Reducing Fracture Risk - Prevention and Screening

Introduction

The most common risk factor for fractures is osteoporosis, affecting over 10 million adults. Osteoporosis majorly affects women when compared to men. It is characterized by porous bone, low bone mass, and structural deformity, which cause a higher risk for fractures. Reduction in estrogen levels in postmenopausal women may also cause increased fracture risk. This article elaborates on preventing, screening, and treating fracture risks.

What Are the Risk Factors for Fractures?

There are various risk factors for fractures. The major factor that has increased the risk of fracture is osteoporosis. In addition to this, the other factors that increase the risk of fracture include:

• Lifestyle Factors - Consumption of more than three drinks in a day may cause an increased risk for fracture, excess vitamin A, aluminum (antacids), inadequate physical activities, immobilization (bed rest), frequent falls, high intake of caffeine, high intake of salt, low intake of calcium, low BMI (Body mass index), use of active or passive tobacco, vitamin D deficiency.

• Genetic Factors - It includes Gaucher disease, cystic fibrosis, homocystinuria, hemochromatosis, glycogen storage disease, Ehlers-Danlos syndrome, idiopathic hypocalciuria, Marfan syndrome, hypophosphatasia, osteogenesis imperfecta, parenteral history of hip fracture, Menkes disease, Riley-Day syndrome, and porphyria.

• Endocrine Disorders - These include diabetes mellitus, Cushing syndrome, hyperparathyroidism, adrenal insufficiency, and thyrotoxicosis.

• Hypogonadal State - Anorexia nervosa, bulimia, androgen insensitivity, hyperprolactinemia, athletic amenorrhoea, panhypopituitarism, Turner syndrome, Klinefelter syndrome, and premature ovarian failure.

• Hematologic Disorders - Hemophilia, leukemia, lymphoma, sickle cell anemia, multiple myeloma, thalassemia, and systemic mastocytosis.

• Autoimmune Disorders - Rheumatoid arthritis, ankylosing spondylitis, and systemic lupus erythematosus.

• Gastrointestinal Disorders - Celiac disease, inflammatory bowel disease, malabsorption, gastric bypass, primary biliary cirrhosis, pancreatic disease, and history of gastrointestinal surgery.

• Miscellaneous Conditions - Alcoholism, chronic metabolic acidosis, depression, congestive heart failure, amyloidosis, end-stage renal failure, epilepsy, emphysema, multiple sclerosis, muscular dystrophy, idiopathic scoliosis, post-transplant bone disease, sarcoidosis, and parenteral nutrition.

• Medications - Anticonvulsants, anticoagulants, glucocorticoids, and chemotherapeutic agents.

What Are the Preventive Methods to Reduce the Fracture Risk?

There are various interventions to reduce the fracture risk. The preventive ways can be categorized as primary and secondary prevention. These primary and secondary preventive methods include:

• Vitamin D and calcium intake.

• Avoidance of falls.

• Avoidance of tobacco.

• Moderate intake of alcohol.

• Weight-bearing exercises.

Vitamin D and Calcium Supplements

• Adequate vitamin D and calcium intake can help maintain bone mineral density and increase bone formation. It effectively helps reduce hip fractures and osteoporosis, especially in older individuals.

• Calcium and vitamin D supplements play an essential role in primary and secondary prevention.

• Studies have shown that only calcium intake may not help in reducing the fracture risk. Its combination with vitamin D supplements is very effective in reducing the risk of fracture especially caused by falls.

• Studies show that 400 IU or less of vitamin D3 and 1000 mg or less of calcium supplements are very effective in postmenopausal women in reducing osteoporotic fractures.

• Adequate calcium is very important for muscle performance and bone health, which helps in balance and reduces falls. The vital function of vitamin D is to maintain serum calcium levels. The sources of vitamin D are sunlight, egg yolks, liver, saltwater fish, fortified foods, and supplements.

• Vitamin D deficiency may cause hypertension, metabolic syndrome, and diabetes mellitus.

• Vitamin D intake above 400 IU may cause some common side effects like hypercalciuria and hypercalcemia. A high intake of vitamin D supplements may also cause nephrolithiasis.

• Calcium intake above 1200 to 1500 mg may cause nephrolithiasis and cardiovascular diseases.

Weight-Bearing Exercises

• Many studies have shown that muscle-strengthening exercises and weight-bearing exercises have largely helped to reduce the risk of fracture.

• It also helps in maintaining posture, strength, and balance to prevent falls.

• It is essential to recommend the type and degree of activities as exercises may also increase the risk of fracture and falls in some persons.

• Some non-weight-bearing exercises are also effective in reducing fracture risk.

Fall Prevention

Self-fall is one of the major risk factors for fracture. Falls can be prevented by interventions like removing fall hazards, hearing corrections, correcting neurological problems, stopping medications that cause imbalance, and using hip pad protectors.

Additional Factors

• Excessive intake of alcohol and tobacco may increase the risk of fracture. So it is very important to reduce the intake of tobacco and alcohol.

• Tobacco and alcohol can majorly affect bone health.

What Are the Screening Methods to Reduce the Fracture Risk?

The screening of fracture risk can be done by using various assessment methods. Bone mineral density is the standard screening tool to assess fracture risk. The screening methods to reduce the risk of fracture include

1. Assessment of Bone Mineral Density

• Bone mineral density can be measured by using dual X-ray absorptiometry.

• A T- score is defined to find the average bone mineral density of a person with appropriate references.

• The cut-off value of the T- score is -2.5 for osteoporosis. Low bone mineral density indicates an increased risk of fracture.

• Assessment of bone mineral density can not predict bone strength.

2. Fracture Risk Assessment Tool (FRAX)

• The fracture risk assessment tool (FRAX) is an online tool that is of zero cost and used to estimate the risk of fracture in the next 10 years, especially in persons with osteoporosis.

• This tool is used in persons with low bone density (osteopenia), persons without osteoporosis medications, and postmenopausal women.

• If the FRAX score is more or equal to 3 percent for hip fractures and more or equal to 20 percent for other major fractures, it indicates the increased risk of fracture and requires immediate treatment.

• It also needs bone mineral density test results.

3. Assessment of Bone Turnover

• It is a principal factor that determines the quantity and quality of bone in adults.

• An imbalance in bone formation and resorption ultimately cause gain or loss in the bone tissues.

• Low bone turnover results in the accumulation of microdamage, increased bone mass, and increased fragility of bone.

• Bone turnover is measured by biochemical bone markers.

Conclusion

Fractures can be prevented by screening them with various assessment tools, knowing about the risk factors, and avoiding certain things that cause an increased risk of fractures. Reaching out to healthcare professionals if they notice that the person is at increased risk for fracture is mandatory and may be beneficial.