Source : INDIA TODAY NEWS
Editor’s Note: In this fortnightly column, top doctors share how they deal with their own health challenges, offering readers expert insight grounded in experience. Read more such stories here.
A few weeks ago, I fractured my wrist. As a physician, I have managed patients with fractures and their complications for years. But wearing a cast myself reminded me of something medicine sometimes fails to communicate adequately: a fracture is not simply a broken bone waiting to unite.
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Even an uncomplicated fracture can suddenly affect your ability to drive, work, exercise, type, cook, bathe or perform seemingly trivial everyday tasks. There are consultations, X-rays, medicines, repeated hospital visits, rehabilitation and lost working hours.
For someone who earns a daily wage, runs a small business or has no paid leave, those lost weeks can have a very real financial cost. But when an older person fractures a bone, particularly the hip, the consequences can be much more serious.
AT 40, A FRACTURE CAN DISRUPT YOUR LIFE. AT 75, IT CAN CHANGE ITS TRAJECTORY
One of the most dangerous sentences I hear around fractures is: “It is only a fracture.” In an otherwise healthy young adult, many fractures heal well and normal life gradually returns. In a frail older person, however, a major fracture can start a completely different chain of events. Pain leads to reduced movement. Reduced movement causes further loss of muscle and strength. The person becomes afraid of falling again.
Walking decreases further. Independence starts disappearing. Someone who was going to the market, bathroom or neighbourhood park independently may suddenly need assistance simply to get out of bed. Prolonged immobility can bring additional problems, including deconditioning, pressure injuries, infections, blood clots and worsening of existing illnesses.
Hip fractures are particularly serious. Orthopaedic guidance recognises them as potentially life-altering events in older adults, associated with loss of function and independence, as well as substantial mortality during the following year.
So, in an elderly patient, the important question is not merely, “Will this bone unite?” It is also, “Will this person return to the life they were living before the fracture?”
SOMETIMES, THE FRACTURE IS THE SYMPTOM
There is another mistake we commonly make. A person slips in the bathroom, fractures a wrist or hip, gets the fracture treated, and everyone moves on.
But I want to know why that particular fall resulted in a fracture. Was the bone already weak? Was there osteoporosis? Was there vitamin D deficiency or another metabolic problem affecting bone? Is the patient taking long-term steroids or another medicine affecting bone health?
Is there kidney, thyroid or parathyroid disease? Has the person’s muscle mass and balance deteriorated? Have there been previous falls that everyone dismissed as “old age”?
A fracture after relatively minor trauma, particularly in an older adult, should sometimes be viewed as a bone-health alarm, not merely an accident. The fracture is visible. The vulnerability behind it may not be.
PLEASE DON’T RESPOND BY SIMPLY BUYING CALCIUM TABLETS
After a fracture, one of the most common reactions I see is: “Doctor, which calcium should we start?” Calcium matters. Vitamin D matters. But bone health is much more than swallowing calcium tablets. Bones are living tissue whose health is influenced by nutrition, hormones, physical activity, age, medications and several diseases.
In appropriate patients, evaluation may include bone-mineral-density testing, such as a DXA scan, and assessment for secondary causes of weak bones.
People at sufficiently high fracture risk may require specific osteoporosis medicines, not merely calcium and vitamin D. And indiscriminate supplementation isn’t the answer either. Current guidance does not recommend that every healthy adult routinely take high-dose vitamin D or undergo repeated vitamin D testing. Calcium is preferably obtained adequately through food, with supplementation used when appropriate.
This distinction becomes even more important in people with kidney disease. As a nephrologist, I frequently deal with patients in whom calcium, phosphate, vitamin D and parathyroid hormone interact in a complicated manner. Chronic kidney disease can produce its own spectrum of mineral and bone disorders.
For these patients, casually adding calcium or vitamin D, particularly specialised forms of vitamin D, without understanding the underlying mineral metabolism can be inappropriate. A weak bone needs a diagnosis, not just a supplement.
YOUR MUSCLES ARE PART OF YOUR FRACTURE-PREVENTION SYSTEM
When we discuss osteoporosis, almost the entire conversation tends to revolve around bones. We forget the structure surrounding them: muscles. Muscle strength, gait and balance help prevent the fall that causes the fracture in the first place. That becomes increasingly important as we grow older.
Regular walking is valuable, but maintaining strength also matters. Appropriate resistance exercises, adequate nutrition and protein intake, and balance training can help preserve physical function.
If your parent has begun walking hesitantly, holding onto furniture, struggling to rise from a chair or repeatedly losing balance, don’t automatically label it “normal ageing.” It deserves attention. The best fracture is the one that never happens.
FALL-PROOF YOUR PARENTS’ HOME BEFORE THEY FALL
Families often make their homes safer after an elderly parent has fractured something. I would rather they do it before. Look around the house from the perspective of someone whose eyesight, reflexes and balance are no longer what they were 20 years ago. A loose bathroom mat, slippery floor, poorly lit staircase, cluttered passage, unsuitable footwear or absence of a grab rail can become surprisingly important.
Also, review eyesight and medications. Some medicines can contribute to dizziness, sedation or low blood pressure and thereby increase the likelihood of falls. And if an older family member has fallen repeatedly, even without sustaining a fracture, don’t wait for the “big fall” before investigating why.
AFTER ONE FRACTURE, THINK ABOUT PREVENTING THE NEXT ONE
Fixing the current fracture is only half the job. Depending on age and circumstances, the period after a fracture can be an opportunity to assess osteoporosis, nutrition, muscle strength, balance, medications, vision and other fall risks.
For older adults recovering from major fractures, rehabilitation is not an optional extra. Physical and occupational therapy can contribute to recovery of function and prevention of further falls.
The goal should not merely be an X-ray showing that the bone has united. The goal is to get the person walking, functioning and living independently again whenever possible.
My own wrist will heal. But it has given me a useful reminder of what I want my patients and their families to remember: at a younger age, a fracture can steal weeks of productivity. In an older person, a major fracture can steal independence.
So don’t wait for a broken bone to start thinking about bone health. Build muscle. Stay active. Eat adequately. Make the home safer. Investigate unexplained or repeated falls. Assess osteoporosis when clinically appropriate. And don’t assume that calcium tablets alone are the solution. Because sometimes the fracture is only what we can see. The real disease is what made the bone break so easily in the first place.
(Dr Anant Joshi is a Senior Consultant Nephrologist at Chiranjeevi Kidney and Dental Clinic, Ashok Vihar, Delhi.)
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SOURCE :- TIMES OF INDIA
