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Dr. Susan E. Brown

Cross-cultural perspective on hip fractures

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When it comes to data regarding hip fractures — the most devastating and costly of all osteoporotic fractures — I’m interested in the cross-cultural perspective.

Across the different continents, we see a great variation in hip fracture incidence. For example, hip fractures are almost unheard of in African and South American popula

tions living traditional lifestyles, while 1 out of 6 Caucasian women in the U.S. who are 50 years or older will experience a hip fracture during her lifetime.

Worldwide, hip fractures are projected to increase nearly fourfold by 2050 due to rising life expectancy and increased abandonment of traditional lifestyles. It is projected, that half of these fractures will occur in Asia.

What do worldwide studies tell us?

1. Current studies report that the highest hip fracture rates are in the US and northern Europe, while the lowest rates are in Africa and Latin America. Asian countries currently exhibit intermediate rates of hip fracture. With industrialization and westernization, hip fracture incidence rises dramatically. This was seen in Taiwan a few decades ago and is now occurring in China where, in Beijing between the early 1990s and 2006, the age-specific (50+) rate of hip fracture increased 2.76 fold in women and 2 fold in men.

2. The vast majority of hip fractures occur in the elderly — by age 90, 32% of U.S. Caucasian women will have experienced a hip fracture.

3. Vitamin D deficiency and probably life-long vitamin D inadequacy as well, are the major underlying causes of bone weakness that predisposes people to fracture. Studies in the United States and Europe report that 75% to 95% of patients with hip fractures are vitamin D insufficient. Low vitamin D results in bone weakness, and bone loss.

4. Ninety-five percent of osteoporotic hip fractures result from a fall. Only about 5% appear to be spontaneous in which a person feels a fracture, then falls.

I’ve devoted an entire section to my website to fracture prevention and healing. I encourage you to start with my article “Fractures 101” for an overview of the physiology, physics, types and risks of fractures.

 

References:

Dhanwal , D. K., E. M. Dennison, N. C. Harvey, and C. Cooper. 2011. Epidemiology of hip fracture: Worldwide geographic variation. Indian Journal of Orthopaedics 45(1):15–22.

Kanis, J. A., A. Odén, E. V. McCloskey, H. Johansson, D. A. Wahl, C. Cooper, and the IOF Working Group on Epidemiology and Quality of Life. 2012. A systemic review of hip fracture incidence and probability of fracture worldwide. Osteoporosis International 23:2239–2256.

Kolata, G. 2009. Study finds steady drop in hip fracture rates, but reasons are unclear. New York Times (August 25).

Lumbers, M., S. A. New, S. Gibson, and M. c. Murphy. 2001. Nutritional status in elderly female hip fracture patients: Comparison with an age-matched home living group attending day centres. British Journal of Nutrition 85(6):733–740.

Xia, W. B., S. L. He, L. Xu, A. M. Liu, Y. Jiang, M. Li, O. Wang, X. P. Xing, Y. Sun, and S. R. Cummings. 2012. Rapidly increasing rates of hip fracture in Beijing, China. Journal of Bone and Mineral Research 27(1):125–129.

 

Better Bones Blog
Dr. Susan E. Brown

New data on declining fracture rates

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In the last few years, I have been reporting about the decreased rates of osteoporotic fracture in the US, Canada, and other highly industrialized countries. I have also noted that Hip fracturethese reductions are not due to the use of osteoporosis drugs. New data from Denmark confirms the same positive trend in this Scandinavian country.

Between 1997 and 2006 the hip fracture incidence rate in Denmark declined by 20% in men and 22% in women. During this same time period, use of osteoporosis drugs increased only 1.8% in women and 0.2% in men aged 60+.

As the investigators report, the number of prevented hip fractures that could be attributed to drug therapy was only 1.3% in men and 3.7% in women.

So what’s behind Denmark’s drop in hip fractures?

Well, researchers are still scratching their heads, but my vote would be increased awareness about — and use of — vitamin D. As I noted in a 2009 medical journal publication, there is good data to suggest that fracture rates worldwide could be reduced by 50% if everyone were to achieve a minimum 32 ng/mL vitamin D blood level.

I’m going to keep an eye out for even more research.

References:

Abrahamsen, B and Vestergaard, P. 2010. Declining incidence of hip fractures and the extent of use of anti-osteoporotic therapy in Denmark 1997-2006. Osteoporosis International, 21:373-80.

Brown, Susan E. 2008. Vitamin D and fracture reduction: An evaluation of the existing research. Alternative Medicine Review, 13(1).

 

Better Bones Blog
Dr. Susan E. Brown

3 tips to help heal fractures

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Breaking a bone can stop us all in our tracks, no matter what age we are. But particularly for women in their 60’s, 70’s, and 80’s, a fracture can come with a lot of fear and, worst of all, the feeling of helplessness. With 9 million osteoporotic fractures occurring every year, you should know that you can do more than just sit back and let it heal. We have much more influence over the healing process than many practitioners convey. Everything from what you eat to how you move can speed or slow down healing.

Here are three ideas that will have you on a fast track to heal your fracture

1. Aspirin and ibuprofen slow healing. What do you reach for when you’re in pain? So many of the people I talk with at the Center for Better Bones say aspirin and ibuprofen are their first choices when in pain. But these anti-inflammatory medications can delay the healing process. Inflammation is an important part of 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 (brand name Tylenol). And I always suggest more natural supplements like vitamin C, quercetin, and omega-3 fatty acids.

2. Your body requires more nutrients, protein, and calories. Fracture healing requires a lot of energy and can increase your metabolism significantly. Depending on the injury, your body could require up to double your normal caloric intake! Protein is particularly important during this time because about half of bone is comprised of protein. The protein matrix is where mineral crystals (the other half of bone) are laid to build strength. Supplementing your diet with minerals like zinc, copper, calcium, phosphorus, and silicon will give your body the building blocks for strong new bone. Vitamins C, D, K, and B6 also specifically help in the bone building process. So don’t skimp on alkalizing fruits, vegetables, nuts, seeds, and quality protein.

3. Exercise may be a good thing. Though it may seem like the last thing on your list, exercising is a key component to speeding fracture healing. For one thing, it increases blood flow to the fractured area, flooding the area with more nutrients to help with healing. Joint loading also prompts the bone to increase matrix synthesis. Of course you’ll want to avoid direct stress on the broken bone, but try range of motion, tendon-gliding, and joint-loading exercises — talk to your practitioner about specific exercises, or get a referral for physical therapy.

There are many other things you can do to speed fracture healing. For more detailed information, read my full article on how to speed fracture healing. You’re not helpless when it comes to healing a fracture. Give yourself a hand with the right bone support.

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Better Bones Blog
Dr. Susan E. Brown

Repeat fractures vs. first fractures

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The nine million osteoporotic fractures that occur worldwide each year give us reason for concern, and recently colleagues to the north asked two interesting questions about who fractures and how much.

How much of the Canadian fracture burden occurs in folks with an osteoporotic bone density, and how much in those with osteopenic or normal bone density?

This question has been asked before, and the Canadian answer was similar to results from around the world — the majority of all Canadian low trauma, “osteoporotic” fractures among both women and men actually occur in folks who have osteopenia or even normal bone density. While those with an osteoporotic bone density have a higher fracture rate, more people have osteopenia, so most fractures occur in this group.

How much of the fracture burden is attributable to first versus repeat fractures?

This inquiry I rate as both original and insightful. So what would be your guess — mostly first fractures perhaps? Yes, using data from the 8-year follow-up Canada wide CAMOS study, researchers found that indeed most fractures were first fractures, but surprisingly a full 40% of all fractures in women and 25% in men were repeat fractures.

Further, repeat fractures occurred in equal proportions among those with osteoporosis and those with osteopenia. We’ve been told before that having a past fracture is one of the best predictors of future fracture, but I believe that we’re just starting to understand that the first low-trauma fracture is likely a screaming red flag regardless of your bone density, and a sign that you need to take action to support your bone health. (For those interested in avoiding any fracture, we suggest you look at our Bone Health Profile).

 

Reference:

Langsetmo, L, Goltzman, D, et al. 2009. Repeat low-trauma fractures occur frequently among men and women who have osteopenic BMD. J Bone Miner Res, 24(9):1515-1522.

 

Better Bones Blog
Dr. Susan E. Brown

Encouraging data on declining hip fractures

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Let’s face it: the number one fear of most people with osteoporosis is fracturing a hip, and for good reason. Hip fractures are physically and financially debilitating, and may even shorten your lifespan. But new research gives us reason to be hopeful: the U.S. hip fracture rate is falling.

This may come as a surprise considering the inflammatory headlines from the U.S. Department of Health and Human Services only weeks ago, declaring dramatic increases in osteoporosis-linked fractures. That data would strike fear into the heart of any woman with a less-than-average T-score! But while it’s true that a larger number of fractures are being diagnosed today than years ago, the rate of fractures — adjusted to the population — is actually shrinking.

Specifically, the reports are as follows:

• Between 1993 and 2003 hospitalizations for hip fracture decreased by 5% and the age-adjusted rates of hip fracture for women and men fell by about 20%.  This is data from the US Nationwide Impatient Sample. (Gehlbach et al. 2007)

• From 1985 through 2005 the Canadian hip fracture rate, adjusted by age, fell by 32% in women and 25% in men. (Leslie et al. 2009)

From my perspective, the most important take-away from this data is that this trend of decreasing hip fractures was well under way long before the new osteoporosis drugs became popular, and scientists agree that this decline in fracture incidence is not due to use of osteoporosis medications.

In fact, I would go so far as to say that the decline is in spite of the use of these medications, which have questionable  benefits with long-term use  and which may even increase the risk of non-traumatic fractures in some women who take them for more than 5 years.

So what can you do to help this encouraging trend to continue? Nourish your bones! Many of the factors that cause hip fractures are within your control, and no one has the power to change them but you. To learn more about opportunities to improve your bone health, take our Bone Health Profile.

 

References:

Gehlbach, SH, et al.  2007. Trends in hospital care for hip fracture.  Osteoporosis International, 18(5):585-591.

Leslie, WD, et al. 2009. Trends in hip fracture rates in Canada. JAMA, 302(8):883-889.