How did you fracture that bone? Bone Density & Bone Quality

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What does the diagnosis of osteoporosis or osteopenia really mean? Should you be afraid or become educated about your condition?

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How did you fracture that bone?

This is a very important question to ask when you break a bone. If you’ve experienced significant trauma, such as being hit by a car, fracturing a bone is not an uncommon result. An example of a low force fracture might occur while walking briskly down the street, where a bone in the foot ends up with a stress fracture – this can be a warning sign of very low bone density, poor bone quality or both. Medically, an example of a low impact fracture (fragility fracture) would be falling from a standing position and fracturing a bone, since most people would not fracture their hip by falling from a standing position. There are exceptions to this rule, however, such as tripping full force onto pavement with a hand flat out and fracturing a wrist. If you think about the spills people take during a sporting event without breaking any bones, you can appreciate how tough and durable the skeleton can be.

Although bone density can be tested, there is currently no way to test for bone quality. While there are new devices that are undergoing testing to see if bone quality can be quantified, with current health care costs spiraling out of control, these tools might not ever be made available to the public at large. However, there are other ways to evaluate bone quality in an individual, which can be done through a comprehensive assessment of the present and past medical history of a patient, including fracture history (especially low-impact fractures).

I take note especially if a patient of mine has had a history of low impact fractures– if they’ve had more than one such fracture, then they may have severe osteoporosis, even if their bone density is not osteoporotic. Bone quality has become a major issue in recent years because the largest class of drugs that are used to treat osteoporosis (bisphosphonates) have been shown to result in compromised bone quality for those who have taken the medication for over 5 years. A small percentage of these people are experiencing horrific non-traumatic femur fractures. Following is a partial list of things that can compromise bone quality:

• Age – as we age, our bone quality will deteriorate. For instance, if a 30 year old has the same bone density as a 65 year old, the 65 year old’s bone quality is not as good and may fracture more easily. However, depending on other factors such as nutrition and exercise, this process can be slowed down to control for how severe the drop is in your bone quality.
• Genetic predisposition for poor bone quality – this does run in families
• Cigarette smoking
• Alcohol – 3 or more glasses per day has been proven to be deleterious to health, but let’s just say alcohol is not good for bone or the body, and that 0-3 glasses/week is more reasonable.
• Lack of exercise that stresses bone
• Poor food quality – a heavily processed food diet with not enough whole foods
• Not having enough specific bone building nutrients including: vitamin D, calcium, magnesium, vitamin K, boron and other nutrients.
• Hormone imbalances in both men and women can lead to bone loss – during a 5-10 year period in and around menopause, a woman can lose up to 20% bone mass!
• Certain medications can impact bone density and likely bone quality:  proton pump inhibitors, glucocorticoids (prednisone), lithium and other medications
• Diet sodas – just eliminate these nutrient robbers (it’s really not that difficult!)
• Digestive disorders – any digestive disorder can result in nutrients not being absorbed. As a consultant, one of my top priorities with my patients is the diagnosis and resolving of digestive problems.

FEMUR FRACTURES CAUSED BY MEDICATIONS FOR OSTEOPOROSIS: A few months ago, I interviewed Dr. Jennifer Schneider regarding the issue of non-traumatic femur fractures, and I highly recommend watching this very revealing webinar to anyone who has been on a bisphosphonate (Fosamax, Boniva, Aconel and others) for 3 years or more. This webinar could save your life or the life of someone you know.

“Dr. Lani interviews Dr. Jennifer P. Schneider, MD, PhD: Osteoporosis Drugs and Low-impact Femur (thighbone) Fractures“ Click here to watch!