Thinner Bones Shorten Life

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Breaking a hip increases an older person's risk of dying. The results are from a Canadian study. Researchers followed more than 7,000 older adults. One of every four people who broke a hip died over the next five years. About one of every six who had a spine fracture died during the same time period. Most of these fractures in older people are due to osteoporosis, or thinning bones. The study was published in the August 4 issue of the Canadian Medical Association Journal.

What Is the Doctor's Reaction?

Previous research has demonstrated that people who suffer an osteoporotic hip fracture have an increased risk of losing their independence and an increased risk of death in the years that follow. Part of this is related to complications of the fracture itself and surgery to repair it. But people with osteoporosis who break their hips tend to be sicker (with a shorter life expectancy) even before the fracture.

A new study provides some of the most compelling confirmation to date of the link between osteoporotic fractures and increased mortality. In addition, it suggests that spine fractures may be nearly as dangerous.

Researchers in Canada studied more than 7,700 adults over the age of 50 who were representative of similarly aged people in the general population. It differed from most prior studies which focused on people most likely to develop fractures, such as older women or those with established osteoporosis.

This new study found that a quarter of men and women who had hip fractures died within 5 years. For those with spinal fractures, nearly 1 in 6 died over that same time period. Smoking, inactivity and having other significant medical problems were also associated with premature death in these individuals.

Most hip and spine fractures in older adults are due to osteoporosis. This is a condition in which bones have reduced strength and fracture easily. A fall from a standing height while walking or standing still will not cause a hip fracture in people whose bone strength is normal. But among those with osteoporosis, bones break with even minor trauma. And in the case of spine fractures, fractures may occur with no trauma at all.

Osteoporosis-related fractures may have an impact on health and longevity far beyond the discomfort of the fracture. The good news is that osteoporosis and fractures are often preventable. And there are more effective treatments for osteoporosis now than ever before.

What Changes Can I Make Now?

It's not clear how much of the higher mortality associated with hip or spine fractures is preventable. To the extent that the higher risk of death is directly related to falls or fractures, fall prevention and the prevention and treatment of osteoporosis may actually be life saving.

You can make the following changes now to reduce your risk of osteoporosis and fractures of the hip or spine:

Get enough calcium and vitamin D, whether in foods, drinks or supplements. For older adults, the recommended amounts are 1,200 milligrams per day of calcium and 400 to 600 units per day of vitamin D (although many experts are now recommending 1,000 units per day). Ten to 15 minutes per day of sun exposure also can boost your vitamin D levels.

Get plenty of weight-bearing exercise. Besides the other health benefits provided by exercise, it can make bones stronger.

Talk to your doctor about having your bone mineral density (BMD) checked. The best time to begin and how often to repeat testing depends on your risk factors for osteoporosis (such as family history).

Choose exercises that target balance, gait stability and strength to reduce the likelihood of a fall. If you have difficulty walking or a tendency to fall, talk to your doctor about seeing a physical therapist. Consider using a cane or a walker.

Review your medicines with your doctor. It may be possible to reduce or stop taking medicines that might increase your risks for falls, or for osteoporosis.

Consider taking a medication that can build bone strength. If you have osteoporosis (based on BMD) or have suffered a low-impact fracture in the past, this may be a good idea. These medicines include alendronate/Fosamax and risedronate/Actonel.

Clearing your home of clutter or loose rugs can reduce the risk of tripping and falling. And if you do fall, wearing hip protectors -- padding worn under the clothes to cushion a fall -- also can lessen the risk of fracture.

What Can I Expect Looking to the Future?

Only recently has research linked osteoporotic fractures with a higher risk of death. In the near future, I believe we will have new and better ways to improve the outlook for people who suffer these fractures. We also should have better ways to prevent falls, and to prevent and treat osteoporosis. This may include more accurate ways to identify those at risk, more effective exercise programs focused on prevention of falls, and more effective medicines to improve bone strength.