Women and Hip Fracture

Fracture of high femur, X-ray image from http://www.positive-way.com/recovery/broken_hip_chronicle.htm
Fracture of high femur, X-ray image from www.positive-way.com/recovery/broken_hip_chronicle.htm

A few weeks ago, my 82-year-old mother broke her hip. This is not my mother’s x-ray, but it is her type of fracture, and pretty much the hardware they used to stabilize it.

She has experienced excruciating pain.

It’s not her first hip fracture. She broke the other hip about five or six years ago, and went on to live independently in a retirement community, walking with a walker and needing no day-to-day assistance.

She would be embarrassed if I told more of her story, but I would like to do a bit of a public service announcement about women and fractured hips. Like, why do we hear about so many of them? What can we (younger women) do, now, to prevent them?

And before we go any further, why is this (from the International Osteoporosis Foundation), news to me?

In white women, the lifetime risk of hip fracture is 1 in 6, compared with a 1 in 9 risk of a diagnosis of breast cancer.

And if you don’t think they can be compared, because breast cancer kills:

In women over 45 years of age, osteoporosis accounts for more days spent in hospital than many other diseases, including diabetes, myocardial infarction and breast cancer;

and

Hip fractures cause the most morbidity [among fractures] with reported mortality rates up to 20-24% in the first year after a hip fracture and greater risk of dying may persist for at least 5 years afterwards.

Do I have your attention yet?

An article in the Journal of the American Medical Association (JAMA, 2009) says this about rate of occurrence:

Between 1986 and 2005, the annual mean number of hip fractures was 957.3 per 100,000 [that’s about 1%]… for women and 414.4 per 100,000[that’s about 1/2%]…for men.

These numbers seemed very low to me but that’s because they refer to everybody, not just older people. So I looked up, “Incidence of hip fracture after 75,” but it’s actually a very difficult number to pin down. This, from a 1996 issue of Bone is about as close as I could get:

The lifetime risk of a hip fracture is 16%-18% in white women and 5%-6% in white men. At the age of 80 years, every fifth woman and at the age of 90 years almost every second woman has suffered a hip fracture.

That sounds more like the experience of people I know.

The Centers for Disease Control (CDC) offers these additional facts:

  1. Women sustain three-quarters of all hip fractures.
  2. White women are more likely to sustain hip fractures than are African-American or Asian women.
  3. In both men and women, hip fracture rates increase exponentially with age. People 85 and older are 10 to 15 times more likely to sustain hip fractures than are those aged 60 to 65.
  4. Osteoporosis, a disease that makes bones porous, increases a person’s risk of sustaining a hip fracture.
  5. The National Osteoporosis Foundation estimates that more than 10 million people over age 50 in the U.S. have osteoporosis and another 34 million are at risk for the disease.
  6. The article also mentions also that 95% of hip fractures are caused by falls.

There are drugs to treat osteoporosis, although they are not without problems. A Facebook friend of mine is aware of some negative side effects of the drug, Fosamax.

As always,  prevention might be the better route. But how do we prevent osteoporosis and falls? We may have heard it before–DIET and EXERCISE! (groan)–but seriously, what an opportunity. There ARE things we can do to reduce the chance of hip fracture.

Let’s start with a few ideas about diet.

Here’s a summary of an interesting study about diet and hip fracture. It was published in the Journal of Gerontology, and the title is “Worldwide incidence of hip fracture in elderly women: relation to consumption of animal and vegetable foods.” I don’t know about you, but I probably wouldn’t have guessed that the high animal-content diet was more closely associated with hip fracture than the high vegetable-content diet. In a direct quote from the article:

Moderation of animal food consumption and an increased ratio of vegetable/animal food consumption may confer a protective effect.

Here’s another example of a simple dietary change you can make. Lots of people have switched from regular yogurt to Greek yogurt (including me, for its higher protein content)–but if you read the label, Greek yogurt sacrifices calcium for protein. Consider switching back to good old regular yogurt. You’ll be adding calcium to your diet, which is good for your bones.

The National Osteoporosis Foundation has this list of high-calcium foods (see how I’m right about plain vs. Greek yogurt?)  Can you add one or two of these to your diet, starting today? I’m going to try almond milk and broccoli rabe. What about you?

Last thoughts for today: How can we best use exercise to help prevent osteoporosis and falls? Start with a fact that is not necessarily intuitive: stress on bones is a GOOD thing. Stress on bones, from the pounding of weight bearing exercise like walking, to the pull of muscle on bones you achieve with resisted exercise, helps bone to constantly reform and strengthen.

This is, in part, why men have fewer hip fractures: testosterone, more muscle strength, more muscle mass. Not much we ladies can do about this, nor is there much we can do about those babies we carried (and maybe breast-fed) for collective years–our bodies automatically served the babies first, from our own personal, and probably dwindling, stores of calcium.

So, while I like to bike because it’s easier on my arthritic knees than walking, I’m trying to do more walking. And although I kind of detest weight-lifting and resisted exercise in the gym, recent dedication to such a full-body strengthening program (designed and carried out inexpensively, with just a few dumbbells and cuff weights, oh, and also a really nice Swiss ball for sit-ups) within weeks flattened my stomach and sculpted my shoulders. Although I couldn’t see much happening in my legs, I figure it worked there, too.

Regarding balance, I’ve never been as sure that we can improve it, at least not as easily as strength. I know my balance is relatively poor, from my own experience and from watching (in awe) the other ladies in yoga class as they stand on one foot for minutes at a time–(Hah! I’m touching down the other toes in seconds!) Websites abound with balance-improving exercises; most of them make me feel like I’m falling. I’ll keep up with yoga, and I think, also, that better core strength (strength through the trunk, i.e., back and abdominals) couldn’t hurt.

Right now, my dear mother hurts. Maybe we can prevent some future hurt, for all of us.

 

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