TOO FEW OF OUR ELDERLY GET THE BEST CARE AFTER A HIP OR OTHER FRACTURE

I don’t think there is anything more feared among seniors than being totally dependent on others for help or for some the thought of being sent to a nursing home because they aren’t able to care for themselves. I know fear of being dependent is the biggest concern for the elderly Cabrini religious sisters I have cared for over the past 26 years. It turns out that suffering a debilitating hip fracture is one of most common reasons a person is sent to a nursing home and when that happens, they all too often don’t get the treatment they need to prevent future fractures and more pain and disability. And what is perhaps worse, despite safe and effective remedies to diagnose and treat osteoporosis, too few people are getting the treatment they need to prevent a disabling hip fracture in the first place.

A new study led by researchers at Harvard Medical School found that fewer than 12% of patients admitted to a nursing home following a hip, wrist or shoulder fracture were treated for the osteoporosis, the bone thinning disease of aging that likely caused their fracture. These findings are not really surprising to me. Previous studies have shown that despite Federal initiatives to increase bone density testing to diagnose osteoporosis, less than 20% of women 65 and older have had a bone density test. More incredible to me - even after suffering fractures from osteoporosis, fewer than 20% of patients receive treatment to prevent future fractures and disability even if they are hospitalized and treated for their fractures.

The good news – there is a lot we can do to diagnose, prevent and treat fractures from osteoporosis and therefore hopefully avoid that difficult decision about a nursing home altogether.

I would urge the following for all women who are at risk for this bone thinning disease:

v  Ask your doctor about getting a bone density test. Experts recommend this test for all women 65 years of age and older and younger women who have a number of risk factors such as family history of hip fracture, chronic use of steroid medication, etc.  CMS (the Center for Medicare and Medicaid Services) has recently cut back on reimbursement to bone density scans done in private doctor’s offices where many of the scans are done so it may soon be more difficult than ever to find a facility to do the test for you.

v  Are you getting enough vitamin D and calcium? Many adults (and children for that matter) have inadequate levels of vitamin D – a vitamin critical for our bone health and the health of many other tissues in our bodies. Current recommendations lag behind the research findings. Discuss with your doctor a daily intake of about 1000 IU. Small amounts of Vitamin D are added to milk and cereal products (100 IU/cup) and in daily multivitamins (400 IU/tablet). If you are still following your grandmother’s advice to take cod liver oil you may be in great shape. One tablespoon of cod liver oil has about 1250 IU of Vitamin D. Everyone post menopause should be getting about 1500 mg of calcium daily – divided up with each meal to get the biggest effect.

v  Move it or lose it.  I am referring to exercise. Strengthening your muscles will strengthen your bones and improve your balance at the same time.

v  If you have suffered from a hip, wrist, spine, or other aging fracture, talk to your doctor about the medications available that can reduce your risk of a future fracture. The family of medications called bisphosphanates is often the first recommended treatment if you have no contraindications. (Fosamax was the first on the market, there are now three others approved by the FDA; Actonel, Boniva and Aclasta.)

My 80 and 90 year-old religious sisters that I have cared for have taught me the importance of emphasizing prevention over treatment. Most of the sisters are taking additional vitamin D and are constantly encouraged to exercise. I often test them to see if they have the strength to get out of a chair powered by their own thigh strength rather than holding on to the arms of the chair. This helps them gauge their strength and balance. And finally, yes, many of them are on bisphosphanates too. Sometimes the addition of medications can make a big difference.

Have you asked your mother about the health of her bones? If you are 65 years old and over, have you had a bone density test? Share your experience with the test. What are you doing to protect your bones? Have you had your vitamin D levels checked? Are you getting enough vitamin D? Has your doctor prescribed medications for your bones?

As always, I welcome your comments and questions at abcnews.com to this very important matter.

Dr. Marie Savard
ABC News Medical Contributor


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