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Once Is Enough: A Guide to Preventing Future Fractures

So, you’ve broken a bone. Only those who have experienced a fracture can truly understand how painful and debilitating it can be. Recovering should be your first priority. However, you and your doctor also will want to determine whether this fracture is a symptom of osteoporosis. If you have this underlying disorder, it puts you at greater risk for future fractures. If you are age 50 or older, there is a very good chance your fracture is related to osteoporosis.

Many people are unaware of the link between a broken bone and osteoporosis. Osteoporosis, or “porous bone” is a disease characterized by low bone mass. It makes bones fragile and more prone to fractures, especially the bones of the hip, spine, and wrist. Osteoporosis is called a “silent disease” because bone loss occurs without symptoms. People typically do not know that they have osteoporosis until their bones become so weak that a sudden strain, twist, or fall results in a fracture.

Osteoporosis is a major public health threat for an estimated 44 million Americans, 68 percent of whom are women. In the United States today, approximately 10 million people already have the disease and nearly 34 million more are believed to have low bone mass, which leaves them at increased risk for osteoporosis. Of the 10 million Americans estimated to already have osteoporosis, 8 million are women and 2 million are men.

One in two women and one in four men will have an osteoporosis-related fracture in their lifetime. At least 90 percent of all hip and spine fractures among older white women can be attributed to underlying bone fragility. Moreover, women near or past menopause who have sustained a fracture in the past are twice as likely to experience another fracture. Yet, unfortunately, only 5 percent of patients with osteoporotic fractures are referred for an osteoporosis evaluation and medical treatment.

The Osteoporosis Evaluation
It is never too late to talk to your doctor about osteoporosis. Ideally, you should talk to your doctor during your recovery about whether you might be a candidate for an osteoporosis evaluation. But even if your fracture has healed, you can be evaluated and begin taking steps to protect your bones now.

Many different kinds of doctors can evaluate and treat osteoporosis. Start with your primary care doctor or the doctor treating your fracture. He or she probably can conduct the evaluation and may then refer you to a specialist, such as an endocrinologist or rheumatologist, if you require treatment.

One thing your doctor will do is ask about your medical history and lifestyle to determine whether you have risk factors for osteoporosis. Some of the factors that increase the risk of developing osteoporosis include personal or family history of fractures; low levels of the hormone estrogen or testosterone; and the use of certain medications, such as glucocorticoids or anti-seizure medications, that may contribute to bone fragility. Your doctor also may want to test your blood or urine and may suggest that you have a bone mineral density test.

A bone mineral density (BMD) test is the best way to determine your bone health. This test can identify osteoporosis, determine your risk for fractures (broken bones), and measure your response to osteoporosis treatment. The most widely recognized BMD test is called a dual-energy x-ray absorptiometry, or DXA test. The test is safe and painless, a bit like having an x ray, but with much less exposure to radiation. It can measure bone density at your hip and spine and takes only 15 minutes to complete. For a DXA test, you will be asked to lie on a table while a machine above you measures your bone density.

Some private insurance plans will cover BMD tests ordered by your doctor. Medicare also may pay for a BMD test under certain circumstances for women and men age 65 or older. Your doctor and his or her office staff can help you determine if Medicare will cover a BMD test for you.