Water pooled on the floor, bumps in parking lots and uneven terrain elicit an entirely new emotion in Sara Bahar these days: fear.
From atop her bicycle seat, the physically fit 50-year-old used to see inclines as a challenge, as something positive that the avid gym goer could do for her muscles and body. But five months ago, while walking through a parking lot, Bahar felt a sharp pain in her hip that knocked her off balance. The slight fall left her with a broken left femur.
Diagnosis: osteoporosis – a bone disease long associated with elderly patients and post-menopausal women. Bahar is neither.
While hers was the kind of fracture that surgeon Dr. Frank Buttacavoli of Aventura’s Orthopedic Care Center associates most commonly with a car accident, it is the kind of fracture that Buttacavoli and a host of other Miami-area physicians are frequently treating in women following low-impact incidents.
“It’s a huge problem. Bone density in middle-aged women is often undertreated or ignored. They need to be getting checked regularly,” said Dr. Rolando Garcia, a spine surgeon at the Orthopedic Care Center in Aventura.
Garcia explained that bone mass reaches its peak in women in their 30s. From there it starts to decrease, with the rate often dependent on myriad factors including family history and lifestyle choices. Heavy alcohol consumption and cigarette smoking are high-risk behaviors that can hasten the loss of bone mass, while medications, such as steroids and estrogen-reducing procedures (hysterectomies) also lead to a weakening of the bones, he said.
According to the National Osteoporosis Foundation, some 54 million Americans have osteoporosis and low bone mass. Studies suggest one in two women and up to one in four men age 50 and older will break a bone due to the disease.
“This is not just your grandmother’s problem,” said Dr. Charles Jordan, an orthopedic trauma surgeon with Miami Orthopedics & Sports Medicine Institute at Baptist Health South Florida.
He pointed out that South Florida is filled with active people — biking, golfing, tennis, running. So if, unbeknownst to you, your bones are becoming more brittle, it won’t take much to chip or break one. This is why education is particularly important, Jordan said, noting he supports a movement afoot in the orthopedic community to begin looking at bone density in younger people. One frequently administered test uses X-rays to measure how many grams of calcium and other bone minerals are packed into one segment of the tissue. The test can identify low bone mass in a condition called osteopenia, a precursor to osteoporosis.
Bone is living, growing tissue that changes throughout a person’s lifespan. Cells continue to turn over in bones the way a snake sheds its skin. If test results show low-density or weaker bones, doctors can start their patients on calcium and Vitamin D supplements, as well as prescription medication designed to strengthen or speed up growth.
Ingesting plenty of calcium and Vitamin D helps to ward off brittle bones. The National Osteoporosis Foundation advises that women 50 years old and younger need 1,000 mg of calcium a day, while women older than 50 should ingest about 1,200 mg a day. As for Vitamin D, 400-800 international units (IU) are recommended for women 50 and younger. That amount jumps to 1,200 IU for older women.
Another segment of the population particularly affected by stress factures is elite-level female athletes, said Dr. Lauren Crocco, an orthopedic trauma surgeon with Miami Orthopedics & Sports Medicine Institute at Baptist. She said medical professionals have found that women who started training at a young age and consistently burned more calories than they absorbed, have affected their hormone levels, resulting in halted menstrual cycles. Less estrogen is produced and, as with menopause, bones break down quicker.
Vivian Miraz-Almasi didn’t know about her low bone mass until she broke her hip. The 66-year-old geologist used to ride her bike for two hours a day and often took two- to three-mile walks. Then, three months ago, she fell from an eight-inch step and despite feeling intense pain, X-rays showed there were no fractures. Days later, standing in the kitchen preparing a meal. Miraz-Almasi shifted her weight, lost her balance and excruciating pain shot from her leg to her hip. X-rays then showed that she fractured her femur. A rod was inserted into her leg and Miraz-Almasi underwent a hip replacement.
“I was surprised. I’ve always been very active,” she said, adding that she, like Bahar, has never been a smoker or a drinker.
Although resolved not to limit her life, Miraz-Almasi said she is more cognizant about how she walks and moves. Doctors prescribed physical therapy and advised her to perform weight-bearing exercises (which strengthens bones more than just walking) and to take Vitamin D and calcium supplements.
Bahar is also hyper vigilant about her movements. She, too, is taking calcium supplements, but her osteoporosis is so severe that she could easily break a bone again if she fell.
“I feel like I became an eggshell. It’s tough trying to go back to a regular life,” she said, noting through physical therapy and surgery she has been able to progress from a wheelchair to a walker to a cane relatively quickly. Still, she is in the process of finding treatments that will help strengthen and regrow her bone mass. She said she is going to try a variety of prescription medications.
In terms of treatment, there is no shotgun approach, said Dr. Violet Lagari-Libhaber, an endocrinologist and assistant professor of clinical medicine in the Division of Endocrinology, Diabetes, and Metabolism at the University of Miami School of Medicine. Intravenous treatments or subcutaneous injections may be used in lieu of various oral medications if patients have had a history of esophageal irritation or stomach ulcers.
A treatment that has brought some relief to one of Garcia’s patients, Mariana Perez, is a kyphoplasty, the surgical filling of an injured or collapsed vertebra. The aim is to restore bone shape and configuration and relieve pain from spinal compression. Perez acquired osteoporosis after having a hysterectomy; the procedure led to diminished estrogen levels, which weakened her bones. Over the past three years she has broken her toe, elbow, foot and ankle (twice) and undergone 11 surgical procedures.
“I used to skate, wear high heels and dance. Now it’s hard to step up into my house,” said Perez, 51. Although the Sunrise resident worries any slight stumble could result in more shattered bones, Perez was quick to point out, “A lot of people have it worse than me.”