A small injury from tripping over a dog leash or missing the bottom step shouldn’t break a bone. But if you’re over age 50 and start having major bone fractures from small injuries, it could be a sign that your bones are thinning. Major bones include the humerus (upper arm bone), femur (thigh bone), wrist, pelvis and spine. Once you have a fragility fracture, your doctor will want to investigate your bone density.
Atrium Health Musculoskeletal Institute Fracture Prevention Program is focused on helping patients prevent fragility fractures. “Our orthopedic teammates will refer patients with fragility fractures to us so that we can evaluate their bone health,” explained JoAnn Holzinger, a family nurse practitioner with the Fracture Prevention Program. “We’ll use tests to evaluate their condition and educate them about osteoporosis. If needed, we’ll prescribe medication to help keep their bones strong.”
Following a fragility fracture, a DEXA (dual energy X-ray absorptiometry) scan is used to evaluate the patient’s bone density. This pain-free X-ray measures calcium and other minerals in the patient’s lower back, hips and wrist. During the 10-minute test, the patient lies on a small table while a low-energy radiation beam moves across their body. The amount of radiation is less than what is used during a chest X-ray.
DEXA scan results are divided into the following T-score ranges:
- Normal range = 1.0 to -1.0
- Osteopenia (reduced bone mass) range = -1.0 to -2.5
- Osteoporosis range = -2.5 and beyond
Atrium Health’s fracture prevention team uses these scores to monitor the success of treatment. Patients on medication for osteoporosis usually have a DEXA scan once every one to two years.
In addition to the scan, the patient will have lab work associated with bone health done to see if there’s a secondary reason for their thinning bones. This blood test will check the patient’s calcium, vitamin D and kidney and liver function. It will also check the patient’s parathyroid hormone, which is the hormone in charge of bone turnover.
To help keep bones as healthy as possible, the fracture prevention team educates patients on fracture risk factors and prevention strategies. “Remember that it’s never too late to get those bones moving,” said Holzinger. “Staying active is critical to bone health, and strong bones are the key to improving quality of life as we age.”
Risk factors for fractures
You may be at risk for a fracture if you meet one or more of the following criteria:
- Age. If you’re over age 50, your risk of fracture increases.
- Family history. If one of your parents broke a hip, you’re at greater risk for having the same fracture.
- History of cancer. Cancer treatment, including chemotherapy and radiation, can cause bone loss and fractures.
- Long-term use of specific medications. Acid reflux medications and proton pump inhibitors, antidepressants and anticonvulsant medications (e.g., gabapentin) can decrease bone density. In patients with rheumatoid arthritis, long-term treatment with prednisone can cause bone loss and fractures.
- Lifestyle-related factors include smoking and heavy alcohol use. A lack of exercise (especially weight-bearing exercise) or the inability to move can cause bones to thin, since they are not stimulated to make new bone.
Fracture prevention strategies
The fracture prevention team encourages making healthy lifestyle choices to keep bones healthy. Here’s what you can start doing right now to prevent fractures:
- Stay active. Your fitness routine should include weight-bearing exercise (e.g., strength and resistance training).
- Eat bone-healthy foods. Eat foods high in calcium and vitamin D, such as milk products and milk substitutes. A recent study on prunes found that people who ate six prunes a day improved their bone density over the course of a year. The skin of the prune is a powerful anti-inflammatory, which is very protective for bones.
- Limit caffeine to less than three cups a day. Elevated caffeine is bad for bones. In addition to coffee, caffeine is found in soda and iced tea.
- Don’t smoke. Tobacco use is known to decrease bone density.
“Even though many lifestyle factors start when you’re young, it’s never too late to start making these changes,” said Holzinger.
Bone-strengthening medications
If your overall T-scores are in the osteoporosis range and you’ve already had a fragility fracture, you’ll likely need medication to improve your bone density.
There are several types of medications used to improve bone health, including:
- Antiresorptives. These drugs slow down the cells (osteoclasts) that are primarily involved in breaking down older bone. This allows the osteoblasts (bone-building cells) to have more time to increase overall bone mass. These cells work together in an ongoing cycle to build new bone and remove old bone. Sometimes this delicate cycle is affected by advancing age and chronic diseases, such as diabetes and rheumatoid arthritis. These medications have varying treatment timelines and may require breaks.
- Anabolic steroids. These drugs are made of natural or synthetic parathyroid hormone, which encourages new bone growth. They are given through daily injections using a multidose injection pen that is sent to the patient’s home each month of treatment. After 18 to 24 months, the patient is transitioned to a maintenance drug that helps preserve new bone growth.
While the length of treatment time with medication varies, patients with osteoporosis will likely require lifelong medication.
Award-winning care
Atrium Health Musculoskeletal Institute recently received the Own the Bone designation. This national program was started by the American Orthopedic Association to help increase knowledge and education in preventing fragility factures. The program recognizes organizations that meet their 10 metrics, which demonstrate a commitment to improving patient bone health after a fracture.
“This recognition assures our patients that we’re working with the best guidelines and collaborating with other top orthopedic surgeons across the country to provide the highest quality orthopedic care,” Holzinger explained.
Learn more about expert orthopedic care at Atrium Health Musculoskeletal Institute.
