One Broken Bone? You May Be at Risk for Another


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Contrary to current guidelines, the authors wrote, “our study’s results are clinically important because, in contrast to a nontraumatic fracture, a fracture that is considered traumatic often does not trigger further evaluation for osteoporosis or counseling regarding increased subsequent fracture risk.” However, they added, “high-trauma and low-trauma fractures show similar associations with low bone mineral density.”

Even younger postmenopausal women who have sustained a serious fracture, studies have found, are at higher risk of having osteoporosis, said Dr. Sundeep Khosla, a bone expert at the Mayo Clinic in Rochester, Minn. “The evidence is pretty compelling that postmenopausal women who fracture, regardless of the level of trauma, should have their bone density evaluated,” he told me. “A fracture suffered in a fall from a standing height confers almost as high a risk of a second fracture as if the first fracture resulted from falling down the stairs.”

Men also face an often ignored risk of second fractures, especially because their first fractures are more likely to result from a traumatic event like a car accident and are not recognized as a harbinger of future fractures, Dr. Schafer said in an interview. Dr. Carolyn J. Crandall, an internal medicine physician at U.C.L.A.’s David Geffen School of Medicine who led the JAMA Internal Medicine study, said that recent studies have documented that older men who suffered a high-trauma fracture were often as likely to have low bone densities as men with a low-trauma fracture and were also at risk of a future fracture.

“Older men may be at a particular disadvantage if we brush off their high-trauma fractures,” Dr. Schafer said. “Men do lose bone with age and develop osteoporosis, though generally later in life than women. They’ve been overlooked. Men who have fractured bones in the past should not be brushed off.”

What, then, is the message for older men and middle-aged and older women and for their physicians?

For starters, the question doctors usually ask, “How did this break occur?” is not relevant. What counts, Dr. Khosla said, is the health of the patient’s bones, and that is determined by a bone density test that measures the mineral content of bones in the spine, hips and sometimes the forearm. The test is painless, noninvasive and brief, and its results are best interpreted by a specialist in osteoporosis.

If the test shows abnormally weakened bones, doctors usually prescribe medication to slow, stop or reverse the process. Treatment should also include lifestyle counseling on diet and exercise, Dr. Khosla said. “Being physically active helps to maintain strength, balance and agility and decreases the chances of falling and breaking a bone.” Weight-bearing and strength-building exercises are important throughout life.

Equally important: Eat a well-balanced diet rich in vegetables, fruits and whole grains, as well as calcium and vitamin D. Avoid smoking and limit your alcohol and caffeine consumption.

Finally, check your home and surroundings for trip hazards and eliminate them. Scatter rugs, shoes and other articles left in mid-floor, lack of handrails, poor lighting especially on stairs — all are bone-shattering falls waiting to happen.

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