The mystery of fragility fractures: Why do bones become so fragile?

Author: Ding Yan: People's Hospital of Yushui District, Xinyu City, Jiangxi Province

Reviewer: Zhu Jiaojiao, deputy chief nurse, the First Affiliated Hospital of Nanchang University

Jiang Gang, deputy chief physician, People's Hospital of Yushui District, Xinyu City, Jiangxi Province

In real life, we occasionally hear the elderly in the community discussing: "Have you heard? xx broke his ribs because of a hug", or "xx broke his ribs because of a sneeze", or "xx accidentally slipped and broke his thigh bone"... Doesn't it sound incredible at first? If you think about it carefully, these accidents are actually similar. Although the causes of fractures are different, they have a common name - brittle fractures.

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1. What is a fragility fracture?

Fragility fractures refer to complete fractures caused spontaneously or by slight external force. Because they are mostly caused by osteoporosis, some people also call them "osteoporotic fractures". Fragility fractures mainly occur in the thoracic spine, lumbar spine, hip and forearm. Behind fragility fractures, there is often an easily overlooked "truth" hidden - osteoporosis. Because of its hidden onset, it is also called the "silent killer".

The results of my country's seventh census showed that the population aged 65 and above accounted for 13.5% of the total population[1], and the prevalence of osteoporosis among people aged 65 and above in my country reached 32.0%[2]. Studies have shown that by 2050, the number of patients with fragility fractures in my country is expected to reach 5.99 million[3]. Fragility fractures are one of the main causes of disability and death among the elderly, among which hip fractures have the highest disability and mortality rates, placing a heavy burden on families and society.

2. What are the causes of fragility fractures?

1. Age

As people age, they gradually lose bone mass, which is one of the driving forces behind osteoporosis. Therefore, advanced age is an important independent risk factor for fragility fractures.

2. Gender

After menopause, women's estrogen levels will drop sharply. Estrogen is important for maintaining bone health. Its decline will lead to calcium loss, so women are more likely to develop osteoporosis than men.

3. Genetic factors

About 50% to 80% of the difference in bone mass between human individuals is determined by genetic factors.

4. Combined with underlying diseases

Combined hypertension, coronary heart disease, diabetes, etc. will increase the risk of fragility fractures.

5. Falling

Falling is the direct cause of fragility fractures. Elderly people with poor physical function may suffer from more severe osteoporosis and a higher risk of recurrent fractures due to long-term bed rest and less activity after fractures.

6. Unhealthy lifestyle

Lack of exercise, insufficient sunlight exposure, smoking, excessive drinking, calcium and vitamin D deficiency, excessive consumption of caffeinated beverages, excessive or insufficient protein intake, high-sodium diet, and low body weight may all promote the occurrence of osteoporosis and increase the risk of fragility fractures.

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3. How to prevent brittle fractures in daily life?

1. Laying the foundation for the "skeleton building"

If the human skeleton is compared to a "bone building", then calcium supplements are like the main raw material - bricks. First of all, we need to take in adequate amounts of calcium and vitamin D as basic supplements for bone health. The Institute of Medicine of the United States recommends that men aged 50 to 70 years should take in 1000 mg of calcium per day; men aged 71 years and over and women aged 51 years and over should take in 1200 mg of calcium per day; adults aged 50 years and over should take in 800 to 1000 units of vitamin D per day to maintain adequate serum vitamin D (≥30 μg/L but ≤50 μg/L), and regularly monitor serum 25-hydroxyvitamin D to guide the amount of vitamin D supplementation [4].

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2. Life lies in movement

It is recommended that the elderly or patients with osteoporosis should reduce sedentary time and perform 150 to 300 minutes of moderate-intensity aerobic exercise per week, or 75 to 150 minutes of high-intensity aerobic exercise per week. They are encouraged to engage in diversified physical activities, such as walking, jogging, Tai Chi, Ba Duan Jin, etc. It should be noted that whether it is outdoor or home activities, one should do it within one's ability and determine the intensity of physical activity according to one's own health level. When chronic diseases prevent at least 150 minutes of moderate-intensity aerobic exercise per week, physical activities should be performed to the best of one's ability and conditions.

3. Maintain a healthy lifestyle

A healthy lifestyle is also crucial to preventing fragility fractures. For people with a long history of smoking and drinking, the incidence of fragility fractures is relatively high. Studies have shown that tobacco may cause an imbalance in bone turnover mechanisms, reducing bone mass and bone density. In addition, the more people drink, the higher the risk of osteoporosis. Therefore, quitting smoking and drinking is a necessary condition for preventing fragility fractures.

4. Prevent falls

Falling is a very common problem for the elderly. Studies have shown that one-third of community residents aged ≥65 years fall at least once a year, and 20% of these falls lead to fragility fractures. To prevent fractures caused by falls in the aging population, the living environment of the aging population can be improved and the risk of falling can be assessed to prevent falls and reduce the risk of fractures.

In short, no matter what, we need to take the issue of fragility fractures seriously. A healthy lifestyle and eating habits, proper exercise and fall prevention measures are critical to preventing fragility fractures. It should be emphasized that if bone pain and joint movement disorders suspected to be caused by osteoporosis occur in life, you should seek medical attention in time to confirm whether a fragility fracture has occurred and take active anti-osteoporosis treatment.

References:

[1] National Bureau of Statistics, Office of the Leading Group of the Seventh National Population Census of the State Council. Bulletin of the Seventh National Population Census (No. 5): Population Age Composition[J]. China Statistics, 2021, 69(5):10-11.

[2] Zhang Zhenlin, Xia Weibo, Li Mei, et al. Guidelines for the diagnosis and treatment of primary osteoporosis (2022) [J]. Chinese Journal of Osteoporosis and Bone Mineral Diseases, 2022, 15(6): 573-611.

[3] Chinese Society of Orthopaedics. Guidelines for the diagnosis and treatment of osteoporotic fractures (2022 edition)[J]. Chinese Journal of Orthopaedics, 2022, 42(22):1473-1491.

[4] LeBoff MS, Greenspan SL, Insogna KL, et al. The clinician's guide to prevention and treatment of osteoporosis[J]. OsteoporosInt, 2022, 33(10):2049-2102.