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You Broke a Bone…How to Avoid Another

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You tripped and broke a bone when you landed on the floor. The pain is gone, your recovery is complete, but you’re left with an unwanted vestige of the event—the fear of falling again…and suffering another break.

Giving up all activity and plopping yourself into a cushy chair is not an option. So we asked Susan Ott, MD, a specialist in bone diseases, for a step-by-step plan to help people who have broken bones and healed to actually get back to living. Here’s what Dr. Ott recommends…

Get evaluated for osteoporosis. This should be your first step if you don’t already know your bone density status. Other diseases such as cancer or infections can weaken your bones, but if you’re over 50 or a younger woman who already went through menopause, your break was likely osteoporosis-related. Depending on the severity of osteoporosis, a strong cough or even a sneeze can be enough to cause a fracture—so you don’t want to be in the dark about it.

Typically, an osteoporotic fracture is one caused just by a simple fall from a standing height rather than by a trauma. Bones in the spine (vertebra), the hip and the wrist are the most bones most often affected, although fractures of the ankles and feet can also be early indications of osteoporosis. (Fractures of toes, hands and fingers don’t count as osteoporotic fractures.)

The lower your bone density, the more careful you’ll need to be. One out of five women who have a spine fracture will have another one the next year if they don’t get treatment, warns Dr. Ott. Those with a hip, leg or arm fracture also have a high risk of more fractures. Medications for osteoporosis aren’t perfect, but they can help prevent future fractures, Dr. Ott said. In clinical trials that have included thousands of women, those treated with placebo had about twice as many second fractures as those treated with osteoporosis medicines, even when they followed advice about exercise, nutrition and fall prevention. Unfortunately, only about 20% of women who are admitted to a hospital with a fracture receive any medical treatment for their osteoporosis. Sadly, osteoporosis is still often ignored. Many fractures could be prevented with more attention paid to treatment. Sometimes women don’t want to take medication because they are worried about side effects, but once you have had a fracture the benefits are far greater than the side effects. After one fracture, the best way to prevent another fracture is to take a medicine and to work out a plan for activities you can do to help strengthen the bones, said Dr. Ott. See “Make the Most of Your Osteoporosis Medications” for tips to make them most effective.

Create a bone-boosting exercise plan. Bones really respond to exercise, and they also respond to a lack of exercise: If you sit or lie around much, your bones will become weaker. If you’re up on your feet, bones get stronger. Different types of exercise can work together to also make your muscles stronger so you’re better able to prevent a fall that could lead to another break.

Weight-bearing exercise isn’t just any exercise where you lift weight—it’s specifically activities in which you move against gravity when you’re upright, benefitting your whole frame. Walking is an example (and a good one). The purposeful stress placed on your bones in weight-bearing exercise causes them to draw in more nutrients and become denser. Do some form of weight-bearing exercise five times a week for at least 30 minutes each time. Besides walking, this can include tai chi, dancing and hiking. If you don’t have arthritis or balance problems, climbing stairs is good, too, says Dr. Ott.

Strength training will develop your muscles so that they can better support your bones. An international panel of experts found that strength training and balance training help prevent falls, resulting in fewer fractures. Do strength training with weights two to three times a week—and don’t feel pressured to weight-train more often because it’s actually essential to wait at least 48 hours between sessions to allow muscles to recover. Two sets of at least one exercise per muscle group is recommended. The guidelines also suggest getting instruction on proper form, using free weights rather than machines if you’re at high risk of a spinal fracture because the forward bending and twisting puts too much strain on your bones, and starting with low weights, especially if you’re new to strength training.

Balance training can take many forms. Tai chi with its combination of gentle movements and mindfulness is very effective for balance as well as weight bearing exercise. One study found that practicing tai chi for at least four weeks not only led to fewer falls, but also reduced the participants’ fear of falling. Yoga is another great choice for improving balance and flexibility.

For more, see Balance Exercises That Boost Stability—and Keep You Steady on Your Feet.

While exercising is critical to bone health, knowing what not to do will also help you avoid another break. If your fracture was due to osteoporosis, skip high-impact exercises, such as jumping and running because they put too much pressure on weak bones. Also, avoid activities that require twisting or bending at the waist such as sit-ups, toe touches and golfing, which pressure the spine and can cause (another) fracture.

Don’t let fear paralyze you. After you’ve broken a bone, it will probably take some time for you to regain your self-confidence. That’s understandable—don’t beat yourself up about it—but be alert to the risk of staying afraid and tentative for too long a time. If you don’t get emotionally as well as physically stronger from exercise, consider working with a physical therapist who can refine your workout program to make you feel more secure when exercising. If the problem is literally in your head, a few sessions with a mental health professional might help. Cognitive behavioral therapy in particularly helped older adults who had a fear of falling overcome that fear.

PRACTICAL STEPS TO AVOID A SECOND BREAK

Eliminate or reduce home hazards. If you haven’t done so yet, go room-by-room and clear the floor where you walk of all tripping hazards ranging from loose throw rugs to electrical cords to furniture or planters with legs that jut out (and, of course, any stacks of books and such if you are prone to clutter!). Area rugs should have skid-proof backing or be placed on non-slip rug pads. Install grab bars in the tub and shower—never rely on a towel rack to help you stop a fall. Don’t ever leave packages or other items sitting in hallways or at the bottom of stairs—it’s too easy to forget they’re there.

Improve home lighting. Have you been making do with dimly lit rooms? Now is the time to upgrade to brighter bulbs and additional light fixtures where needed. Be sure there’s a light switch at every room’s entrance so you can turn lights on before you walk in. Keep a flashlight and extra batteries in your night table in case your power goes out. Stay up to date with vision checks. Wearing an outdated eyeglasses prescription increases tripping and bumping risk significantly, Dr. Ott said.

Wear appropriately soled shoes indoors and out. At home, low-heeled shoes rather than socks or even slippers will give you better footing. Outside, choose rubber-soled shoes and boots.

Don’t smoke cigarettes. Not only are they harmful to your heart, lungs, and blood vessels, they also reduce strength of the bones.

Eat your calcium. Getting this vital nutrient from food is better than relying on supplements, Dr. Ott said. Put yogurt, cottage cheese and dark green leafy vegetables (other than spinach—your body doesn’t absorb much of its calcium, she said) on the menu. You can get calcium’s partner, vitamin D, from 10 to 15 minutes of sun exposure two to three times per week, but depending on where you live, that’s not always possible and some people need to avoid the sun. It’s safe to take a D supplement of 1,000 IU daily, Dr. Ott said. Note: Alcohol interferes with your body’s ability to absorb calcium. And if you’re even a bit tipsy, you’re more likely to fall.  Limit alcohol to one drink a day or less.

Know how to fall. It’s best to fall forward in a ball or backward on your butt. Tumbling sideways or straight down increases your risk of a broken hip. With falling forward, you may break wrist or arm, but those are not as severe as a hip fracture. If you’re at high risk for a fracture, consider underwear or pants with padding at the hips, available online at sites such as AliMed.com, which will absorb some of the trauma to your bones in case of a fall (research on their effectiveness is mixed, but some research found that they aren’t more effective simply because people don’t wear them).

Review medication side effects with your doctor. A number of drugs for very common conditions ranging from high blood pressure to insomnia to allergies can interfere with your balance. Ask about other medication options.

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Source: Susan Ott, MD, professor of medicine at the University of Washington School of Medicine in Seattle and a specialist in bone diseases. Date: August 9, 2018 Publication: Bottom Line Health
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