FAMILY MEDICINE® COLUMN
By John C. Wolf, D.O.
Associate Professor of Family Medicine®
Ohio University College of Osteopathic Medicine
ESTROGEN AND EXERCISE CAN REDUCE FRACTURES IN WOMEN
Question: My sister has had a hip fracture. I know that taking calcium is important in reducing my risk of hip fracture, but are there other things I should do?
Answer: Hip fractures, particularly in the elderly, are often associated with loss of bone strength. To understand why our bones become more fragile as we age, it is necessary to understand a little bit about how they normally function. Our bones made up of both living cells and stored minerals (principally calcium) are not inert objects. Instead, they are in a constant state of flux. In adult life the amount of new cells and minerals that are added each day are roughly equal to that which is taken out. This process is known as "absorption" and "re-absorption," and the end result is that our bones appear unchanging.
In osteoporosis, bone loss is greater than bone production and the bones, therefore, lose mineral content. This makes them weaker and increases the risk of a broken hip. It also makes spinal and wrist fracture much more likely.
Twenty-five million Americans suffer from osteoporosis and women are afflicted with it eight times more often than men. The greatest risk for osteoporosis comes from age alone. Fifty percent of women 50 and older have this condition.
There are several things that reduce one's risk of fractures from osteoporosis. Consuming 1,000 to 1,500 milligrams of calcium each day, as you suggested, is an important first step. An eight ounce glass of skim milk or calcium-fortified orange juice provides 300 milligrams, as does eating 1 1/2 cups of broccoli. Most people, however, prefer taking a calcium supplement instead of consuming sufficient quantities of these calcium-rich foods. In addition to the calcium, it is also important to take 400 IU of vitamin D every day for those of us who live where sunlight exposure in very low in the winter months.
Taking estrogen, whether by mouth or by skin patch, reduces the risk of osteoporosis related fractures by 50 percent for post menopausal women. Regular vigorous physical activity and larger body size are also beneficial.
There are a few medicines that help increase bone strength while there are many more that tend to contribute to osteoporosis. Your doctor or pharmacist can talk with you about the benefits and risks posed by any drugs you take.
Sometimes specific preventive therapy should be started before you have a fracture. Gathering information about bone density can be of some limited help in this regard. Other factors such as family history, vision, coordination, balance, muscle strength and body build also need to be looked at. From your letter, the only one of these risk factors that I know about is your family history. Before I could make a recommendation about whether or not estrogen or other preventive therapy is warranted, I would need to know if you have a frail or sturdy body build, if you can maintain your balance when doing "heel-to-toe" walking, and how "in shape" your muscles are. Your family physician can examine you and take all these matters into consideration.
Regardless of how physically fit you are, I recommend you talk with your doctor about the types of physical activity that would be best for you. If you are not in shape, you need to get in shape; and if you are in shape, you need to stay in good condition through sane and sensible exercise.
There are also general safety issues such as use of throw-rugs, lighting, extension cord use, and placement of grab rails in the bathroom that your doctor will probably want to talk to you about, too. Each of these items also relates directly to your risk of hip fracture. In this case it's not by strengthening bones but by significantly reducing your risk of falling.
Family Medicine® is a weekly column. To submit questions, write to John C. Wolf, D.O., Ohio University College of Osteopathic Medicine, Grosvenor Hall, Athens, Ohio 45701.