A fracture after a minor fall may signal osteoporosis. Learn when to consider screening and how to protect your bones.
Falls account for more than 60% of trauma activations at the Washington Health Trauma Center. The health system’s recent Community Health Needs Assessment also identifies injuries from falls as the leading cause of preventable emergency department visits in the Tri-City Area.
“Many patients are not diagnosed with osteoporosis until they experience a fracture,” says Dr. Daniel Torba, a board-certified family medicine physician at Washington Health. “We want to change that by encouraging patients to talk with their primary care provider about screening. Early detection also helps identify risks so people can take necessary steps to prevent fractures before they happen.”
The circumstances of a fracture can offer an important clue about bone health. A fracture caused by a fall from standing height or less is often called a fragility fracture. A break in the wrist, hip or spine after a low-impact fall can be a sign of weakened bones. Any adult over age 50 who experiences a fracture after a minor fall should discuss evaluation for osteoporosis with their healthcare provider, even if previous bone density testing was normal.
“Osteoporosis is a condition where bones lose density and strength, making them more likely to break,” explains Dr. Torba. “Catching the disease at the stage of a wrist fracture provides a critical window of opportunity, allowing people to protect their health before a more debilitating injury occurs, like a broken hip, spine, or shoulder.”
When to Ask About Bone Density Testing
A dual-energy X-ray absorptiometry (DEXA) scan is a quick, painless test that measures bone density. The timing of repeat scans depends on initial results, age and individual risk factors.
Talk with your primary care provider about bone density testing if any of these apply:
- Women 65 and older: Routine screening is recommended. Bone loss often accelerates after menopause as estrogen levels decline.
- Postmenopausal women under 65 with increased fracture risk: This can include low body weight, parental hip fracture, smoking, or excessive alcohol use.
- Men 70 and older: Some specialty guidelines recommend testing at this age; discuss your individual risk with your provider.
- Adults with other risk factors: Earlier testing may be appropriate after prior fragility fractures, long-term corticosteroid use, or medical conditions that cause bone loss.
For postmenopausal women and men 50 and older, DEXA results include a T-score, which compares bone density with that of a healthy young adult. A score of -1.0 or higher is normal; a score below -1.0 and above -2.5 indicates low bone mass (osteopenia); and -2.5 or lower indicates osteoporosis.
Doctors may also use the Fracture Risk Assessment Tool (FRAX) to estimate a person’s 10-year risk of hip fracture or another major osteoporosis-related fracture. FRAX considers age, sex, height, weight, prior fractures, parental hip fracture, smoking, alcohol use and certain medical conditions or medications. Bone density results can be included when available.
Steps to Lower Your Fracture Risk
“Osteoporosis does not need to be a discouraging diagnosis,” Dr. Torba emphasizes. “Once osteoporosis is diagnosed, we can develop a treatment plan to strengthen bones, slow bone loss and, most importantly, reduce the risk of future fractures.” Ultimately one low-impact fracture can alert you to make some lifestyle changes that may prevent a more debilitating injury down the line.”
A bone-strengthening and fracture-prevention plan may include:
- Commit to weight-bearing and balance exercise: “Regular exercise is one of the most important ways to maintain bone strength,” says Dr. Torba. “I encourage patients to aim for at least 30 minutes of weight-bearing activity on most days, combined with strength training two to three times a week and exercises that improve balance.” Walking, dancing, resistance training, and tai chi are all good examples. Patients with established osteoporosis or prior vertebral fractures may require exercise modifications.
- Prioritize dietary calcium and vitamin D: Food is the preferred source of calcium. Women 51 and older and men 71 and older generally need 1,200 mg of calcium daily; men 51 to 70 need 1,000 mg. Adults 50 and older generally need 800 to 1,000 international units of vitamin D daily. Ask your clinician whether supplements are appropriate.
- Discuss medication options: Depending on fracture risk, medication may be recommended alongside exercise and nutrition. Options include oral medications such as alendronate (Fosamax), injections such as denosumab (Prolia) and infusions such as zoledronic acid (Reclast).
- Improve home safety: Install grab bars in the bathroom, improve lighting and remove tripping hazards.
- Review your medications: Ask your primary care provider or pharmacist whether any medicines might cause dizziness or drowsiness and increase fall risk.
Washington Health offers free community fall prevention classes through its Trauma Center Injury Prevention Program. Learn more at washingtonhealth.com/trauma or email garrett_cordes@washingtonhealth.com. To find a primary care provider and discuss bone density screening, visit washingtonhealth.com/PrimaryCareCenters.