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Fear of Fracture
Assess your chance of having a break

For older adults, a fractured (broken) bone is more than just an inconvenience. It can mean the difference between independence and being forced to rely on others. For some, a bad break can even lead to early death. For this reason, medical and public health efforts are focusing more on preventing fractures.

Considering two risk factors can give you an idea of whether you are likely to break a bone. Now, a new, free and easily accessible tool also helps assess your risk.

Risk Factor One - How strong are your bones?

Until recently, a bone density test ordered by a doctor was the only reliable way to check the strength of your bones. This tool can tell whether your bone density puts you at:

• ‘normal’ risk of fracture.
• about twice the risk of fracture compared to someone with ‘normal’ bones (osteopenia)
• about five times the risk of fracture (osteoporosis).

However, this test does not estimate your risk of breaking a bone within the next 10 years. A number of other factors must be considered to make that calculation.

A terrific new website designed in Alberta has great information on preventing falls. www.findingbalancealberta.ca

The FRAX tool

If you want to assess the probable strength of your bones, a new tool is now available on-line. The FRAX® tool, developed by the World Health Organization, does not require a special medical test. You can find it free of charge on the University of Sheffield website. Click on the ‘Calculation Tool’ link at the top of the page, and select the Canadian version.

The beauty of this tool is that it predicts fracture risk immediately. It is not necessary to know your bone density number, although if you have had the test you can factor it in. Past history, family history, age, smoking, alcohol use, steroid use, and whether you have rheumatoid arthritis are all considered. The FRAX® tool predicts your risk of breaking a bone in the next 10 years. This is more specific than being told you have ‘double’ the risk compared to someone else.

At this stage, you may choose to work with your doctor to change some medical risk factors. You might consider starting on a bone density medication, or, if you smoke, get help in quitting.

Risk Factor Two - Are you likely to fall?

The second consideration involves your chance of hurting yourself – in particular, of falling. Many older people hesitate to go out in winter because the streets are too slippery. Falls are the leading cause of injury in seniors, and about one in three fall every year. For those over age 75, it is the most common cause of accidental death.

You may worry that if you fall you may break a bone. If it does not heal well, you must depend on others. Wearing a cast can make you lose muscle, which can be hard to rebuild. Using crutches is more difficult for those who are frail. Sadly, breaking a hip increases the chance of dying within the next year.

Preventing falls is your best way to protect mobility, function and independence. Your risk can be predicted by answering two questions:

• Have you fallen once or more in the last 12 months?
• Do you have difficulty balancing or walking?

If the answer is yes, ask your doctor about how your medical conditions and medications might cause dizziness or drowsiness. It is very important to ask yourself questions too.

• How is your strength and balance?
• Do you pay attention to where you are walking, and focus on the task at hand?
• Do you wear reliable shoes that help you maintain your footing?’
• Could hazards in your home, such as cords, loose rugs or missing handrails, cause you to fall?

Protect your bones

You can avoid a fracture in several ways.

• Talk to your family doctor about bone density testing and your calcium and vitamin D levels. If your calcium or vitamin D intake is low, improve it with diet and supplements. Your doctor may prescribe medication to increase your bone density.
• Calculate your risk using the FRAX tool.
• Discuss the results with your doctor.Review medications at least once a year to be sure they do not cause (or worsen) conditions like dizziness or drowsiness. Be sure you take medications properly, and do not mix them with alcohol.
• Get active. No matter how frail you may be, 30 minutes of daily activity is essential. If you are somewhat active, using a Wii Fit Balance Board can be fun and very effective for improving balance. Dance, bowl, or do Tai Chi. If you are in a wheelchair, move your arms and legs.
• Deal with hazards in your home. Most falls happen on stairs, in the bathroom or kitchen. Improve lights and handrails. Remove clutter and secure loose rugs.

The chances of breaking a bone only get worse if you do not remove possible fall hazards. Take steps to prevent falls and perhaps a disabling fracture.

As you grow older, avoiding fractures makes a huge difference to your quality of life. Care for yourself by protecting your bone health and taking action to prevent falls.