequency, causes and healing in the different areas.

In the following video, I use my skeleton friend, “Bone-a-parte,” to show you exactly where the four main types of hip fractures occur. When you look at your bone density reports you’ll notice that the density of several different parts of the hip has been measured. So when the report talks about the neck of the hip, the trochanter or the total hip, you’ll understand exactly what each of those means. I’ll also give you some key tips for avoiding fractures in the first place.

For more information about fractures, see my article “How to speed fracture healing” and for building strong bones through a natural approach, try my Better Bones Program.