Fragile bones are bones that break with low energy injury or a fall from standing height or less. We may encounter this when our grandparent has a hip fracture – found on the floor and taken to a hospital for emergency surgery followed by a course of physical therapy and rehab, someti mes requiring long-term care in a nursing facility. This fragility fracture, or ‘bone attack’ is an intimate unexpected failing in our bone health and it changes all our lives, from patient, to caregiver and beyond. We do not plan for emergency hip fracture repair surgery as we do for elective total hip replacement, and so are not mentally prepared to go from walking to invalid to surgery overnight. We have agendas, we have obligations, we have our lives to lead, without breaks in our steps. A fracture was not in our cards but 50% likelihood that we will have another break one year after a hip fracture.
We must therefore realize that fixing the fracture itself, through orthopedic hardware, is not the end of treatment. It is just beginning, not only in terms of rehabilitation but in terms of durable bone health. If a concrete dam bursts and floods the plains below and all we do is patch the hole, we have not taken care of the primary source of the problem which is the weakened concrete and the overflow of water upstream. We may be able to rebuild a dam from the ground up, by removing the old structure, bypassing the water, and then pouring brand new fresh reinforced concrete, as expensive or impractical as that sounds. We cannot remove old bones and replace them with new young ones, at least not yet – 3D bio-printing may change that in the future, but not now. Therefore, we need to replenish the strength of bones by taking advantage of their physiology and biological activity. Unlike concrete, bones are alive and can improve their structure just as much as they can deteriorate – through movement, exercise, nutrition, diet, medications and environment.
The flood in this analogy is the epidemic loss of bone tissue (mineral, collagen, matrix) – osteoporosis. Keep in mind, this does not imply that we have so much bone tissue that it bursts out of our bones like the dam over-spill. Instead, there are silent leakage points in our bones slowly leaching the minerals and deteriorating the tissues to a breaking point, whereby the collapse is the first sign of weakness. We never want to think of ourselves as weak. We may feel we have strong bones and even deny testing or results that reveal osteoporosis and may even refuse further testing or treatment. We must be honest not only with ourselves but our science. Could we have prevented this break? Could we have foreseen this break? Could we have been protected before we broke? Yes. Outcome data in the literature supports this. Osteoporosis screening, primary prevention and secondary fracture prevention and treatment strategies of at-risk or high-risk patients with drug or biologic therapeutics that help build and strengthen bones and or prevent further bone loss, do work. However, less than 20% of patients that should be treated with an osteoporosis drug are actually treated, even after a fracture. Imagine only 20% of heart attack victims receiving a beta-blocker. This is an 80% care gap.
Much like the tip of the iceberg, the hip fracture is a sentinel event that should steer us toward the bigger underlying problem – lack of a strong foundation. Imagine now a house with a termite infestation with pores throughout the structure, an impending collapse, do we simply place a strut next one pillar alone, or fumigate the house, patching up each and every hole? The latter is where we are missing the mark. Porosity in our bones is weakening our strength and diluting our quality. We need to cut our losses and prevent future breaks. Let’s stand up together and build our bones, not just for ourselves, but our future generations through education and action.
Protect, promote and provide healthy living bones through prevention and treatment.