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Falls are serious at any age, and breaking a bone after a fall becomes more likely as a person ages. Many of us know someone who has fallen and broken a bone. While healing, the fracture limits the person’s activities and sometimes requires surgery. Often, the person wears a heavy cast to support the broken bone and needs physical therapy to resume normal activities. People are often unaware of the frequent link between a broken bone and osteoporosis. It is known as a silent disease because it progresses without symptoms, osteoporosis involves the gradual loss of bone tissue or bone density and results in bones so fragile they break under the slightest strain. Consequently, falls are especially dangerous for people who are unaware that they have low bone density. If the patient and the doctor fail to connect the broken bone to osteoporosis, the chance to make a diagnosis with a bone density test and begin a prevention or treatment program is lost. Bone loss continues, and other bones may break.
Even though bones do not break after every fall, the person who has fallen and broken a bone nearly always becomes fearful of falling again. As a result, she or he may limit activities for the sake of “safety.” Among Americans age 65 and older, fall-related injuries are the leading cause of accidental death.
This publication explores the components of the Fracture Triangle and offers tips for reducing the chances of fall-related fractures that result from low bone mass and osteoporosis. If one of the following three factors is modified, the chances of breaking a bone are greatly reduced:
The Fall Itself
The Force and Direction of the Fall
The Fragility of the Bone(s) That Take the Impact
Several factors can lead to a fall. Loss of footing or traction is a common cause of falls. Loss of footing occurs when there is less than total contact between one’s foot and the ground or floor. Loss of traction occurs when one’s feet slip on wet or slippery ground or floor. Other examples of loss of traction include tripping, especially over uneven surfaces such as sidewalks, curbs, or floor elevations that result from carpeting, risers, or scatter rugs. Loss of footing also happens from using household items intended for other purposes – for example, climbing on kitchen chairs or balancing on boxes or books to increase height.
A fall may occur because a person’s reflexes have changed. As people age, reflexes slow down. Reflexes are automatic responses to stimuli in the environment. Examples of reflexes include quickly slamming on the car brakes when a child runs into the street or quickly moving out of the way when something accidentally falls. Aging slows a person’s reaction time and makes it harder to regain one’s balance following a sudden movement or shift of body weight.
Changes in muscle mass and body fat also can play a role in falls. As people get older, they lose muscle mass because they have become less active over time. Loss of muscle mass, especially in the legs, reduces one’s strength to the point where she or he is often unable to get up from a chair without assistance. In addition, as people age, they lose body fat that has cushioned and protected bony areas, such as the hips. This loss of cushioning also affects the soles of the feet, which upsets the person’s ability to balance. The gradual loss of muscle strength, which is common in older people but not inevitable, also plays a role in falling. Muscle-strengthening exercises can help people regain their balance, level of activity, and alertness no matter what their age.
Changes in vision also increase the risk of falling. Diminished vision can be corrected with glasses. However, often these glasses are bifocal or trifocal so that when the person looks down through the lower half of her or his glasses, depth perception is altered. This makes it easy to lose one’s balance and fall. To prevent this from happening, people who wear bifocals or trifocals must practice looking straight ahead and lowering their head. For many other older people, vision changes cannot be corrected completely, making even the home environment hazardous.
As people get older, they also are more likely to suffer from a variety of chronic medical conditions that often require taking several medications. People with chronic illnesses that affect their circulation, sensation, mobility, or mental alertness as well as those taking some types of medications (see above table) are more likely to fall as a result of drug-related side effects such as dizziness, confusion, disorientation, or slowed reflexes.
Drinking alcoholic beverages also increases the risk of falling. Alcohol slows reflexes and response time; causes dizziness, sleepiness, or lightheadedness; alters balance; and encourages risky behaviors that can lead to falls.
The force of a fall (how hard a person lands) plays a major role in determining whether or not a person will break a bone. For example, the greater the distance of the hip bone to the floor, the greater the risk of fracturing a hip, so tall people appear to have an increased risk of fracture when they fall. The angle at which a person falls also is important. For example, falling sideways or straight down is more risky than falling backward.
Protective responses, such as reflexes and changes in posture that break the fall, can reduce the risk of fracturing a bone. Individuals who land on their hands or grab an object on their descent are less likely to fracture their hip, but they may fracture their wrist or arm. Although these fractures are painful and interfere with daily activities, they do not carry the high risks that a hip fracture does.
The type of surface on which one lands also can affect whether or not a bone breaks. Landing on a soft surface is less likely to cause a fracture than landing on a hard surface.
Preliminary research suggests that by wearing trochanteric (hip) padding, people can decrease the chances of fracturing a hip after a fall. The energy created by the fall is distributed throughout the pad, lessening the impact to the hip. Further research is needed to fully evaluate the role of these devices in decreasing the risk of a hip fracture following a fall.
Although most serious falls happen when people are older, steps to prevent and treat bone loss and falls can never begin too early. Many people begin adulthood with less than optimal bone mass, so the fact that bone mass or density is lost slowly over time puts them at increased risk for fractures.
Bones that once were strong become so fragile and thin that they break easily. Activities that once were done without a second thought are now avoided for fear that they will lead to another fracture.
Safety first to prevent falls: At any age, people can change their environments to reduce their risk of falling and breaking a bone.
Outdoor safety tips:
Indoor safety tips:
Take steps to lessen your chances of breaking a bone in the event that you do fall:
Individuals can protect bone health by following osteoporosis prevention and treatment strategies:
People need to know whether they are at risk for developing osteoporosis or whether they have lost so much bone that they already have osteoporosis. Although risk factors can alert a person to the possibility of low bone density, only a BMD test can measure current bone density, diagnose osteoporosis, and determine fracture risk. Many different techniques measure bone mineral density painlessly and safely. Most of them involve machines that use extremely low levels of radiation to complete their readings. Sometimes, ultrasound machines, which rely on sound waves, are used instead.
Individuals may wish to have a BMD test to determine current bone health. Today, Medicare and many private insurance carriers cover bone density tests to detect osteoporosis for individuals who meet certain criteria. Talk with your doctor about whether or not this test would be appropriate for you. Falls are serious, but simple, inexpensive steps can be taken to reduce your risk of falling and of breaking a bone if you do fall.
|Life-stage group||Calcium mg/day||Vitamin D (IU/day)|
|Definitions: mg = milligrams; IU = International Units
Source: Food and Nutrition Board, Institute of Medicine, National Academy of Sciences, 2010.
|Infants 0 to 6 months||200||400|
|Infants 6 to 12 months||260||400|
|1 to 3 years old||700||600|
|4 to 8 years old||1,000||600|
|9 to 13 years old||1,300||600|
|14 to 18 years old||1,300||600|
|19 to 30 years old||1,000||600|
|31 to 50 years old||1,000||600|
|51- to 70-year-old males||1,000||600|
|51- to 70-year-old females||1,200||600|
|>70 years old||1,200||800|
|14 to 18 years old, pregnant/lactating||1,300||600|
|19 to 50 years old, pregnant/lactating||1,000||600|
For additional information on osteoporosis, contact:
Toll free: 800-624-BONE (2663)
For additional information on fall prevention, contact:
The National Institutes of Health Osteoporosis and Related Bone Diseases ~
National Resource Center acknowledges the assistance of the National Osteoporosis Foundation in the preparation of this publication.
This publication contains information about medications used to treat the health condition discussed here. When this publication was developed, we included the most up-to-date (accurate) information available. Occasionally, new information on medication is released.
For updates and for any questions about any medications you are taking, please contact
U.S. Food and Drug Administration
Toll Free: 888–INFO–FDA (888–463–6332)
For additional information on specific medications, visit Drugs@FDA at www.accessdata.fda.gov/scripts/cder/drugsatfda. Drugs@FDA is a searchable catalog of FDA-approved drug products.
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