If you're unlucky enough this winter to slip on an icy surface and break a bone, you may need to do more than just treat the injury.
If you're 50 or older, ask your doctor for a bone density test, advises the National Bone Health Alliance. Made up of 47 health care organizations, the alliance says only 20% of those who break a bone are tested or treated for osteoporosis. More than 2 million breaks a year in the USA are linked to osteoporosis, a chronic illness in which bones become brittle.
"If the break is due to osteoporosis and you don't do anything about it, you're likely to fracture again," says alliance executive director David Lee. Genetic factors are the biggest contributors to bone health, but smoking, too much alcohol and not enough exercise also play roles, as do low levels of calcium and vitamin D.
Bone mass remains generally stable until age 50, Lee says. Women lose 2% to 3% of bone in the first five years after menopause and then at a rate of about 1% a year. Men lose bone more slowly, and the most dramatic losses occur after age 70.
One misunderstanding "is that it's a little old ladies' disease." Lee says about half of women and a quarter of men older than 50 will break a bone as a result of osteoporosis. And about half of those who do will break another bone later. But second fractures can be prevented, he says.
"People break bones, go to the emergency room, get the fracture fixed and are sent home," says Ethel Siris, director of the Toni Stabile Osteoporosis Center at Columbia University Medical Center in New York. "The fracture-fixers are good at what they do, but their job is not to prevent the next fracture."
That's up to you and your doctor, Siris adds. Despite recent concerns about long-term use, treatments have been shown to strengthen bones and lower fracture rates, she says. They include:
Bisphosphonates. Physicians used to recommend that patients with osteoporosis stay on the drugs (which include Fosamax, Reclast and Actonel) once they start. But a rare, atypical femur fracture and several other problems in some patients has changed that. In May, the Food and Drug Administration required makers to update labels to include an "Important Limitation of Use" statement: "The optimal duration of use has not been determined. All patients on bisphosphonate therapy should have the need for continued therapy re-evaluated on a periodic basis." Now, patients whose bone density improves might be told to "take holidays" from the drugs.
Calcium and vitamin D. Studies in 2012 linking high calcium levels to increased risk of heart disease recommended people get most of their calcium from their diet. Siris says more research needs to be done to confirm those studies; people shouldn't stop taking calcium (and vitamin D) if they don't get enough from foods: dairy products, kale, broccoli and fortified fruit juices.
"But taking more isn't necessarily better," she says. The National Institute of Medicine says women 50 and older need 1,200 milligrams of calcium daily; men need 1,000 milligrams a day until age 71, then 1,200 milligrams a day. Depending on how much sunlight you get, you might also need a vitamin D supplement.
Some people stop taking them citing side effects: nausea and irregular heartbeat with bisphosphonates; nausea, constipation and increased heart rate with calcium supplements.
Orthopedic surgeon Rick Dell of Kaiser Permanente says a new program of testing and monitoring has led to a 40% reduction in the expected number of hip fractures. "We keep an eye on patients, and when they don't refill a prescription, we know," he says. "When that happens, we call the patients and give them a nudge."
That kind of follow-up is "an absolute slam dunk" in helping prevent second fractures, Siris says.
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