Broken hip - too little bone late in life and/or lots of reasons for falling

Broken hip certainly is painful, but is also a major reason for people losing their independence (or their life.)

Occasionally a broken hip may cause pain for weeks before it is discovered, as the bone ends were jammed together as they broke. The thigh bone at the side of the hip becomes more prominent as the bones bend at the fracture site.

It is usually immediately obvious, as the person cannot stand and their leg is shortened and twisted out.

The person may trip and fall, or they may fall after the hip fracture occurs. Falls in elderly people in USA cause 60 deaths⁵ per 100,000 population each year

Too little bone - osteopenia, osteoporosis mostly

We all lose bone, brain cells etc as we age - but we improve in other ways.

The main problem with bones is having too little to start with. Peak bone mass occurs in our early twenties. It is partly determined by inheritance, but also on how active we were up to this age.

Calcium supplements for teenagers do not result in sustained increases in bone mass after they are ceased.

My naturopath mentor used to find that most people's bodies could not use calcium supplements effectively at first. It was quite a significant milestone, often after months of other treatment, when they started to need calcium.

Calcium supplements on their own, reduce the risk of fracture only marginally, and are associated with an increased risk of myocardial infarction².

Another major factor operating at all ages, is our excessive intake of phosphate in soft drinks and meat.

Another cause is very likely our frequent mouth breathing and generally breathing too much!

Most people will find the last assertion hard to accept, but the success of buteyko method training in lots of areas of health, makes it likely to be true.

Zinc, magnesium, vitamins D and K may be important.


Falling over - falls prevention always worth action

The last mentioned vitamin D is important for lots of reasons.
In one trial¹ with three month follow up, the incidence of falls was almost halved and musculoskeletal function improved among elderly people who had 800 IU vitamin D with calcium compared with calcium alone.

Along with our bones etc, our digestive system also becomes less efficient with age. I find that digestive complaints are often helped by supplements of digestive enzymes taken with meals. It is very likely that assimilation of nutrients improves as dyspeptic symptoms abate.

I figure that better nutrition will translate into better bones, and what may be even more important, stronger muscles.

Regular exercise, uncluttered floors, good footwear, minimum use of drug therapy, can all be important. One very simple exercise is to develop the habit when sitting, of straightening one's knee a little to lift the foot off the floor. Alternate legs and hold the foot up as long as you can. This is to strengthen the quadriceps muscle of the front of one's thigh, which is very important in prevention of falls.


Bone mineral density test and Singh index

Long bones such as the femur in your thigh are a cylinder with expanded ends which form joints with other bones.

The middle part or shaft, is of quite thick, solid bone. At the ends, the bone is thinner but is well supported by an internal scaffolding of "cancellous" or "trabecular" bone.

The Singh index is based on the appearance of the trabecular bone structure of the upper femur on a plain X-ray.

The groups of trabeculae are lost progressively as the bone thins, as in the pictures.

This is not as easy as the Dual energy X-ray absorptiometry (DEXA) scan, ideally needing two independent skilled radiologists reports.

It is useful here to understand what happens to the bone, leading to broken hip etc.

Studies of exercise in children, re: bone strength

One study³ in 3-4th graders in British Columbia, used 10 tuck jumps 3 times weekly and incorporating jumping, hopping, and skipping into twice weekly physical education classes.

This was enough to increase upper thigh BMD by an extra 1% in 8 months - compared to regular physical education classes.

A large Swedish study has just been reported⁴ in 2010, which compared 200 with 60 minutes per week of school physical education classes, over 5 years.

This similarly showed improved bones in the group on more exercise.

This is at school, and is good, but this type of broken hip prevention should start at home when possible.

References for broken hip page

1. Bischoff HA, Stähelin HB, Dick W, Akos R, Knecht M, Salis C, et al. Effects of vitamin D and calcium supplements on falls: a randomised controlled trial. J Bone Miner Res 2003;18: 343-51

2. BMJ July 29, 2010 online at http://www.bmj.com/content/341/bmj.c3691.full

3. McKay HA et al, Augmented trochanteric bone mineral density after modified physical education classes: a randomized school-based exercise intervention study in prepubescent and early pubescent children. J Pediatr. 2000 Feb;136(2):156-62. http://www.ncbi.nlm.nih.gov/pubmed/10657819

4. Detter FTL et al, American Society for Bone and Mineral Research (ASBMR) 2010 Annual Meeting: Abstract 1103 Presented October 17, 2010. (reported on Medscape)

5.

http://www.cdc.gov/nchs/products/vsrr/mortality-dashboard.htm



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