To help prepare you for KERA’s “Broken Hip” panel discussion here next week, we’re revisiting an interview that first appeared on the Think radio show, hosted by Krys Boyd, earlier this year. Dr. Alan Jones, medical director of orthopedic trauma at Baylor University Medical Center at Dallas, was one of the guests who spoke about the impact of this serious injury (Listen to the full hour-long podcast).
Dr. Jones will be one of the featured speakers at the event on Tuesday night at the Baylor Charles A. Sammons Cancer Center at Baylor University Medical Center at Dallas. Here are some highlights of questions (and answers) that came in from listeners on the earlier episode of Think.
Do men with osteoporosis have the same rate of hip fracture complication and death that women do?
Men are the more fragile of the sexes in this case. Men have a higher mortality rate [after a fracture]. We have a much lower incidence of osteoporosis. But for the same amount of bone mass, men have equal numbers of fractures. We just don’t have as much osteoporosis in general. Once you’ve had a hip fracture as a male, you are much more likely to succumb to the complications and die within a year. In some studies it’s as high as 40 percent.
What is the reason for that?
It’s hard to know. My personal opinion is that men who have hip fractures tend to be from a very ill population to start with and many of them will have cardiac problems and other issues. They are the example of people who are barely living, with their life in balance medically, and a hip fracture just tips them over the edge and everything else gets them out of balance and out of control and they can’t really recover from it.
I’m a Latina and I’m 75. Whenever I go to the doctor, they ask me if I’ve had a bone density test, and I tell them, ‘no, I’m a Latina.’ In fact, I tell them that women in my family live into their 90s. And I don’t know a single one who has had a broken hip. Is there any research that has been done on specific ethnic populations that can answer this?
There is. The unfortunate news for you is that Latinas are not immune to osteoporosis. Now, not having a family history is a very positive thing. Family history of osteoporosis is a big risk factor for both osteoporosis and hip fracture. However, you absolutely do need a bone density examination because you may very well have osteopenia or osteoporosis and that needs to be treated if you do.
When do you recommend that people start having bone density tests and how often do they have to have them?
Typically at about age 50. And that may vary according to family history. In general, fairer skinned people have a higher risk of osteoporosis. So, for example, if you are of Northern European descent and are female, I would absolutely do it by age 50 or even sooner, especially if you have a history of multiple fractures in your family. And depending on what that initial result is, you may never need another one done or you may want another one done in five or 10 years. If you’ve ever had a stress fracture or if you’ve had any sort of hormonal difficulties or irregular menstrual periods as a female, or went through menopause at a relatively early age. All of those are risk factors of having bone problems, so you might want to think about getting the test at an earlier age. But certainly by 50 … and that’s men and women.
When elderly people break bones, they tend to heal slowly. Is there any way to speed healing, with any sort of medications or anything?
There is a lot of research going on, but as of today there is not much you can do, that I know of, to speed healing or make it go faster. People with osteoporosis heal the same way people without it do, their bones are just weaker. One thing that does affect fracture healing quite a bit is the use of tobacco or smoking, really any kind of nicotine. So for patients, if they can do one thing to speed things up, it would be to quit smoking.
How does tobacco or smoking affect bone healing?
It constricts the blood flow and the vessels respond to that by tightening down. So if there is less blood flow, there is less oxygen, then there is less nutrition to the fracture site. And that is the most important thing the body can do is bring that nutrition to that area.
So a lifetime of smoking is also a risk factor for breaking a hip … what about alcohol?
Absolutely. For two reasons: If you drink enough alcohol you are much more likely to fall. Alcohol does have some detrimental effects to bone health. It’s not entirely clear how it directly affects bone health. But we do know that people who have more than three alcoholic drinks a day are more likely to have osteoporosis and more likely to have a hip fracture.
Beyond the physical and medical aspects of dealing with a broken hip, what is your advice for dealing with the psychological aspects of a fall?
There is a very real psychological fear of having another fall. So using the appropriate assistive devices, usually a walker at first, then typically progressing to a cane in many cases, gives the patient a lot more security when they’re walking. You can also make the area where they live and where they are maneuvering fall-proof, making it a more friendly environment.
So, for example, taking away stairs, little things like moving cords, rugs or other things that are going to make them more prone to a fall helps build their confidence and minimize their risk of another fall. A lot of it is a cheerleading effect from family and other caregivers—just getting them back into their normal activities.
We have some people that just really want to stay in the hospital and I always tell patients you don’t want to stay in the hospital longer than you need to be there. You are used to living at home; let’s try to do everything we possibly can to get you back to your quality of life, running your errands, playing with your dog, seeing your kids or grandkids or neighbors. One thing I try to share with my patients is the importance of activity and exercise to help prevent that next fracture. It’s not just strengthening your bones, but also your muscles, practicing balance, that helps prevent falls.