Hip Fracture = Very High Risk For Another Fracture

A word from your Rheumatologist, Dr. Paul Howard MD, FACR “Hip Fracture = Very High Risk For Another Fracture”

Is this a surprise? – Any significant adult fracture over the age of 50 is most likely related to osteoporosis and predicts a much higher risk of more fractures. Yes, it is very surprising that most people who break a hip are not evaluated or treated subsequently for osteoporosis. In fact, the data is dismal. After a hip fracture, only 3 percent – yes that is not a typo and not 30 percent but rather 3 percent, receive evaluation and treatment for osteoporosis 6 months after a hip fracture and it is lower for less serious fractures.

Studies show that after a hip fracture has been repaired, patients are often left unprotected and at risk for another osteoporotic fracture. The surgeon’s job is done, and then it is up to the patient’s personal physician to evaluate and prescribe measures and medications to prevent the next fracture. The risk is very high. It is estimated that another osteoporotic fracture will occur 5-7x more likely after a hip fracture.

The decline in initiating treatment with any medication was recently reviewed in a New York Times article quoting a national study of 97,169 patients who fractured their hip from 2004-2015. Published in JAMA Geriatrics, they found a continuous decline in patients starting osteoporotic medication after fracture from 9.8% in 2004 to a depressing 3.3% in 2015.

The cause of the decline is related to the exaggerated publicity given to the very rare risk of osteonecrosis of the jaw and uncommon atypical femoral fractures who take bisphosphonates for years. What is not appreciated is the fact that the risk for hip and other osteoporotic fractures are much high – by 2000 to 10,000 times.

It is important to understand and appreciate the rare side effects in order to make a reasoned decision concerning treatment for osteoporosis. We can help you make these decisions and monitor your bone density and risk for fracture. We can also provide recommendations to naturally help reduce the risk for fractures by taking adequate calcium, the best type, correct dosing of vitamin D and the necessary exercise.

The bottom line – do not get paralyzed by the concern for side effects alone. Look at the risks and benefits of treatment and evaluate if the risks are out weighed by the benefits. Each person is different and we help make these assessments on a person- by-person basis.

Lastly, if you are refused surgery because you are taking osteoporosis medications, it is a good idea to seek out a second opinion.