Osteoporosis and fractures

[ERCougar]

I just read something really interesting yesterday and I thought I'd pass it along to the women on here. For a long time, we've been pushing calcium and magnesium to prevent hip and spine fractures from osteoporosis. This has always bugged me a little, because there's never been any proof that it works, and it doesn't make a lot of sense intuitively, but I'll get back to that. Additionally, we do DEXA scans do assess your "level" of osteoporosis, and thus your risk for hip fracture. If you score high, you're put on "bisphosphonates", drugs that remodel the bones, essentially making them stiffer.

There are a couple of problems with this approach. First, I see plenty of people who fracture their hips with NO history of osteoporosis. I also see plenty of people on bisphosphonates who fracture their hips. Secondly, what keeps bones from breaking isn't their stiffness, it's their pliability. This is why kids get greenstick fractures (where only "half" the bone breaks) instead of complete fractures.

Anyway, what I read yesterday finally confirms my suspicions on this and I think we'll get a lot more research in this direction in the coming years. This may be a few years old, as I'm admittedly out of the primary medicine field, so if you already know this, I apologize. Scientists are now hypothesizing that collagen production is what decreases fracture risk and the vitamin K stimulates collagen production. This makes much more intuitive sense. The good news is that you don't need a ton of vitamin K--a serving of spinach would give you about ten times what you need each day, IIRC. But you should pay attention to it, and if you don't get in in your diet, take a supplement. If you're on coumadin, you'll need to increase that dose.

Spinach really is super food.

[ERCougar]

So I shouldn't be too surprised that this isn't a hot topic on a sports message board, but at least pass this on to your mothers, wives, etc. This is a big deal. Hip fractures have somewhere around a 33% one-year mortality. Granted, there are a whole lot of other factors contributing, but a huge part of that is the sudden loss of mobility and function that occurs and everything that goes with that. Anything we can do to prevent hip fractures is worth it.

(This does affect men as well, although to a lesser extent.)

[TripletDaddy]

ER, I think it is interesting, but not sure what the action item should be.

Is it just to ensure that we are all getting the RDA of Vitamin K in our daily meal? Why is this any different than just the standard message of getting the RDA of all vitamins, osteo issues aside?

[ERCougar]

ER, I think it is interesting, but not sure what the action item should be.

Is it just to ensure that we are all getting the RDA of Vitamin K in our daily meal? Why is this any different than just the standard message of getting the RDA of all vitamins, osteo issues aside?

Don't get me wrong--I'm not bugged that people aren't commenting on this. I just find this to be one of the more interesting findings to come out recently, one that passes the sniff test, and I really think will be one of the major preventive medicine measures in the future. I just wanted to pass it on.

As far as action items, there's a lot more we have to learn about the right amounts but from the study I just googled, the women with the lowest quartile of fracture risk were eating 3-4x the RDA of Vitamin K, where the highest fracture risk women were eating just below it. What that tells me is that this may be an area where supplementation may be helpful. Of course, dietary sources are always better.

One thing you should know about RDA--these are fairly arbitrary numbers and are intended to prevent malnutrition, not necessarily to promote optimal health. We're still learning about optimal amounts on all vitamins and I expect that to continue.

In the end, I guess the action item is to eat lots of leafy greens (best sources of Vitamin K). Nothing earth-shattering there, but an extra motivator to do it.

[woot]

ER: When old folks fracture their "hip" what is it that actually fractures? Does the greater trochanter snap off or does the proximal femur just split down the middle between the trochanter and the femoral neck? I assume it isn't the acetabulum or any other part of the pelvis. I should probably know this already but I assume you've seen it often enough first hand to provide a good idea.

[ERCougar]

ER: When old folks fracture their "hip" what is it that actually fractures? Does the greater trochanter snap off or does the proximal femur just split down the middle between the trochanter and the femoral neck? I assume it isn't the acetabulum or any other part of the pelvis. I should probably know this already but I assume you've seen it often enough first hand to provide a good idea.

It's the femur that fractures. Most commonly the fracture goes through the femoral neck. I'm not sure what you mean by "between the trochanter and the femoral neck" as they're right next to each other. Sometimes, hipe will fracture right through the trochanter.

Acetabular fractures would be classified under pelvic fractures and are pretty rare without some degree of trauma (MVA, fall from a height, etc). Hip fractures are almost always ground-level falls, and personally, I think that the fracture comes before the fall, i.e. the femoral neck fractures, causing the person to fall. This is sort of controversial, but I bet it turns out to be right.

[woot]

It's the femur that fractures. Most commonly the fracture goes through the femoral neck. I'm not sure what you mean by "between the trochanter and the femoral neck" as they're right next to each other. Sometimes, hipe will fracture right through the trochanter.

Acetabular fractures would be classified under pelvic fractures and are pretty rare without some degree of trauma (MVA, fall from a height, etc). Hip fractures are almost always ground-level falls, and personally, I think that the fracture comes before the fall, i.e. the femoral neck fractures, causing the person to fall. This is sort of controversial, but I bet it turns out to be right.

Interesting. By between the greater trochanter and femoral neck I was thinking of a radiograph I saw one time in which somebody's proximal femur was just split down the middle (as in parallel to the diaphysis) so that it didn't really go through the femoral neck but didn't go through the trochanter either. That was probably not typical. Thanks for the info. So your idea is that the weight placed on the femur causes it to snap just from normal walking? That's kinda scary but it seems possible.

Regarding supplementation, I read something last semester in which vitamin D supplements were more effective than calcium supplements at maintaining bone density, since calcium is so available in food but many people are vitamin D deficient due to never getting outside. I don't know how solid the evidence was as I was probably skimming. Do you have thoughts on that? This isn't the sort of thing I usually get into so I'm mostly ignorant.

[Babs]

So I shouldn't be too surprised that this isn't a hot topic on a sports message board...

lol. ER, your post was up for a few hours on a Sunday afternoon. Rule of thumb: don't post anything you want anyone to notice on a Sunday. All boards are slow on Sundays - this one all the moreso because of its religious affiliation.

Anyway, as to your post about collagen and fractures:
so why is it that underweight caucasian and asian women are most likely to suffer these fractures? Do we produce less collagen?

You know, I remember when I was first reading about this (I'm a relatively high risk in the long run, so this is a matter of interest to me) that they said that asian women showed a much lower bone density than whites, but also had a significantly lower incidence of fracture. Obviously, the identification of a more accurate predictor of risk might explain that seemingly counterintuitive fact.

[ERCougar]

Interesting. By between the greater trochanter and femoral neck I was thinking of a radiograph I saw one time in which somebody's proximal femur was just split down the middle (as in parallel to the diaphysis) so that it didn't really go through the femoral neck but didn't go through the trochanter either. That was probably not typical. Thanks for the info. So your idea is that the weight placed on the femur causes it to snap just from normal walking? That's kinda scary but it seems possible.

Regarding supplementation, I read something last semester in which vitamin D supplements were more effective than calcium supplements at maintaining bone density, since calcium is so available in food but many people are vitamin D deficient due to never getting outside. I don't know how solid the evidence was as I was probably skimming. Do you have thoughts on that? This isn't the sort of thing I usually get into so I'm mostly ignorant.

Yeah, I once saw a fracture like that. Not very common, obviously.

As you probably know, Vitamin D is required for the body to absorb calcium, so if you're deficient, all the calcium in the world doesn't do you any good.

I don't have a problem with calcium and magnesium (and Vitamin D) supplementation. It's cheap and relatively harmless. People just need to keep it in perspective and realize that the benefits are very small, if any. Also, I think we're going about it the wrong way. Women generally don't start supplementing until menopause (or close to it). That's way too late--the bone matrix is already set and only decays from there. Supplementation, if it needs to happen, should happen in adolescence.

[ERCougar]

lol. ER, your post was up for a few hours on a Sunday afternoon. Rule of thumb: don't post anything you want anyone to notice on a Sunday. All boards are slow on Sundays - this one all the moreso because of its religious affiliation.

Anyway, as to your post about collagen and fractures:
so why is it that underweight caucasian and asian women are most likely to suffer these fractures? Do we produce less collagen?

You know, I remember when I was first reading about this (I'm a relatively high risk in the long run, so this is a matter of interest to me) that they said that asian women showed a much lower bone density than whites, but also had a significantly lower incidence of fracture. Obviously, the identification of a more accurate predictor of risk might explain that seemingly counterintuitive fact.

I'm not sure why, although I have a couple of guesses. First, overweight women generally have higher estrogen levels and estrogen is known to support bone density. Second, I suspect that a lifetime of weight-bearing promotes stronger bone development in much the same way that exercise does. Third, thinner people are more likely to have mineral deficiencies in their diets, simply due to lower volumes.

Take that for what it's worth. I don't think anyone really knows.

[Pheidippides]

Yeah, I once saw a fracture like that. Not very common, obviously.

As you probably know, Vitamin D is required for the body to absorb calcium, so if you're deficient, all the calcium in the world doesn't do you any good.

I don't have a problem with calcium and magnesium (and Vitamin D) supplementation. It's cheap and relatively harmless. People just need to keep it in perspective and realize that the benefits are very small, if any. Also, I think we're going about it the wrong way. Women generally don't start supplementing until menopause (or close to it). That's way too late--the bone matrix is already set and only decays from there. Supplementation, if it needs to happen, should happen in adolescence.

Well that makes me happy. If there are three things that I got almost too much of as a kid, it would be calcium, magnesium and Vitamin D.

[RockyBalboa]

Along with her other various medical problems and ailments, my Mom has been told she has very thin bones.

Almost 3 years ago she accompanied my sister up to Rexburg to see my sisters daughter. Well my Aunt (my mom's Sister) lives in St. Anthony.

As My sister got out of the car, she turned around and didn't see my Mom anywhere. She walked around the side of the car and there my Mom was on the driveway facedown after slipping on the ice while getting out of the car.

She broke her Humerus bone in 3 places and had to have 4 pins inserted. According to the Doctor it took twice the normal healing time because of her bones. Whether he was feeding her a line or not I have no idea.

I'm still pissed about the care she received. After her pins were removed she developed a 2 foot by 2 foot bruise underneath her arm that extended around her stomach and to her back. She said it was extremely painful. We take her into the emergency center and apparently the Doctor didn't account for all of the pins he had pulled out of her and one had somehow lodged inside and worked it's way down her causing the bruise and internal bleeding.

Amazing that a Physician of 20+ years experience could actually miss the fact that he put 4 pins in, but only took 3 of them out.

[Mrs. Funk]

So how does osteoporosis affect old injuries? Are you more susceptible if you have prior trauma to the bones and subsequent healing? Any thoughts...

[ERCougar]

So how does osteoporosis affect old injuries? Are you more susceptible if you have prior trauma to the bones and subsequent healing? Any thoughts...

I have no idea. Osteoporosis typically manifests in spinal fractures and hip fractures, so if you haven't injured either of these, I can't imagine how it would affect it. Does osteoporosis make you more vulnerable to refracturing your tibia if you've already fractured it? Possibly, although healed bone tends to be stronger than unbroken bone (bones rarely break in the same place twice), so the effect would be due to global weakening if anything.