Falls increase with age and are a stronger predictor of fractures than bone mineral density (BMD) measured by osteoporosis screening, according to the JAMA (Mar.26, 2008). Also, a person after age 45 with a history of fracture resulting from mechanical forces that would not ordinarily cause fracture in a healthy adult (fragility fracture) has a higher risk of bone fracture than an individual without such a history, all other factors, including age and T- score being equal.
More falls with increasing age, are a major cause of death in the elderly, and result from the normal loss of coordination, balance, quick reflexes, and strong muscles. Thus, the ability to avoid injury is a major determinant of fracture, more important than bone strength per se. BMD, bone mineral density which is measured in only two or three pre-defined locations varies greatly from one area of bone to another, and is only one measure of bone strength, the others being the size and thickness of the bone itself, bone microstructure, amount and type of bone protein cross links, porosity, accumulated damage (microcracks), etc.
Bis- or diphosphonates, such as Alendronate (Fosamax ©), Ibandronate (Boniva ©-Thanks, Sally Field), calcium, vitamin D, and estrogens have all been shown to increase bone mineral density and decrease fractures and mortality. “However, in two well-designed studies in which elderly individuals were enrolled on the basis of being at increased risk of hip fracture because of factors other than low BMD, treatment with bisphosponates did not decrease risk of hip fractures.”
Common sense suggests that training exercises for all patients, not just the elderly, to improve muscle strength, balance, techniques to avoid falls, even tai chi, -should be as good an investment as putting everyone on diphosphonates. The World Health Organization (WHO) and other organizations have recommended using an individual’s 10 year-fracture risk as a guide to treatment decisions, not just the BMD.
Far too many patients, especially younger women may be taking diphosphonates solely on the basis of abnormal bone mineral density tests. After all, it’s a $6 billion market, beginning to shrink until the latest and more risky long-acting compounds, such as Zolendronate started appearing. Read what Gillian Sanson has to say in her outstanding book, The Myth of Osteoporosis MCD Century Publications, 2003.