Women unaware of bone fracture risks
Keeping your bones
healthy and strong
In addition to risk factors like a prior bone fracture, family history of hip fracture, low body weight, alcohol intake of three or more drinks per day and rheumatoid arthritis, loss of bone mass after menopause is one of the main causes of bone fractures. A woman’s skeleton is designed to lose bone rapidly when estrogen levels fall, which is what happens during menopause. Estrogen is one of several hormones that regulate the normal activity of bone cells. When estrogen levels drop off, bone mass declines which may lead to osteoporosis, low bone density and a higher risk for bone fractures.
Lifestyle changes
The activities and lifestyle changes that help reduce the risk of fracture are similar to those that help promote general good health: a balanced diet, regular exercise, not smoking, not drinking alcohol to excess and routine preventive medical care. The best diet to ensure an adequate intake of calcium and vitamin D includes non-fat dairy, leafy green vegetables and egg yolk. The recommended calcium intake for post-menopausal women is 1,000-1,500 IU a day. Women can get enough vitamin D by eating fortified foods, or by taking vitamin D supplements.
In addition to making healthy food choices, exercise is essential to maintaining strong bones. Weight-bearing exercise is the best at maintaining bone mass and I would encourage all middle-age adults (women and men) to engage in some form of resistance weight training. Maintaining bone and muscle mass is one of the best ways to maintain overall health as we age. Muscle is more effective at absorbing the impact of a fall than is fat, so it directly protects against fracture. In addition, people who are physically active have improved balance and coordination and will tend to avoid falls better. A healthy weight — not too thin and not too heavy — is ideal for fracture prevention.
Young adults and women who have yet to begin menopause should consider a healthy diet and an active lifestyle as preventive health measures that can reduce bone loss and fracture risks later in life. This is particularly important in adolescence, when the skeleton is rapidly growing. Young women should also be aware that prolonged abnormalities in their menstrual cycles can lead to low estrogen levels and bone loss.
Osteoporosis and health screenings
Until a bone fracture occurs, osteoporosis is a condition without symptoms. Bone density testing is an important part of fracture risk assessment but must be compared to other clinical information, especially when making decisions about treatment. Several leading health organizations, including the National Ostoeporosis Foundation, recommend that women over 65 and men over 70 get routine bone density screenings. They also suggest that younger women and men get screened based on their clinical risk factors or if they have a fragility fracture after 50 years of age. Patients with special medical conditions associated with bone loss such as rheumatoid arthritis or organ transplantation may also need to be screened earlier.
Ostoeporosis can be a major cause of suffering, healthcare expense and even premature death. Women can improve and maintain bone mass by not smoking, following a healthy lifestyle and especially by getting ample exercise. However, menopause and genetics are realities that we have little control over. Even women who do "all the right things" can develop osteoporosis and still be at risk for fractures. Approaching middle age, women and men should discuss their risk of osteoporosis with their primary care physician. It may be difficult to reverse poor health habits, but it is never too late reap the benefits of an exercise program or healthier food choices.
Dr. Wysolmerski is an attending endocrinologist at Yale-New Haven Hospital and a professor of medicine in Yale School of Medicine’s department of internal medicine.
September 2009
New findings show that women who are 55 years of age or older, who have an increased risk of bone fracture because of family history, steroid use, or other risk factors, tend not to perceive their heightened risk.
The findings, reported at the European Symposium on Calcified Tissues, come from the Global Longitudinal Study of Osteoporosis in Women (GLOW). The study enrolled 60,393 women recruited from 615 primary care physician practices in 10 countries.
While there are many means available to lower fracture risk, patient adherence is often poor, said principal investigator Dr. Silvano Adami, professor of medical and surgical sciences at the University of Verona in Italy. It's important for doctors to identify factors that may enhance or impede patient adherence.
Sixty-six percent who had a history of fracture perceived their risk of future fracture to be lower than or the same as other women their age. Of the women with a diagnosis of osteoporosis, 55 percent believed that they did not have an increased fracture risk.
Adami and colleagues compared the self-perceived risk for osteoporotic fracture among women 55 years of age or older with characteristics known to increase fracture risk.
Women were asked to rate their perceived risk of fracture compared with women of the same age using a 5-point scale that ranged from "much lower" to "much higher." The risk factors included a prior bone fracture, a mother who had a hip fracture, weight of less than 125 pounds, alcohol intake of more than 20 drinks per week, current steroid use and rheumatoid arthritis.
Sixty-six percent who had a history of fracture perceived their risk of future fracture to be lower than or the same as other women their age. Of the women with a diagnosis of osteoporosis, 55 percent believed that they did not have an increased fracture risk.
The data also showed that 75 percent of women with a high risk of fracture, based on their scores on the FRACTURE Index, felt that their risk was lower or the same as other women their age. The FRACTURE Index is a tool for predicting fracture risk in postmenopausal women that takes into account age, bone mineral density, fracture after 50 years of age, weight of less than 125 pounds, smoking status and use of arms to stand up from a chair.
When interpreting the findings, Adami cautioned, it's important to take into account that participating physician practices and patients volunteering from those practices may differ from non-participants and thus may not be representative of the general population.
"The main risk factors for osteoporotic fracture have been clearly identified, and it is now the time for women to become fully aware of these risk factors and take appropriate measures," he concluded.
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