April 25, 2014

Building stronger bones key to reducing fractures from falls

To those around her, it looked like a minor fall. Patricia Pineyro lost her balance during a wedding in Guayaquil, Ecuador, last year and tumbled to the ground.

To those around her, it looked like a minor fall. Patricia Pineyro lost her balance during a wedding in Guayaquil, Ecuador, last year and tumbled to the ground.

But the injury Pineyro sustained was serious. Her right thigh bone fractured in eight places. She later learned why.

“It was because I had osteoporosis,’’ said Pineyro, 51, of Coral Gables. “I had no idea.’’

The link between low bone density and fragility fractures is well documented. About 1.5 million Americans suffer osteoporosis-related fractures annually, according to the American Association of Orthopaedic Surgeons. That's more than heart attacks, strokes and breast cancer combined.

It's a costly problem.

Americans spend about $20 billion annually to treat osteoporotic fractures, according to the International Osteoporosis Foundation. The figure is expected to grow to $25 billion by 2025.

Those numbers have prompted orthopedic surgeons to take a new approach to fragility fractures.

“We are no longer just treating the fracture,’’ said Dr. Charles Jordan, of the Doctors Hospital Center for Orthopedics and Sports Medicine. “We are treating the musculoskeletal system as a whole.’’

An estimated 34 million Americans suffer from osteopenia, a condition characterized by low bone density, or the more severe bone disease known as osteoporosis, according to the National Institutes of Health.

Roughly 80 percent are women.

For most people, the risk of osteopenia and osteoporosis increases with age.

“A bone has a honeycomb structure,’’ explained Dr. Dan Chan, an orthopedic trauma surgeon at Memorial Healthcare System in Hollywood.

“As we age, the structure becomes filled more with empty space and less with the structural components of bone.’’

Brittle bones are less able to withstand stress and minor falls, said Dr. Violet Lagari-Libhaber, an assistant professor at the University of Miami Miller School of Medicine who specializes in osteoporosis.

“Any sort of torque or force that would have been OK in your 30s is now extremely dangerous,’’ Lagari-Libhaber said. “It doesn’t have to be a traumatic fall.’’

A fracture can have serious consequences. About one in four osteoporosis-related, hip fracture patients end up in long-term nursing home care, Chan said.

Half of them wind up unable to walk without assistance. And about 20 percent die within one year.

“A good percentage of people don’t return to their previous level of independence,’’ Chan said. “People who were already using a walker are now wheelchair bound.’’

To minimize the damage, orthopedic surgeons must respond quickly.

“Our first order of business is to treat the fracture, because these are fractures that cause immobility,’’ Jordan said.

He and other surgeons are taking advantage of new technology that can be used to repair fractured bones, as well as advances in the types of surgeries they perform.

“We’re doing more total hip replacements now,’’ Chan said. “The evidence has shown that people who get a total hip replacement do better than people who get a partial hip replacement. There is a better long-term outcome and less pain.’’

Surgeons also are working to address what is often the underlying problem: low bone density.

The effort is part of an international campaign by groups like the American Association of Orthopaedic Surgeons, the American Orthopaedic Association and the International Osteoporosis Foundation to break the cycle of fragility fractures by preventing repeat occurrences.

“There have been certain initiatives to have the orthopedic surgeon play a greater role in treating the disease,’’ Chan said.

After surgery, Jordan sends his patients for blood tests and bone density screenings that can indicate osteopenia and osteoporosis. If the patient is at risk of developing either condition, Jordan will recommend a regimen of calcium and vitamin D supplements. For patients with osteoporosis, he also may recommend pharmacological treatments that slow bone depletion.

Jordan doesn't work alone, he said. He treats his patients in concert with their primary care physicians.

“We're making sure the whole patient is taken care of,’’ he said.

Pineyro, who fractured her thigh bone, had emergency surgery in Ecuador. She later had a second surgery at West Kendall Baptist Hospital because the plate that had been used to reconstruct her femur was too large, she said.

Jordan, who treated Pineyro in South Florida, started her on the osteoporosis medication, Forteo, which helps build new bone.

Pineyro said her bone density already has improved.

“I’m very positive that this will really help me,’’ she said.

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