Winter falls, bone fractures may point to osteoporosis

• 2 million broken bones a year are due to osteoporosis
• Bone mass remains generally stable until age 50
• Bone-density tests recommended for patients 50 and older who've broken bones

If you're unlucky enough this winter to slip on an icy surface and break a bone, you may need to do more than just treat the injury.

If you're 50 or older, ask your doctor for a bone-density test, advises the National Bone Health Alliance, made up of 47 health care organizations. It says only 20% of people who break a bone get a test or treatment for osteoporosis. More than 2 million incidents a year in the USA are linked to osteoporosis, a chronic illness in which bones become brittle.

"If the break is due to osteoporosis and you don't do anything about it, you're likely to fracture again,'' says David Lee, executive director of the alliance. Genetic factors are the biggest contributors to bone health, but smoking, too much alcohol, and not enough physical activity also play roles, as do having low levels of calcium and vitamin D.

Bone mass remains generally stable until age 50, Lee says. Women lose 2% to 3% of bone during the first five years after menopause and then at a rate of about 1% per year. Men lose bone more slowly, with the most dramatic bone loss occurring after age 70.

A misunderstanding about the disease "is that it's a little old ladies' disease." Lee says about half of women and a quarter of men over 50 will break a bone due to osteoporosis. And about half of those who do will later break another bone. But second fractures can be prevented, he says.

"People break bones, go to the emergency room, get the fracture fixed and are sent home,'' says Ethel Siris, director of the Toni Stabile Osteoporosis Center at Columbia University Medical Center in New York. "The fracture fixers are good at what they do, but their job is not to prevent the next fracture."

That's up to you and your family physician, Siris adds. Despite recent concerns about long-term use, these treatments have been shown to strengthen bones and lower fracture rates, she says. They include:

• Bisphosphonates. Physicians used to recommend patients with osteoporosis stay on the drugs (which include Fosamax, Reclast and Actonel) once they start. But a rare, atypical femur fracture and several other problems in some patients has changed that. In May, the FDA required drug manufacturers to update the label to include an "Important Limitation of Use" statement: "The optimal duration of use has not been determined. All patients on bisphosphonate therapy should have the need for continued therapy re-evaluated on a periodic basis." Now, patients whose bone density improves might be told to "take holidays" from the drugs.

• Calcium and vitamin D. Studies in 2012 linking high calcium levels to an increased risk for heart disease recommended people get most of their calcium from their diet. Siris says more research needs to be done to confirm those studies and that people shouldn't stop taking calcium (and vitamin D) if they don't get enough from daily intake of dairy products, kale, broccoli and fortified fruit juices.

"But taking more isn't necessarily better,'' she says. According to the National Institute of Medicine, women ages 50 and older need 1,200 milligrams of calcium daily; men need 1,000 milligrams a day until age 71, then 1,200 milligrams a day. Depending on how much sunlight exposure you get, you might also need to take a vitamin D supplement.

Some people suffer from side effects of bisphosphonates (nausea, irregular heartbeat) and calcium supplements (nausea, constipation, increased heart rate) and stop treatments on their own. Kaiser Permanente orthopedic surgeon Rick Dell says a new program of testing and monitoring patients has led to a 40% reduction in the expected number of hip fractures.

"We keep an eye on patients, and when they don't refill a prescription we know,'' Dell says. "When that happens we call the patients and give them a nudge.''

That kind of follow-up is "an absolute slam dunk'' in helping prevent second fractures, Siris says. "You need to make sure people stick with it."