Preventing Falls and Fractures

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Every year in the United States, one of Preventing Falls and Fracturesevery three people older than 65 suffers a serious fall. Older people, especially postmenopausal women, are prone to falling - often impaired by strength, vision and medications that may induce poor balance. Postmenopausal women are also more likely to suffer from osteoporosis, the disease that leads to the gradual loss of bone density, making bones brittle and susceptible to breaks.

Menopause is a major risk factor for fracturing bones during a fall because the diminishing loss of estrogen during that period leads to rapid bone loss. Many older women are unaware they have osteoporosis and low bone density. Only a bone mineral density test, an x-ray, can measure current bone density, diagnose osteoporosis and determine a woman's fracture risk. It can lead to prevention as well as treatment.

How to prevent osteoporosis

Increasing calcium intake has been proposed as a way to prevent osteoporosis. An abundance of calcium does not necessarily result in bone gain or even in prevention of bone loss. However, a calcium deficiency will worsen bone loss. Vitamin D helps the body absorb calcium and contributes to the building of new bone. Osteoporosis develops when the breakdown of bone exceeds new bone growth.

Vitamin D is also an important nutrient in the effort to prevent hip fractures in postmenopausal women. When researchers at Brigham and Women's Hospital in Boston studied postmenopausal women admitted to the hospital with hip fractures, comparing them to similar women without such fractures, they found that women with hip fractures had significantly lower levels of vitamin D. Hip fractures, a major complication of falls in the elderly, occur in more than 250,000 Americans each year.

Treating osteoporosis to reduce injury from falls

There are ways to treat osteoporosis, which, in turn, lessen the likelihood of vertebral fractures. The drug Evista® (raloxifene) can increase bone mineral density in the spine and hip and help reduce spinal fracture in women with osteoporosis, according to a study in the Journal of the American Medical Association. However, among more common side effects of Evista are hot flashes and leg cramps.

Researchers from Kaiser Permanente in Oakland, California also concluded that Evista was helpful after they looked at more than 7,000 women with osteoporosis undergoing this drug treatment for three years. All the women in that study were at least two years past menopause. These women reduced bone turnover and the incidence of vertebral fractures by 35 percent to 50 percent.

Other medications to help treat osteoporosis include biphosphonates, (such as Fosomax® Actonel® and Boniva®), calcitonin, estrogen and the newly approved Forteo® (teriparatide).

How to "fall-proof" your home

For many elderly people, the home can be a hazardous place. Homes with loose throw rugs, runners and mats, curled carpet edges, electrical cords, and slippery uncarpeted floors and stairs can turn into booby traps.

A Yale School of Medicine study of people ages 72 and older living in and around New Haven, Connecticut found that the most dangerous part of the house was the floor in living rooms, bedrooms, bathrooms and hallways. In nearly 80 percent of homes, the floor was filled with little dangers that represent a major hazard - throw rugs, carpet edges, small objects, electrical cords and slippery floors.

The bathroom was determined to be the most dangerous, filled with loose mats; slippery tubs and showers, which lacked nonskid mats or abrasive strips and grab bars; poor lighting; and toilets that were too wobbly or too low for an older person to rise from safely.

Stairways were the second most dangerous zone, according to the study, which was published in the American Journal of Public Health. Nightlights and light switches at the top and bottom of stairways were missing, as were handrails. Uneven steps spelled further trouble.

Kitchens were next on the list, with poor lighting, unstable step stools and storage areas that required an older person to reach high or bend low.

Preventing falls

Preventing falls is key to avoiding injury from osteoporosis. Weak bones are slow to heal, so even a minor fracture can be disabling to an elderly person. To prevent falls, the American Federation for Aging Research offers the following advice:

  • Do a safety check around your home.
  • Get rid of rugs or cords that might trip you. Have someone install sturdy handrails on all stairways and grab bars in bathrooms.
  • Cover stairs with lightly woven carpet or nonskid treads. Do not wax floors and always clean up spills as soon as they happen. Avoid climbing and reaching up to high shelves. Use a step stool with handrails.
  • Take an exercise class, such as yoga or tai chi, that will increase your strength and improve your balance.

Researchers at Emory University found that the Chinese martial art of tai chi improved balance in older people after just a few weeks and cut the risk of falling nearly in half. Before taking any exercise class, be sure to get approval from your health care provider.

How to protect yourself if you fall

Learning how to fall is a good protective measure. You can learn how to use your reflexes and change your position to break a fall. You can reduce the risk of fracturing a bone and are less likely to break your hip as a result of a fall, if you land on your hands or grab onto an object as you fall. Even if you break an arm or wrist, at least it does not carry the same risks associated with fracturing your hip. If you do sustain a fracture, it's very important to engage in rehabilitation to regain full mobility.

Check your medications

Any time you get a new prescription for any condition, ask your pharmacist or health care provider about side effects, such as dizziness or blurred vision, that may upset your balance.

Dress right

Always wear low-heeled shoes with rubber soles for good traction. Never wear slippers, shoes with leather soles or high heels. Ask your health care provider about protective gear and accessories that protect your limbs and hips in case you do fall.

Drink moderately

Not only does alcohol interfere with healthy bone formation, but drinking can also make you unsteady and put you in danger of falling and fracturing your bones.

The American Academy of Orthopedic Surgeons offers a free brochure on fall prevention, available by calling (800) 824-2663 or by sending a stamped, self-addressed business-size envelope to Don't Let a Fall Be Your Last Trip, American Academy of Orthopedic Surgeons, P.O. Box 1998, Des Plaines, Ill. 60017

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