Wednesday, November 28, 2007

Backs and Bones

This is the view I see too often as I work with patients who are trying to regain their mobility and independence. In the past ten years I have kept a database of my adult Home Care patients including the reason for their referral to physiotherapy services. I have seen nearly 3000 patients in this decade and the most frequent diagnosis is a fractured hip. After that, general frailty, falls and an assortment of other fractures including spinal compression fractures, shoulder and pelvic fractures compose the majority of my caseload. This pattern is also seen in the admissions to the geriatric rehabilitation hospital where I work. In fact, I see many of the same patients repeatedly in the hospital and community.

This lady's kyphotic spine is typical of many like her who have advanced osteoporosis (not to be confused with osteoarthritis). Women in her age group have often been under treated for this condition. There are improved diagnostic and treatment options available now and osteoporosis does not have to lead to disability. One in four women over 50 and one in eight men have osteoporosis. The Ontario Osteoporosis Strategy is working to improve education, identification and treatment of this condition. By identifying people at risk, particularly younger, ambulatory patients with low impact fractures, providing educational materials starting in elementary schools, and improving the use and accuracy of BMD testing, the goal is to decrease the cost of osteoporosis to individuals and the health care system.

Early detection of this condition is very important. Here is a list of risk factors from the website of Osteoporosis Canada. It is important to note changes in height as the loss of 2 or more inches during adulthood is a strong predictor of osteoporosis. Femail Doc of Doc of Ages wrote a post this week about the class of antidepressants known as SSRI's and the increased incidence bone fragility and falls in people who use them. It is important to be informed and proactive about our health and the health of our loved ones. My husband's mother had a height loss of several inches, a shoulder fracture and hip fracture before she was started on medication to improve her bone density. There is no need for this to happen any more.
Here is an interactive bone health tool from the USA National Institute of Health called Check up on your Bones. Or follow any of the other links above for plenty of useful information.


  1. Excellent information...If I had a dollar for every unnecessary fracture I've seen in my gerontological nursig career, I could have funded a nice vacation in a warm place complete with frothy drinks with little umbrellas! (winter must be here)

  2. Ruth, this is very good info. I checked risk factors and will find my height in the physical training facility tomorrow. Haven't done that in many years!

    My Mom had osteoporosis and a fractured hip after a fall about four years ago. The doctors said her case was minor.

  3. Wonderful information Ruth. There are way too many unnecessary fractures.

  4. K&M- All these fractures do guarantee my employment, but it would be better to work on the prevention end of things for sure.

    Mary- You go and measure your height, now and every year. There is no such thing as "minor" osteoporosis. A hip fracture is devastating. Yet many doctors continue to minimize the importance of good testing and treatment.

    Jayne- I know you could tell many first hand stories too.

  5. Anonymous4:32 pm GMT-5

    Do I have any osteoporosis to worry about on this side of the family? I don't think there is any on my mother's side.

    Thank you for all the info, my friend was just diagnosed with a kind of osteoporosis in her spine, she fractured a vertebrae last year, and she is only 40!

  6. Jaspenelle- While genetics can play a role, there are lots of other risk factors in developing osteoporosis. Yes, it is in the family. Nutrition, lifestyle, other diseases, certain medications etc, can also increase the risk for osteoporosis. Your friend is young to develop it, but it is not all that unusual.


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