Falls are the immediate cause of most “wrist”, shoulder and ankle fractures, and of many Hip fractures. Two or more falls in a year indicate a need for more than basic balance and strength training. You need to analyze why you fell. Then work to avoid repetition. Formal Physical Therapy, teaching exercises to do at home, is best.
Major Fall Risk Factors: loose rugs and minor step-ups into a room; the scuffing gait needed for slippers, sandals or clogs; poor vision and bifocals; bending to pick something off the floor without hanging on to support; not using chair arms; slow gait; and not using a cane or walker on uneven surfaces (out-of-doors). If you have any of these, work to eliminate them.
Walking for exercise does NOT reduce falls. Even walking over a mile daily. Balance and strength training DO reduce falls. The simplest to do at home is to stand on one leg. The goal is 30 seconds. Many of us need to hang on to something solid at first and gradually work up to “no hands”. PT will teach additional exercises as you improve.
Lifestyle Integrative Functional Exercises! Look at all daily activites, then modify your lifestyle to avoid Fall Opportunities. Avoiding Falls is just as important as taking osteoporosis medications for Avoiding Fractures.
Take Control Naturally. Avoid Falls. Avoid Fractures.
Jay Ginther, MD
Driving to Chicago in February was cold and snowing. But it was hot indoors at the ISCD (International Society for Clinical Densitometry) Annual Meeting and Position Development Conference (PDC).
While no new technologies were introduced, the PDC evaluated the scientific studies of several recent innovations. Most are best done in research centers. One recent innovation could make it to clinical centers. Trabecular Bone Score (TBS) is a software addition to DXA that adds information about the quality of bone by re-analyzing the L1, L2, L3 vertebrae.
We have discussed how adding Vertebral Fracture Assessment (VFA) to a DXA Bone Mineral Density (BMD) improves Fracture Risk calculation. TBS has the same potential. The main issues blocking TBS are software cost, added time, and the fact that all insurances (including Medicare) currently do not pay for it.
We also attended presentations about patient treatment issues. Fracture Prevention is much more than just checking a T-score with DXA. National experts shared their knowledge of medical issues that can strongly influence Bone Health and Fracture Risk. More about these sessions next time.
You can Take Control of your Future with action to decrease your fracture risk.
Jay Ginther, MD
DXA is very good at determining Bone Mineral Density (BMD), provided you look at the images and over-read the computer. DXA alone is less good at predicting Fracture Risk. But, Fractures are what we want to avoid.
At the International Society for Clinical Densitometry (ISCD) meeting this week, we will discuss the other modalities, which supplement DXA to obtain greater accuracy. Vertebral Fracture Assessment (VFA) helps evaluate bone quality. FRAX was specifically designed to predict Fracture Risk. QCT (Quantitative Computerized Tomography) has been added in recent years as an alternative to DXA.
ISCD will discuss adding TBS (Trabecular Bone Score), Hip Structural Analysis, Hip Axis Length, and uses of Central CT. We are constantly pushing toward our goal – Prevent Fractures.
Preventing Fractures is not just DXA. Get a Complete Bone Health Evaluation.
Take Control of your future. Check your bone health.
Jay Ginther, MD
Fractures get no respect. 20% of women and over 30% of men over 65 die within 6 months of a Hip Fracture. But nobody is worried about hip fractures!
Hip Fracture is never mentioned on the death certificate. The complications of the hip fracture get all the credit. Pneumonia, pulmonary embolis (blood clots), worsening heart failure, kidney failure or even septicemia (infection in the blood stream) from bed sores might make the list, but not the initial event, the hip fracture.
Nearly 80% of Vertebral Fractures are mistaken for pulled muscles or arthritis in the back. Yet vertebral collapse fractures are a strong indicator of death within the year in men and women. Again, pneumonia, heart failure, respiratory failure (shortness of breath), malnutrition from inability to eat enough get the blame. The vertebral fractures and resulting kyphosis (humpback) never get credit for the misery and death they cause.
More women die each year from complications of fractures than from breast cancer or stroke or heart attack. Nobody seems to care, because the fracture itself is never blamed for the complications it causes.
If we identified the original fracture starting the rapid decline, we would be more concerned with bone health and fracture risk. As it is we ignore fracture risk at our peril, especially as we get older like me (60’s).
Respect Fracture Risk. Take Control of your future.
Jay Ginther, MD