Experts say that although between 20% and 30% of hip fracture patients die within a year of the event – from reasons including complications from the fracture as well as health issues as a result of falling in the first place, like circulatory diseases and dementia – it doesn’t have to be this way.
Despite popular belief, bone mineral density loss, which significantly increases the risk of fracture, need not necessarily be part of the ageing process, and minor lifestyle changes can create a ripple effect, substantially reducing the risk of fractures.
In a recent study published in the Journal of Bone and Mineral Research, researchers analysed findings from the Dubbo Osteoporosis Epidemiology Study – one of the longest running studies on osteoporosis in the world.
The Sydney Morning Herald reports that for the past 30 years, the Dubbo study has followed thousands of adults over 60, looking at fracture incidence and risk factors. Compared with the first group which was studied, the second group increased their bone mineral density by about 3%.
Despite this “very modest” improvement, there was a 45% reduction in hip fractures across the cohort, said study leader Tuan Nguyen, a world-leading researcher in osteoporosis who has been working in the field since the 1990s.
Nguyen said this level of reduction is typically associated with a 10% increase in bone mineral density, meaning these new findings were quite surprising.
A distinguished professor of predictive medicine at the University of Technology in Sydney, Nguyen calls this “The Rose” paradox. British epidemiologist Geoffrey Rose hypothesised that if we can improve a major risk factor, like cholesterol, by a very modest amount, we can substantially reduce the outcomes of cardiovascular disease.
“This is consistent with our data – that a very small increase in bone mineral density translates into a huge reduction in the community,” said Nguyen. “That small improvement can be translated into a huge reduction in fracture risk. That is what we want.”
Professor Cathie Sherrington, who leads the Physical Activity, Ageing and Disability Research Stream at the University of Sydney, said: “This is an important paper due to the population health approach being taken to an important health problem.”
The fact that most hip fractures – 60% in women and 70% in men – occur in people who do not have osteoporosis, makes it even more essential for everyone to do what they can to prevent falls.
“The good news is that exercise that prevents falls could also prevent these injuries,” says Sherrington. There are other ways to protect our bones too.
Bone mineral density is about 50% modifiable through minor lifestyle changes, Nguyen said.
Research has found a number of “universally applicable” modifications that can lead to a greater reduction in hip fractures.
Exercise regularly and safely
Less than half of all Australian adults are sufficiently active, yet previous research has found that elderly individuals allocated to an exercise group had a 50% lower risk of fracture than those who weren’t.
Balancing exercises, “like standing on one leg and embracing your inner flamingo” are important, but people need to do more than that.
Mopping, brisk walking, cycling, swimming and mowing the lawn are all great. But bones love variety, so it can also be helpful to try weight-bearing exercises, as well as activities like dancing, where the body moves in different directions at different speeds.
Quitting smoking (because smoking stimulates bone resorption – the process where bones are absorbed and broken down by the body– because it restricts oxygen-rich blood in the body, inhibits the absorption of calcium, causes more free radicals and affects hormones), is also a good idea.
The rate of bone-loss among cigarette smokers is double, Nguyen said, estimating that if the 12% of daily smokers in Australia quit, hip fractures could be reduced by 20%.
Eat more calcium
He said calcium was an essential mineral for maintaining bone health but half of all Australians consumed less than recommended level of calcium each day (1000-1300mg).
Get some vitamin D
Vitamin D is needed to absorb calcium, and foods like mushrooms, liver, eggs and oysters contain vitamin D. However, sunlight was still the best way to get our hit of vitamin D
Study details
Prevention of hip fractures: trade-off between minor benefits to individuals and large benefits to the community
Thach Tran, Thao Ho-Le, Dana Bliuc, Jacqueline Center, Robert Blank, Tuan Nguyen.
Published in Bone & Mineral Research on 28 August 2023
Abstract
Goeffrey Rose postulated that a population-based measure bringing a small benefit to each individual can yield large benefits to the community. We aimed to test this axiom by quantifying the relationship between change in bone mineral density (BMD) and hip fracture incidence between two prospective cohorts separated by ~10 years. In this prospective population-based Dubbo Osteoporosis Epidemiology Study (DOES), the participants aged 60+ were recruited in two waves: the initial cohort (1311 women, 842 men) in 1989-1992, and the second cohort (974 women, 544 men) in 1999-2001. The incident hip fracture was radiologically ascertained. Femoral neck BMD was measured biannually. Multivariable-adjusted Cox's proportional hazards models were adjusted for the predefined covariates such as age, BMI, lifestyle factors, falls, and prior fracture. Compared with the initial cohort, the second cohort had a higher femoral neck BMD by ~ 0.04 g/cm2 in women and 0.03 g/cm2 in men. However, the prevalence of osteoporosis in the second cohort was halved (prevalence ratio 0.51, 95% CI 0.36-0.73 in women; 0.45, 0.24-0.84 in men), and its hip fracture incidence was significantly reduced (hazard ratio 0.54, 95% CI, 0.38-0.78 in women; 0.39, 0.19-0.80 in men). Sensitivity analyses indicated that the “effect” was unlikely due to unmeasured confounders. These findings suggest that a population-wide strategy aiming at enhancing BMD across the entire population could lead to a substantial decrease in the incidence of hip fractures.
Dubbo study information (Open access)
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