Fall Prevention Is the Most Vital Factor for Stopping Osteoporosis Bone Fractures

Beneath is an approximation of this video’s audio content material. To see any graphs, charts, graphics, photos, and quotes to which Dr. Greger could also be referring, watch the above video.

Bone mineral density screening could also be a billion-dollar trade, however solely 15 p.c of low-trauma fractures (which means from a fall not more than from standing top) are on account of osteoporosis in older ladies. Solely 15 p.c of fractures are on account of having low bone density. Between the ages of 60 and 80, hip fracture danger will increase 13-fold in women and men, whereas the age-related decline in bone mineral density accounted for less than a twofold elevated danger. So, the contribution of declining bone density to the exponential improve in hip fracture danger with age is comparatively small. The overwhelming majority of our age-related rise in hip fracture danger seems to don’t have anything to do with the measured density of our bones.

So, what’s the principle contributor? Fall danger. And not using a fall, even fragile hips don’t fracture. Falls are the first reason for fractures—together with vertebral fractures. The disparity between women and men in hip fracture charges is primarily not as a result of males have stronger bones, however as a result of ladies fall extra typically. Docs simply asking the easy query, “Do you’ve gotten impaired stability?” can predict about 40 p.c of all hip fractures––greater than a bone scan prognosis of osteoporosis. Even a weak osteoporotic bone is powerful sufficient to outlive regular life actions with out the extreme loading that comes from a fall impression or, within the case of the backbone, bending along with your again to elevate one thing moderately than your knees.

The primacy of falls in fracture danger explains quite a few obvious osteoporosis paradoxes. For instance, even though about 75 p.c of your bone mass could also be decided by your genes, the heritability of bone fractures seems negligible at older ages (as a result of the propensity to fall is way much less inherited).

It additionally explains the poor predictive worth of bone density screening for fractures. Including bone mineral density measures to a hip fracture danger rating primarily based simply on age, intercourse, top, weight, using a strolling support, and cigarette smoking standing did little to enhance its predictive energy. A provocative editorial printed within the Journal of Inside Medication entitled “Osteoporosis: The Emperor Has No Garments” steered that it could be safer and simpler to deal with fall prevention moderately than pharmaceutical intervention.

Though solely about 5 p.c of falls lead to a fracture, falls are quite common amongst the aged, due partly to age-related muscle weak point and lack of stability. Greater than a 3rd of these aged 65 or older fall annually. After a hip fracture, fewer than 50 p.c regain their pre-fracture perform by way of strolling means and independence. What can we do to forestall injurious falls?  Primarily based on dozens of randomized managed trials, the only intervention most strongly related to a discount in fall charges: train.

So, train doesn’t simply increase bone density. Extra importantly, it additionally reduces the variety of falls over time by 23 p.c, and the variety of fallers by 15 p.c. So, in case you adopted 1,000 folks round age 75 for a 12 months, and 480 fell a complete of 850 instances with out train, including train could be anticipated to lead to 72 fewer fallers and 195 fewer falls.

Tai Chi seems to scale back falls by 19 p.c, stability and purposeful workouts (like sit to face) might scale back falls by 24 p.c, and a number of workouts—sometimes stability and purposeful train plus energy coaching—might scale back falls by 34 p.c.

The lowered falls price then interprets into fewer fractures. A latest meta-analysis discovered that train interventions—largely utilizing a mixture of resistance train to enhance decrease limb muscle energy and stability coaching—lower fracture charges practically in half. One year-long trial that mixed energy coaching with step and leaping aerobics, and targeted on stability and agility, resulted in 74 p.c fewer fractures over the five-year interval after the examine ended. Moreover, greater than 70 p.c of the ladies within the combo train group went these 5 years with no single injurious fall––in comparison with lower than half of these within the management group.

Trials on hip protectors, which cushion a sideways fall on the hip with plastic shields or foam pads sewn into particular underwear, are sometimes plagued with poor compliance. Research haven’t discovered them to be helpful for lowering hip fracture charges amongst these dwelling at residence, however trials in nursing houses or residential care services do present a small discount in danger––translating into about 11 fewer folks out of a thousand struggling hip fractures on account of sporting hip safety.

There are additionally commonsense measures one can make use of. High quality enchancment trials involving interventions like affected person training have proven a ten p.c discount in fall charges. For instance, maintain issues inside attain so that you don’t want to make use of step stools. Use non-slip mats within the bathtub and bathe. Add seize bars within the toilet. Hold flooring litter free. Take away small throw rugs, or use double-sided tape to maintain them from slipping. And ensure all staircases have handrails and sufficient lighting. You would additionally keep away from taking walks throughout inclement climate, and for individuals who stroll leashed canines, contemplate selecting smaller breeds, or guaranteeing correct coaching to forestall them from lunging. In any other case, the principle methods to forestall fractures might not have modified a lot over the many years for the reason that traditional paper entitled “Methods for Prevention of Osteoporosis and Hip Fracture.” The principle methods to forestall these fractures are to “quit smoking, be energetic and eat nicely.”

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