Fracture Prevention: 6 Tips to Fight Fractures, Slips, and Falls

Learn how just a little effort and forethought today can help you prevent fractures tomorrow.

From the WebMD Archives

If you have osteoporosis, treating the condition directly -- with medicines or calcium supplements -- is obviously important. But it's also crucial to do everything you can to avoid the most serious risk of osteoporosis: broken bones. Practicing fracture prevention is a vital part of your osteoporosis treatment.

According to the National Institutes of Health, osteoporosis causes 1.5 million bone fractures every year. And these broken bones can be a lot more than painful and inconvenient. They can have a devastating and sometimes permanent impact on your health.

So what can you do to avoid broken bones and painful rehab? Here's a list of six tips for fracture prevention that every person with osteoporosis should know. By asking your doctor the right questions -- and making a few changes to your habits -- you can greatly reduce your risks.

The Importance of Fracture Prevention

In people with osteoporosis, fractures can happen anywhere, but wrist fractures, hip fractures, and spinal fractures are the most common. The effects can be serious. 700,000 people with osteoporosis fracture their vertebrae every year, and many are left with chronic pain. Of the 300,000 people with osteoporosis who have a hip fracture this year, half will never be able to walk again without assistance. And a staggering 20% of people over age 50 who break a hip will die within a year from complications.

If you're older and have osteoporosis, not only are falls much more dangerous, but they're more likely too. As you age, your body's muscle tone decreases. Your vision worsens. You're more likely to need medications, which can affect your balance. Even seemingly trivial things, like needing to go to the bathroom more in the night, can up your odds of falling. Essentially, a number of minor risks associated with aging coalesce at the same time, greatly increasing the possibility of a fall and fractured bone.

The good news is that with some simple changes to your lifestyle, you can seriously lower these risks. Here's a rundown of what you can do.

Fracture Prevention Tip: Exercise to Improve Balance and Strength

Many people with osteoporosis worry about the risks of exercise. After all, if you're jogging on a treadmill or out hiking, aren't you at higher risk of falling? What could better protect you from a broken bone than sitting in a comfy armchair all day?

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Although the argument makes intuitive sense, it's actually backward. The fact is that exercisingreduces your risk of falls.

"Keeping physically active helps your reflexes stay sharp and your muscles stay strong," says Shreyasee Amin, MD, a rheumatologist at the Mayo Clinic in Rochester, Minnesota. "That can help with coordination and lower your risk of falling." If you're fit, your balance is better, and that makes you much less likely to take a fall than someone who has become bedridden and infirm.

Aside from improving your balance and strength, exercise also has a direct impact on the strength of your bones. Bone is a living tissue. Like muscle, it weakens if you don't exercise it. By staying fit, you can make your bones stronger and less likely to break during a fall. Experts generally recommend a combination of weight-bearing exercise (like walking), resistance exercise (like lifting weights), and flexibility and balance exercises (like yoga or tai chi).

However, a note of caution: always talk to your doctor before starting up an exercise routine. High impact exercise, like jogging or tennis, may not be safe for some people with osteoporosis, since the physical pounding could cause a fracture. Even some seemingly benign exercises, like crunches, can be risky for people with weak vertebrae, Amin tells WebMD.

Fracture Prevention Tip: Tread Carefully

If you have osteoporosis, you need to consider more than fashion when choosing your shoes. Wearing the wrong sort of footwear can really increase your risk of a fall.

But happily, you don't have to be stuck with "sensible shoes" either. Just look for low-heeled shoes that offer good support and have rubber soles rather than leather ones. While sneakers are fine, avoid ones with deep treads that can trip you up.

Also, it's time to start wearing shoes inside the house too: walking around in socks and slippers can increase your risk of slipping.

When you're walking outside, play it safe. Walk on the grass when it's been raining or snowing, since you're more likely to slip on concrete. Always put down salt or kitty litter on icy patches around your home.

If you have difficulty walking due to a medical condition such as arthritis or another problem, make sure to use the assistive device recommended by your doctor or physical therapist such as a cane or walker.

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Fracture Prevention Tip: Know How Medicines Might Affect You

Unfortunately, as you get older, you're more likely to need daily medications. And all medications have side effects, some of which can increase your risk of having a fall. Medications that can cause dizziness or lack of coordination are:

Other drugs, like some corticosteroids, are also associated with a higher risk of osteoporosis and fractures. Just the number of medicines you take can increase the danger. Studies have linked taking four or more prescription medicines with a higher rate of falls, regardless of what the drugs are.

But given that you need these medicines for other health reasons and can't just stop taking them, what should you do? Go over all the drugs you take with your doctor. Bring in a list or the bottles themselves. Keep in mind that one doctor -- like your primary care provider -- might not know what other doctors -- like your cardiologist, or rheumatologist -- have prescribed.
If any of the medicines you take are increasing your risk of falls, see what can be done. It's possible that your doctor can change your dosage or change medicines altogether so that you're less likely to take a fall.

And keep in mind that alcohol -- along with illicit drugs -- are also a risk. Anything that impairs your functioning bumps up your risk of falling.

Fracture Prevention Tip: Lighten Up

As you age, you may notice that your vision isn't quite as keen as it once was. Sometimes this is due to a treatable health condition, like cataracts. But it's also the result of natural, physiologic changes that can't be controlled.

"As we get older, we lose some of the contrast sensitivity in our vision," says John Schousboe, MD, director of the Park Nicollet Clinic Osteoporosis Center in St. Louis Park, MN. "This makes it harder to discern objects," especially in low light. So you need to brighten up your home. Here are some tips.

  • Install overhead lights in all rooms, so you don't have to stumble around in the dark to find the lamp.
  • Use nightlights in your bedroom, bathroom and any hallways that connect them.
  • Make sure all stairways, both inside and outside, are well lit.
  • Keep a flashlight by your bed.

If you're concerned about the high electric bills that could come with brightening up your home, consider compact fluorescent bulbs. They work in regular light sockets and offer the same amount of light as traditional incandescent bulbs, but use much less electricity. They also last much longer, which reduces the number of times you have to hazard standing on a stepladder to change a bulb.

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Fracture Prevention Tip: "Fall-Proof" Your Home

Given that you probably spend the bulk of time in your home, a key part of fracture prevention is to make it safer. But this advice is often ignored. "Many people just don't do a very good job fall-proofing their homes," says Amin.

So what should you do?

  • Keep rooms free of clutter -- get rid of those piles of clothes and boxes of papers.
  • Put down carpet or plastic runners on polished -- and potentially slippery -- floors.
  • Get throw rugs, electric cords, and phone lines off the floor.
  • Make sure to have handrails on all stairs.
  • Install railings in the bathroom around the toilet and the shower.
  • Put a rubber mat on the floor of your bath or shower.

Fracture Prevention Tip: Treat Health Conditions

Many chronic diseases and health conditions become more common as you get older. Some can affect your strength or physical functioning and increase the risk of a fall. Arthritis can make it hard to move around. Obviously, vision problems directly increase your risk of tripping. Other conditions associated with fractures include chronic lung disease, hyperthyroidism, cancer, chronic liver disease, chronic kidney disease, and endometriosis.

If you have any other health conditions, ask your doctor if they might increase your risk of a fall. If they do, see if any treatments might help. One difficulty is that some of these problems may come on so gradually that you might not even notice. For instance, you might not realize that your vision is slowly getting worse, or if your gait has become a little less steady. That's why it's important to get regular check-ups: not only with your doctor, but your eye doctor and any other specialists you need.

Bone Fractures Aren't Inevitable

Even with precautions, some types of bone fractures are tough to avoid. Just a mild bump can be enough to break a bone in people with severe osteoporosis. Only 10-15% of vertebral fractures are caused by falls, Schousboe says. Many are caused by physical stress, perhaps by something as simple as bending over or even coughing.

But this just drives home how important prevention is: since some fractures can't be prevented, you need to work on the fracture risks you can control. While bone fractures may be more likely as you get older, they aren't inevitable.

Sure, some of these fracture prevention tips require a little effort and forethought on your part. It's easy to put them off or ignore them. But are they worth it? You bet. Better to take precautions now than regret not taking them later -- while you lie in a cast counting the panels in your hospital room ceiling.

WebMD Feature Reviewed by Louise Chang, MD on July 27, 2007

Sources

SOURCES:

Shreyasee Amin, MD, rheumatologist, assistant professor of medicine, Mayo Clinic, Rochester, Minn.

Fiechtner JJ, Postgraduate Medicine, September 2003; vol 114.

National Institutes of Health web site: "Osteoporosis Overview."

John Schousboe, MD, director, Park Nicollet Clinic Osteoporosis Center, St. Louis Park, Minn.; consultant rheumatologist, American College of Rheumatology.

U.S. Department of Health and Human Services and the National Institutes of Health web sites: "Osteoporosis."

WebMD Feature: "Exercise for Osteoporosis."

© 2007 WebMD, Inc. All rights reserved.

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