Extra Padding

Extra Padding

Specialized padding protects football players, but apparently it does nothing to help protect the elderly from hip fractures.

In a new study, Harvard Medical School researchers lead a team that examined the effectiveness of padded devices designed to help prevent hip fractures. The devices were made of foam, covered with a hard polyethylene shield, and were tested on more than 1,000 subjects in nearly 40 nursing homes. After 20 months the study was concluded when it became obvious that there was no difference in the rate of hip fracture between those who wore the padding and those who didn’t.

Writing in a recent issue of the Journal of the American Medical Association, the researchers concluded: “Hip protectors, as currently designed, are not effective for preventing hip fracture among nursing home residents.”

So until someone perfects a padding design that offers genuine protection, there are a number of more effective steps the elderly can take to reduce their risk of hip fracture.

Inadvertent risk

Searching back through the e-Alert archives I found four circumstances that may increase the risk of hip fracture. Each of these circumstances can be modified to reduce fracture risk.

* Circumstance One: High Homocysteine

In 2004, researchers used blood samples collected from the Framingham Heart Study to assess levels of the amino acid homocysteine in more than 1,100 women and 825 men over the age of 59. Medical records were followed for about 15 years. Results showed that women with the highest levels of homocysteine had almost twice the risk of hip fracture compared to women with the lowest levels. Among men the link was even more pronounced: Those with high homocysteine levels had nearly four times the risk of hip fracture as the men with low levels. A similar trial in the Netherlands produced comparable results. Homocysteine can be lowered with folic acid supplements and regular exercise

* Circumstance Two: Proton-Pump Inhibitor (PPI) Drugs

PPIs are used to address heartburn, acid reflux, and other gastrointestinal reflux diseases, but this class of drugs may impede calcium absorption while also reducing bone resorption (part of the natural process that renews bone structure). University of Pennsylvania researchers compared PPI use with incidence of hip fracture in nearly 150,000 subjects over the age of 50. Results: Low dose PPI produced only slight risk of hip fracture, but subjects who used PPIs for more than a year increased risk of hip fracture by 44 percent compared to subjects who didn’t use PPIs. Use of high dose PPIs over a long period substantially increased fracture risk.

* Circumstance Three: Antidepressant Drugs

In a five-year trial that followed 8,000 women over the age of 65, subjects who took antidepressants were found to be 70 percent more likely to suffer disabling hip fractures. Researchers suspect that reduced alertness, prompted by the drug use, was to blame for the higher incidence of fractures.

*Circumstance Four: Asthma Inhalers

Doctors have known for some time that taking steroids in pill form contributes to bone loss. In a 2001 study of 109 women between the ages of 18 and 45, researchers found that subjects who took frequent puffs from asthma inhalers significantly increased their rate of bone loss. Researchers recommended that asthma patients use the lowest effective dose from inhalers, engage in weight-bearing exercise, and supplement with calcium and vitamin D.

Supplements on the Must List

Supplement with calcium and vitamin D. Provided your doctor agrees, that’s pretty good advice for just about anyone who wants to improve bone health and reduce fracture risk.

In a 2003 Harvard study that included more than 72,000 women, subjects who consumed at least 12.5 mcg of vitamin D daily from a combination of food and supplements had a 37 percent lower risk of hip fracture than women who consumed less than 4 mcg per day. The research also indicated that among older women, vitamin D intake provided better protection for bones than calcium.

Nevertheless, as we’ve seen in many studies, vitamin D and calcium work hand-in-hand when it comes to bone health. In a 2005 review of a dozen placebo-controlled studies, bone disease researchers in Belgium found that vitamin D supplementation alone provided no significant effect on hip fracture risk, but when calcium supplements were added, fracture risk dropped by nearly 20 percent.

You can find in-depth commentary about supplementing with calcium in the e-Alert “Panoramic View” (7/5/07), available at this link: http://www.hsionline.com/ealerts/ea200707/ea20070705a.html