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Preventing Osteoporosis Fractures

Posted Aug 24 2008 1:49pm
DAVID R. MARKS, MD: Hi, and welcome to our webcast. I'm Dr. David Marks. For women with osteoporosis, the biggest concern is not thinning bones, it's broken bones. Hip or spinal fractures can be devastating to the lives of otherwise healthy women. Today we'll take a close look at the risk of fractures and what can be done to avoid them.

Joining me is Dr. Michelle Warren. She's the Director of the Center for Menopause, Hormone Disorders and Women's Health at Columbia University in New York. We're glad to have you here.

Now, what are the consequences of undiagnosed osteoporosis?

MICHELLE WARREN, MD: Basically fractures, and they're devastating whenever they occur, but spinal fractures often go undiagnosed and cause terrible pain. Women go to bed for two weeks and lose height and they develop an ugly hump, and they can develop gastrointestinal problems as the spine collapses. The hip fractures are even more devastating because almost 20 percent of women who have a hip fracture die if they're over 65.

DAVID R. MARKS, MD: Are hip fractures the most common fracture?

MICHELLE WARREN, MD: Spinal fractures are the most common, but they often go undiagnosed, which is interesting. We focus on hip fractures because after an elderly patient has had a hip fracture, the quality of life is so affected.

DAVID R. MARKS, MD: Tell me how it affects a person's life. Some people might think, "A hip fracture, okay. So you break your leg and you get better." That's not the case?

MICHELLE WARREN, MD: Not if you've ever taken care of anybody elderly. What happens is hospitalization, operation, physical therapy, and very often a nursing home for a while until the patient learns the skills to walk again. And then the issue is whether they're going to be able to live alone. So that depends on how good their balance is and how good their strength is. Very often it's related to age, but in the population that's over 70, it's a devastating thing, and it very often means that they become dependent on others.

DAVID R. MARKS, MD: I've heard a lot about people who were healthy and had a hip fracture, and then they kind of went downhill from there mentally and physically. Do you see that often?

MICHELLE WARREN, MD: It's very common. I think not only do doctors worry about it, but patients themselves recognize this because they've seen it in their friends.

DAVID R. MARKS, MD: What is it about this? There's no connection between the head and the hip. What is it about this problem?

MICHELLE WARREN, MD: It's a big operation, and patients who are elderly are taken out of their environment for a long period of time. Very often you do need blood transfusions because you can bleed into the broken hip. So there are issues of blood pressure and blood pressure falling. You're quite sick after a hip fracture. It's not a small event at all.

DAVID R. MARKS, MD: What about spinal fractures, the very common fractures that occur? Are they as devastating?

MICHELLE WARREN, MD: No, they're not quite as devastating, but they are an important signal that there's osteoporosis, and they're very common. The problem with spinal fractures is that they cause terrible pain. Patients can be in bed for two weeks to a month without knowing that they have a spinal fracture, because very often we don't look for them. But if you've had one spinal fracture, you have four times the chance of getting another within a year, so it's an important thing to know about.

DAVID R. MARKS, MD: There's also wrist fractures. Those are also common.

MICHELLE WARREN, MD: Right, what they call a Colles' fracture. They are common because as patients get older, if they trip and fall they're apt to fall on an outstretched hand and they break that bone. That is also often a sign of osteoporosis, but not always. It's not quite as common. It just happens to be a very common fracture because elderly people tend to fall a lot.

DAVID R. MARKS, MD: Are those the three most common fractures, hip, wrist and spinal fractures?

MICHELLE WARREN, MD: Right, Colles' of the wrist, hip and spine are the most common.

DAVID R. MARKS, MD: What is the cost of all this financially? Is there any kind of estimate?

MICHELLE WARREN, MD: The last time I looked, the cost to the healthcare system is enormous. It's one of the most important charges to Medicare. It's in the billions of dollars. So it's a big issue. The problem is, of course, it tends to be a silent disease and you don't know you have it until all of a sudden you have a hip fracture. Very often, once a patient has a hip fracture it's too late to intervene aggressively, to really help that patient get back to being independent. Not always, but about 20 percent of patients, no matter how you treat them, still end up very crippled by osteoporosis.

DAVID R. MARKS, MD: Briefly, what can a person do to try to prevent these fractures?

MICHELLE WARREN, MD: You can choose your parents wisely, because it's a familial disease. You can eat well when you're an adolescent. You can exercise. As you get older, if you think you have risk factors, you need to get a bone density test, and it should be done for a woman at menopause, because that's when she will lose a lot of bone. If you don't have risk factors, then you should always have a bone density test after 65.

DAVID R. MARKS, MD: And obviously following up with the doctor regularly is the most important factor.

MICHELLE WARREN, MD: Right. But I find that women have to ask for this bone density test, because doctors are very busy, and if they go in with another problem, that may not be addressed. So I find that women have become educated about this issue and it's important to ask for a bone density test.

DAVID R. MARKS, MD: Thank you for joining us. Women, take charge of your health care. Thanks for joining our webcast. I'm Dr. David Marks. Goodbye.

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