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Wednesday, September 13, 2017

Calculating Carbohydrates — Precursors of Glucose

When you eat a meal, the immediate source of glucose in your blood comes
from the carbohydrates in that meal. One group of carbohydrates is the
starches, such as cereals, grains, pastas, breads, crackers, starchy vegetables,
beans, peas, and lentils. Fruits make up a second major source of
carbohydrate. Milk and milk products contain not only carbohydrate but
also protein and a variable amount of fat, depending on whether the milk is
whole, lowfat, or fat-free. Other sources of carbohydrate include cakes, cookies,
candies, sweetened beverages, and ice cream. These foods also contain a
variable amount of fat.

To determine what else is found in food, check a source such as The
Official Pocket Guide to Diabetic Exchanges, published by the American
Diabetes Association and the American Dietetic Association, or The Diabetes
Carbohydrate and Fat Gram Guide, published by the American Diabetes

Determining the amount of carbohydrate

How much carbohydrate should you have in your diet? The current recommendation
is between 40 to 65 percent of daily calories. In our experience,
those who keep their carbohydrate intake on the lower side of that range
have less trouble controlling their blood glucose levels and maintaining
lower levels of blood fats. Your registered dietitian may recommend more.
We wouldn’t argue as long as you can maintain satisfactory blood glucose
levels while not increasing the level of triglyceride, a blood fat.

Considering a Vegetarian Diet

The evidence for the benefits of vegetarian eating for your health is growing.
There are several degrees of vegetarian eating:

✓ Vegan leaves out all animal meats and products including dairy.

✓ Lacto-ovo vegetarian includes eggs, milk, and milk products.

✓ Pesco-vegetarian includes fish with eggs, milk, and milk products.

A study in the May 2009 issue of Diabetes Care compared the eating patterns
in Seventh Day Adventists, a group in whom there were different patterns of
vegetarianism. The study found that the group that followed a vegan diet had
the lowest average body mass index (BMI), 23.6, while lacto-ovo vegetarians
had a BMI of 25.7, pesco-vegetarians had a BMI of 26.3, and nonvegetarians
had an average BMI of 28.8. The prevalence of diabetes increased from 2.9
percent in vegans to 7.6 percent in nonvegetarians.

A second key study in the March 2007 issue of The Archives of Internal
Medicine looked at 322,263 men and 223,390 women who provided detailed
histories of their diet and other habits including smoking, exercise, alcohol
consumption, education, weight, and family history of cancer. Over the
course of ten years, 47,976 men and 23,276 women died. Their meat consumption
varied from 1 ounce to 4 ounces a day and processed meat (like
hot dogs, salami, etc.) ranged from once a week to one and one half ounces a
day. The number of excess deaths attributed to high meat consumption was
large. The authors drew the following conclusions:

✓ If these groups are representative of all Americans, over the course of a
decade, the deaths of 1 million men and half a million women could be
prevented by eating less red and processed meats.

✓ People should eat a hamburger only once or twice a week maximum.

✓ People should eat steak only once a week maximum.

✓ People should eat processed meats less than once in six weeks

Controlling Your Blood Pressure

Keeping your blood pressure in check is particularly important in preventing
the macrovascular complications of diabetes. But elevated blood pressure
also plays a role in bringing on eye disease, kidney disease, and neuropathy.
You should have your blood pressure tested every time you see your doctor.
The goal is to keep your blood pressure under 130/80. (See Dr. Rubin’s book
High Blood Pressure For Dummies, 2nd edition, published by Wiley, for a complete
explanation of the meaning of these numbers.) You may want to get
your own blood pressure monitor so that you can check it at home yourself.
The statistics about diabetes and high blood pressure are daunting. Seventyone
percent of diabetics have high blood pressure, but almost a third are
unaware of it. Almost half of them weren’t being treated for high blood pressure.
Among the treated patients, less than half were treated in a way that
reduced their pressure to lower than 130/80.
You can do plenty of things to lower your blood pressure, including losing
weight, avoiding salt, eating more fruits and vegetables, and, of course, exercising.
But if all else fails, your doctor may prescribe medication. Many blood
pressure medicines are available, and one or two will be exactly right for you.
See High Blood Pressure For Dummies, 2nd Edition, for an extensive discussion
of the large number of blood pressure medications.
One class of drugs in particular is very useful for people with diabetes with high
blood pressure: angiotensin converting enzyme inhibitors (ACE inhibitors),
which are especially protective of your kidneys. If kidney damage is detected
early, ACE inhibitors can reverse the damage. Some experts believe that all
diabetics should take ACE inhibitors. We believe that if there’s no evidence of
kidney damage and the diabetes is well controlled, this isn’t necessary.

Treating diabetes

Treatment of diabetes involves three essential elements:

✓ Diet: If you follow the recommendations in this book, you can lower
your average blood glucose by as much as 30 to 50 mg/dl. Doing so can
reduce the complication rate by as much as 33 percent.

✓ Exercise: We touch on exercise in Chapter 3 and cover it more extensively
in Diabetes For Dummies, 3rd Edition (Wiley).

✓ Medication: Diabetes medications abound — there are far too many to
discuss here, but you can find out about them in Diabetes For Dummies,
3rd Edition

Consequences of Diabetes

If your blood glucose isn’t controlled — that is, kept between 70 and 139 mg/
dl after eating or under 100 mg/dl fasting — damage can occur to your body.
The damage can be divided into three categories: irritations, short-term complications,
and long-term complications.


Irritations are mild and reversible but still unpleasant results of high blood
glucose levels. The levels aren’t so high that the person is in immediate lifethreatening
danger. The most important of these irritations are the following:

✓ Blurred vision
✓ Fatigue
✓ Frequent urination and thirst
✓ Genital itching, especially in females
✓ Gum and urinary tract infections
✓ Obesity
✓ Slow healing of the skin

 Short-term complications

These complications can be very serious and lead to death if not treated.
They’re associated with very high levels of blood glucose — in the 400s and
above. The three main short-term complications are the following:

✓ Ketoacidosis: This complication is found mostly in type 1 diabetes. It
is a severe acid condition of the blood that results from lack of insulin,
the hormone that is missing. The patient becomes very sick and will die
if not treated with large volumes of fluids and large amounts of insulin.
After the situation is reversed, however, the patient is fine.

✓ Hyperosmolar syndrome: This condition is often seen in neglected
older people. Their blood glucose rises due to severe dehydration and
the fact that the kidneys of the older population can’t get rid of glucose
the way younger kidneys can. The blood becomes like thick syrup. The
person can die if large amounts of fluids aren’t restored. They don’t
need that much insulin to recover. After the condition is reversed, these
people can return to a normal state.

✓ Hypoglycemia or low blood glucose: This complication happens when
the patient is on a drug like insulin or a pill that drives the glucose down
but isn’t getting enough food or is getting too much exercise. After it
falls below 70 mg/dl, the patient begins to feel bad. Typical symptoms
include sweating, rapid heartbeat, hunger, nervousness, confusion, and
coma if the low glucose is prolonged. Glucose by mouth, or by venous
injection if the person is unconscious, is the usual treatment. This complication
usually causes no permanent damage.

Long-term complications

These problems occur after ten or more years of poorly controlled diabetes
or, in the case of the macrovascular complications, after years of prediabetes
or diabetes. They have a substantial impact on quality of life. After these
complications become established, reversing them is hard, but treatment is
available for them early in their course, so watch for them five years after
your initial diagnosis of diabetes. See Dr. Rubin’s book Diabetes For Dummies,
3rd Edition (Wiley), for information on screening for these complications.
The long-term complications are divided into two groups: microvascular,
which are due at least in part to small blood vessel damage, and macrovascular,
associated with damage to large blood vessels.

Microvascular complications include the following:

✓ Diabetic retinopathy: Eye damage that leads to blindness if untreated.
✓ Diabetic nephropathy: Kidney damage that can lead to kidney failure

Types of diabetes

The following list describes the three main types of diabetes:

✓ Type 1 diabetes: This used to be called juvenile diabetes or insulindependent
diabetes. It mostly begins in childhood and results from the
body’s self-destruction of its own pancreas. The pancreas is an organ of
the body that sits behind the stomach and makes insulin, the chemical
or “hormone” that gets glucose into cells where it can be used. You can’t
live without insulin, so people with type 1 diabetes must take insulin
shots. Of the 24 million Americans with diabetes, about 10 percent have
type 1.

✓ Type 2 diabetes: Once called adult-onset diabetes, type 2 used to begin
around the age of 40, but it is occurring more often in children, many of
whom are getting heavier and heavier and exercising less and less. The
problem in type 2 diabetes is not a total lack of insulin, as occurs in type
1, but a resistance to the insulin, so that the glucose still doesn’t get into
cells but remains in the blood.

✓ Gestational diabetes: This type of diabetes is like type 2 diabetes but
occurs in women during pregnancy, when a lot of chemicals in the mother’s
blood oppose the action of insulin. About 4 percent of all pregnancies are
complicated by gestational diabetes. If the mother isn’t treated to lower
the blood glucose, the glucose gets into the baby’s bloodstream. The baby
produces plenty of insulin and begins to store the excess glucose as fat in
all the wrong places. If this happens, the baby may be larger than usual and
therefore may be hard to deliver. When the baby is born, he is cut off from
the large sugar supply but is still making lots of insulin, so his blood glucose
can drop severely after birth. The mother is at risk of gestational diabetes in
later pregnancies and of type 2 diabetes as she gets older.

✓ Other types: A small group of people with diabetes suffer from one of
these much less common varieties of diabetes:

• Latent autoimmune diabetes on adults (LADA), which has characteristics
of both type 1 and type 2 diabetes
• Genetic defects of the beta cell, which makes insulin
• Medications that affect insulin action like cortisol or prednisone
• Diseases or conditions that damage the pancreas like pancreatitis
or cystic fibrosis
• Genetic defects in insulin action

Recognizing Diabetes

With so much diabetes around these days, you may think that recognizing it
should be easy. The truth is that it’s not easy, because diabetes is defined by
blood tests. You can’t just look at someone and know the level of glucose —
blood sugar — in his or her blood

The level of glucose that means you have diabetes is as follows:

✓ A casual blood glucose of 200 milligrams per deciliter (mg/dl) or more at
any time of day or night, along with symptoms such as fatigue, frequent
urination and thirst, slow healing of skin, urinary infections, and vaginal
itching in women. A normal casual blood glucose should be between 70
and 139 mg/dl.

✓ A fasting blood glucose of 126 mg/dl or more after no food for at least
eight hours. A normal fasting blood glucose should be less than 100 mg/dl.

✓ A blood glucose of 200 mg/dl or greater two hours after consuming 75
grams of glucose.

A diagnosis of diabetes requires at least two abnormal levels on two different
occasions. Don’t accept a lifelong diagnosis of diabetes on the basis of a
single test.

A fasting blood glucose between 100 and 125 mg/dl or casual blood glucose
between 140 and 199 mg/dl is prediabetes. See Dr. Rubin’s book Prediabetes
For Dummies (Wiley). Most people with prediabetes will develop diabetes
within ten years. Although people with prediabetes don’t usually develop
small blood vessel complications of diabetes like blindness, kidney failure,
and nerve damage, they’re more prone to large vessel disease like heart
attacks and strokes, so you want to get that level of glucose down. Sixty
million people in the United States have prediabetes

Knowing When to Call a Doctor

You may find it hard not to worry about the slightest sniffle your little darling
gets, but more often than not it’s nothing serious. However, you do need to
call a doctor if:

Your baby under 3 months old has a fever – this must always be
regarded as potentially serious.

Your child’s listless or miserable even after you’ve brought down her

Your child’s breathing is rapid or laboured.

Your child’s colour changes from pink or red to mauve or blue.

Your child has a convulsion (fit).

Your child loses consciousness.

Your child has blood in her urine, vomit, or stools.

Keep in mind that young children can develop dangerous symptoms quite
rapidly. If your child’s poorly, keep a close eye on her and call your doctor if
you’re in any doubt.

Spotting the Signs That Something’s Wrong

Even if you do everything right, your child’ll get ill – and probably quite frequently.
This isn’t a bad thing: Your child’s body needs to come into contact
with bacteria and viruses in order to build up a good resistance to the germs.
In fact, some research shows that the more illnesses your child gets in the
first few years of life, the healthier she’s likely to be later.

Of course, you won’t welcome every cold and tummy bug your child falls
victim to. After all, caring for an ill child can be extremely worrying, especially
when you can’t quite work out what’s wrong. Try to keep things in perspective:
All children get ill, and in the vast majority of cases the illnesses
aren’t serious and don’t pose any threat to your child’s long-term health.
However, if you’re at all concerned about your child, get her checked out by a
doctor. And try to be aware of the signs of diseases such as meningitis, which
need urgent medical treatment

The person who can tell better than anyone else whether your child is ill is
you. Follow your instincts: You’re likely to be able to spot when something’s
not quite right. Signs that your child has a bug include the following:

A fever: The presence of a fever almost always means an infection.
Fever itself is not dangerous – it’s the body’s normal reaction to the
presence of foreign organisms – but you need to bring down your child’s
temperature to avoid overheating, which can cause a febrile convulsion.

Irritability or lethargy: Your child’s behaviour may be influenced by a
fever. The raised temperature may make her irritable, drowsy, or lethargic
Coughing: This is a common sign that your child has an infection.

Vomiting and diarrhoea: Symptoms like these are usually associated
with problems directly involving the tummy or bowel, such as gastroenteritis
or food poisoning, although sometimes they occur for other reasons.
Some children vomit if they have a high temperature; others vomit
if they’re emotionally upset.

Yes, diarrhoea really can be a cause for celebration! If your child is suffering
from diarrhoea as well as vomiting, she probably has a tummy
bug, which usually settles on its own with no ill effects.

 Vomiting without diarrhoea, especially if
accompanied by fever, may have a different cause such as a urine infection.
If you’re in doubt, ring NHS Direct (0845-4647) or speak to your GP
or health visitor.

A rash: Rashes often suggests a viral infection. The presence of a rash
doesn’t usually make the illness any more serious – in fact, it can help
your doctor diagnose illnesses such as German measles and chickenpox.
But if your child has a rash, ask your doctor to check it out to ensure that
she’s not displayinga symptom of meningitis or another dangerous illness.
The easiest way to test for meningitis is the ‘glass test’. Press the bottom of
a glass on to your child’s rash. If the rash fades or disappears, it is almost
certainly not meningitis; if the rash remains, your child may have meningococcal
septicaemia (blood poisoning) – so call an ambulance immediately.
The list above is a very general description of a few of the most common
childhood symptoms. More detailed info on what to look out for appears
elsewhere in the book. If you’re caring for an infant, head to Chapters 7 and 8,
which are devoted to infant healthcare. For older children

Keeping Your Child Healthy

Illness is one of the things we fear most for our children. It’s impossible – and
unnecessary – to shield your child from every bug out there, but you can
help to boost her health and vitality, making her stronger and better able to
fight off illnesses efficiently.

Eat, drink, and be healthy

If you want your child to eat healthily, you need to serve her a wide variety of
nutritious foods for energy, growth, and development. This means giving
processed and junk foods a wide berth – but it doesn’t mean not being flexible.
Food isn’t worth arguing over, and if your child insists on eating curly
cheesy crisps, that’s fine – as long as they don’t form her staple diet. If most
of the food your child eats is nutritious, you’ll be keeping her in tip-top condition.
Try doing the following to make sure that she eats well:

Give your child at least five helpings of fruit and vegetables a day –
fresh, frozen, canned, dried, or juiced. You’re probably already aware
of this important point, but there’s no harm in stressing it again. Fruit
and veg contain the crucial nutrients needed to maintain a healthy
digestive system, create new body tissue, fight infections, and a lot
more. Try to offer your child at least one orange and one green fruit or
vegetable every day, as they are known to be particularly beneficial and
may help to prevent cancer and other serious diseases.

Fruit or vegetable juice only makes up one of her daily portions of fruit
and vegetables, no matter how much she drinks. That’s because other
goodies in the flesh are not included in juice, and digesting whole fruit
and vegetables benefits her system.

Make sure that your child eats breakfast. Studies show that if your child
eats breakfast, she’s far less likely to become obese in later life. Skipping
breakfast can cause blood-sugar problems and make your child’s metabolism
sluggish, which is bad for the digestive system. Most experts say
that breakfast’s the most important meal of the day: Breakfast eaters are
less likely to contract diabetes or have high cholesterol, which is a
known risk factor for heart disease.

Maintain your own healthy diet. You’re important too! Eating healthy
food yourself is one of the best ways of getting your child into good
habits, so make sure that you tuck in to your greens. Studies also show
that children who have regular family mealtimes are more likely to have
healthier diets than those who don’t. Snacking in front of the telly is a
definite no-no.

Offer as much unprocessed food as possible, and get into the habit of
reading labels on the foods you serve. Check for things such as hidden
fats, sugars, additives, and salt. Foods with lots of preservatives and
added flavourings are often deficient in essential nutrients and high in
unhealthy (and unnecessary) chemicals. Salt’s a particular danger – it
can cause health problems, including high blood pressure and heart
conditions. And sugar (and sugar substitutes), additives, and colourings
have been linked with everything from behavioural problems to physical

Get your child to drink six to eight glasses of water a day. Drinking
enough fluids is vital. Water’s the best drink by far – try to keep sugary
drinks and juices to a minimum, and don’t serve them at all between
meals because they are lethal to tiny teeth. The British medical profession
has been telling us for many years that most children aren’t drinking
enough. Dehydration leads to many short-term and long-term health
problems: Lack of water can cause headaches, constipation, and poor
concentration, to name but a few things.

A good way to tell whether your child’s dehydrated is to check the
colour of her urine. Her urine should be a pale straw colour: If it’s dark
yellow, she may well be dehydrated. A sunken fontanelle (the soft spot
on a baby’s head) can also indicate dehydration.

A moving story

Exercise is vital for everyone – especially your child. Whether your child’s
dancing around the living room or entering a swimming gala, getting active is
all good stuff. Exercise boosts circulation and helps infection-fighting lymphatic
fluid to move throughout the body. Exercise is great for your child’s
emotional health too: When your child exercises, her brain releases chemicals
called endorphins, the body’s natural feel-good chemicals. Your active
child develops stronger muscles and bones, is less likely to become overweight,
has a reduced risk of developing type 2 diabetes, and has lower blood
pressure and cholesterol levels compared with inactive children. For more
details on the benefits of exercise and for suggestions for keeping your child

Breathing easy

In the UK, around 17,000 children under the age of 5 years are admitted to
hospital every year with illnesses related to passive smoking. Not smoking
around your child is a crucial way of safeguarding her health. Scientists have
shown that passive smoking has a lasting impact on the long-term health and
respiratory system of children. Inhaling cigarette smoke increases the risk of
asthma and other acute respiratory conditions and contributes to many
childhood illnesses, including bronchitis, pneumonia, asthma, middle-ear
infections, cot death, and possibly even autism. If your child inhales cigarette
smoke, she’s also at increased risk of developing certain kinds of cancer,
including lung cancer. Research has even found a link between lower IQ levels
and exposure to cigarette smoke.

Going outside the house to smoke doesn’t fully protect your child – although
of course outside is far better than smoking indoors. Research shows that poisonous
chemicals from cigarette smoke cling to your clothes and hair and are
released back into the air – and then inhaled by your child. When researchers
measured toxic chemicals in the blood of children whose parents smoked outdoors,
they found the levels of chemicals to be far higher than in children
whose parents never smoked at all, inside or out.

All you need is . . .

. . . love! To thrive, your child needs lots of cuddles and human contact, particularly
with her main carers. Studies show that lack of love and affection is
as damaging to children as food deprivation: Adequately nourished babies
deprived of human relationships become impeded in their development in
both mind and body.

We cannot overemphasise the importance of touch – human contact is critical
for development and well-being. Babies who are held cry less than those
who aren’t, and those who’re cuddled and massaged frequently tend to have
better immune systems and handle stress more efficiently than those who
aren’t. The need for touch continues into childhood and beyond. One study
showed that when children were massaged regularly for a month, blood glucose
levels dropped dramatically in diabetic children and the children were
able to reduce their medication, while asthmatic children had fewer asthma
attacks. Massage also reduced the symptoms in children with autism, severe
burns, cancer, and arthritis.

Monday, August 21, 2017

Preparing to Meet the Doctor

Making a list of important questions before seeing any doctor for
the first time or when you’re going to discuss a specific problem is
always a good idea. For some reason many people’s anxiety levels
shoot through the roof when visiting the doctor’s office, often
causing them to forget why they came in. Maybe the antiseptic
smell or the white lab coats do it, but something about the whole
environment can be frightening. Be prepared and make a list so
you don’t forget.

Everyone’s list will be a little different, but use the following basic
questions to get started:

Do you treat many patients with osteoporosis?
What kind of diagnostic tests do you usually conduct?
Will you call me when you get the results, or do I need a
follow-up appointment?
How can I reach you if I have questions?
Will my insurance pay for the tests to be done?
What is your background in treating osteoporosis? Have you
taken additional training to treat it?

You may not be comfortable asking the doctor questions, because
you were raised not to question the doctor. Don’t worry about
asking the doctor for clarification. Most doctors today are interested
in educating their patients and want you to ask questions about
anything that isn’t clear to you. So ask away! And if your doctor
doesn’t feel that way, she may not be the right doctor for you!
Before you even walk in the door, you can ask the office staff the
following questions:

What medical school did the physician attend?
Where did the physician receive her postgraduate training?
Is the physician board certified?
Does the physician’s office have its own bone density
With what hospitals is the physician affiliated? Some insurance
companies have this data available on their Web sites.
The Web might list the medical schools of the physicians who
participate in their network, for example.

Getting ready for your
first appointment

Before you go for your first appointment, put together a manila
folder of “must have’s,” so you don’t forget anything. Make sure to
put the following items in the folder:
Your list of questions

Your medical records, including blood tests done within the
last two years and consultations with other physicians
The scans from your Dual Energy X-ray Absorptiometry (DXA
scan), a specific type of test that measures your bone mineral
density (see Chapter 9 for more on the DXA scan)
Any X-rays (the actual X-rays, not just the reports)

A list of drugs you’re taking for your osteoporosis, as well as a
list of all other medications and vitamins you take with
dosages, including any over-the-counter (OTC) medications
Chapter 8: Finding (and Paying For) a Doctor to Treat Osteoporosis 123
A list of all other health issues you have, because they may
affect your doctor’s recommendations
A list of your other doctors’ names and phone numbers just in
case your doctor wants to speak with them to coordinate
your care

Making sure you’ve found Dr. Right
Finding the right doctor isn’t always easy

 Even if the doctor you’re
seeing has the best reputation in town, he may not be right for
you if:

He makes you feel uncomfortable asking questions.

He doesn’t answer your questions to your satisfaction.

He doesn’t call you back within a reasonable time when you
have concerns.

You may need more than one visit to figure out whether your new
doctor is right for you. Your first visit may be awkward for a number
of reasons: you’re nervous, the doctor is having a bad day, the
office seems disorganized with long waiting times, or the front-desk
staff is unfriendly. Don’t let one bad experience scare you away, if
you feel comfortable with the doctor otherwise.

Choosing a specialist

Many different medical specialties are available where practitioners
may choose to treat patients with osteoporosis. Your primary doctor
can help you decide which one of the following is best for you:

Rheumatologists: Rheumatologists (your co-author Dr.
O’Connor is one) diagnose and treat diseases of the bones,
joints, and muscles, including autoimmune diseases such as
120 Part III: Diagnosing and Treating Osteoporosis
lupus. Rheumatology is a subspecialty of internal medicine
and requires board certification in both internal medicine and

Endocrinologists: Endocrinologists treat diseases of the endocrine
system, which is certainly no surprise. The endocrine
system comprises the glands and hormones that control your
body’s metabolic activity. Endocrinologists treat diabetes, thyroid
problems, and pituitary diseases. Endocrinology, like
rheumatology, is a subspecialty of internal medicine.

Endocrinologists may be especially interested in osteoporosis
because endocrine problems often result in osteoporosis.
Refer to Chapter 3 for a complete discussion of risk factors.

Geriatricians: Geriatricians treat geriatric patients (also
known as senior citizens). When are you in this category?
Although most people would say “never,” the accepted definition
of “geriatric” is age 65 and above.

Because osteoporosis is often, but not always, a disease of
aging, many geriatricians have a special interest in treating it.

Gynecologists: Because women comprise the largest group of
osteoporosis patients, many gynecologists, doctors who treat
women’s health, also treat patients with osteoporosis. If
you’re a man with osteoporosis, though, you may feel a little
funny sitting in the waiting room.

Orthopedic surgeons: Orthopedic surgeons specialize in the
treatment of bones and muscles. Some are interested in treating
osteoporosis, while some aren’t.

Physiatrists: Physiatrists are often confused with everything
from psychologists to podiatrists! Physiatrists specialize in
physical medicine and rehabilitation, dealing with acute
injuries as well as chronic conditions such as arthritis and

Different Types of Fractures

Certain types of fractures are more commonly associated with
osteoporosis and other bone diseases. In this section we define
these common fracture types and the difficulties they can cause.

Falling on outstretched arms

Wrist fractures, often called Colles’ fractures, typically occur as a
result of osteoporosis. These breaks usually happen in the radius,
Chapter 7: Facing the Consequences of Bones Gone Bad 109
the ulna, or some of the other small bones in your wrist (see Figure
7-1). Colles’ fractures often occur when you fall and put your
arm out to break your fall.

Figure 7-1: A wrist or Colles’ fracture is very common in people with osteoporosis.
Darker lines show where the wrist might break.
Treatment requires casting or some other form of immobilization.
Sometimes you may require surgery. You may experience loss of
motion of your wrist, but this type of fracture isn’t nearly as devastating
as a hip or spinal fracture.

However, the occurrence of a wrist fracture is clearly a warning
sign that you may have an overall reduction in the strength of your
bones. A Colles’ fracture is therefore considered a fragility fracture,
and your doctor needs to evaluate you for the possibility of osteoporosis
or other bone disorders.

Who are more prone to wrist fractures? Among American women,
the incidence of wrist fractures increases rapidly at the time of
menopause and plateaus at about 700 per 100,000 persons per year
after age 60.
110 Part III: Diagnosing and Treating Osteoporosis
“I broke my hip! Or was it
my femur?”
What is commonly referred to as a “broken hip” is actually a fracture
of the femur, the longest and heaviest bone in your body. The
fracture is usually found at the neck of the femur, where it connects
to the pelvis.

More than 300,000 people fracture their hip each year in the United
States. In fact, hip fractures (see Figure 7-2) are the second most
common type of osteoporotic fracture.

Figure 7-2: A “hip fracture” is actually a fracture of the femur, oftentimes in the
femoral neck, which is an area that is particularly weak.

Ninety percent of all hip fractures are related to osteoporosis. Hip
fractures are devastating and can have long-term consequences. A
hip fracture
Requires a trip to the emergency room. In the United States,
in 1995, hip fractures resulted in 800,000 visits to emergency
Requires hospitalization with period of immobility. In 2003,
in the United States, there were 300,000 hospital admissions
for hip fracture (defined as a fracture of the head of the
Chapter 7: Facing the Consequences of Bones Gone Bad 111
femur) in one year. There could be more fractures not
included in this analysis.

Often requires surgery. You need a new hip or a pin in your
hip. (See Chapter 13 for more details about the surgery after
hip fractures.) Surgery on your hip can be complicated by
very serious problems including infection, pneumonia, and
blood clots in your legs or lungs.

Fractures of the femoral neck are very close to the hip joint.
As a result, doctors can’t immobilize this area with a cast.
In addition a hip fracture can lead to
Increased disability from hip surgery. One-fourth of all people
with a hip fracture become disabled in the year after their
fracture. Hip fractures result yearly in more than 7 million
days of reduced activity.

Increased chance of ending up in a long-term care facility.
Almost 75 percent of all nursing home admissions are related
to hip fractures from osteoporosis, which accounts for
approximately 6,000 admissions yearly. Almost half the
expense of hip fracture healthcare is paid to nursing homes.
(In 1995, 180,000 people ended up in a chronic care facility
because of a hip fracture.)

Reduced life expectation. Hip fracture affects your health and
ability to care for yourself (your risk of dying even!).
If you were able to get around without a walker or other aid at
the time of your hip fracture, fracturing you hip will almost
triple (2.8 times) your risk of dying in the next three months,
compared to people who don’t have a fracture.

According to one study of women older than 65, each standard
deviation decrease in bone density at the hip resulted in a 30 percent
increase in total mortality. (See Chapter 9 for more info on
standard deviations and bone density testing.)

Although we aren’t intending to scare you, we want you to be aware
that hip fractures are serious health problems that can result in
your dying sooner than you would have without a fracture. The
key is to avoid fracturing a hip. How can you stay alive longer by
being fracture free? Prevention, prevention, prevention!

Falling and hip fractures

“Grandma fell and broke her hip.” You’ve undoubtedly heard someone
say this or you’ve even said it yourself. She actually fractured
her femur, probably near the femoral neck.

112 Part III: Diagnosing and Treating Osteoporosis
Some studies show that occasionally people don’t “fall and break
their bone” at all. Instead they have a fracture of the femur from
the simple stress of putting their foot down on a step. So the fracture
causes the fall and not the other way around! How often this
actually happens is difficult to say. Nonetheless, people in the
healthcare field definitely want to prevent as many falls as possible
by changing the environment and preventing hazards.

Some people are more prone to falling than others; they have
what’s known as postural instability. Your co-author Sharon is one
of these people. If you’re one, you undoubtedly already know it.
You may walk into walls and trip over a crack in the sidewalk.

Doctors aren’t quite sure what causes postural instability, but it
may be because you have visual issues, don’t judge spatial relationships
well, can’t decipher depth perception, or have poor contrast

Whatever your reason for being spatially challenged (or as your
grandchild may say, a klutz), you need to be especially careful
when you have osteoporosis. If you’re a klutz, you know you’re
going to fall or trip sooner or later, and every fall increases your
chance for injury.

The Centers for Disease Control (CDC) statistics indicate that onethird
of all people older than 65 fall each year, and that the majority
of fractures result from falls. The good news is that most falls
occur in your own home.

Why is this good news? It’s good news, because you can control
your own environment. You can’t control the supermarket that
mops aisle one and forgets to put out a “Be Careful” sign, but you
can determine where you place your furniture and the kind of rugs
you have on your stairs. (See Chapter 13 for more on falling and
fractures.) You can also take preventive measures to avoid a fall.
(And make sure to stay off that ladder!)

Facing Fragility Fractures

Your doctor may often use the phrase “fragility fracture” when you
experience a broken bone with minimal trauma. You probably
know that experiencing a fracture with normal, healthy, strong
bones is certainly possible. For instance, a child who falls from a
tree and fractures an arm can have normal bone strength, but the
impact is still too great to withstand a break. On the other hand,
people with osteoporosis or other problems, such as osteomalacia
(adult rickets), can develop a fracture without a significant injury.

Hip fractures, vertebral compression fractures, and wrist fractures
all should alert your physician to investigate your situation carefully
and further delve into the possibility of you having lost bone
strength. In infancy, the occurrence of multiple fractures should
alert your pediatrician to the possibility of osteogenesis imperfecta.

Your doctor also may diagnosis osteoporosis if you’re unfortunate
enough to require surgery on a broken bone. During surgery, your
orthopedic surgeon can directly assess your bone quality. She may
call a consultation after the procedure because your bones appear
thin during the operation “like potato chips.” You don’t want to
hear this term when describing your bones, do you? (And to think,
you don’t get any sour cream and chive dip to go with them.)

Increasing evidence suggests that any fracture in women or men
older than 55 can be the first indication of a metabolic bone problem.
Other fractures seen in osteoporosis include rib fractures,
fractures of the arm (humerus), and pelvic bone fractures.

Finally, multiple fractures, even with significant trauma, should
alert your physician to the possibility of a metabolic bone disease
and prompt referral to a specialist.

For example, one of your co-author’s nephews experienced three
fractures over a two-year period while playing ice hockey. His doctors
started him on vitamin D supplements, because he lived in
New Hampshire, where the exposure to sunlight is variable. He
hasn’t had a fracture since!

Aging and Your Bones

bones are beautifully engineered and
marvelously efficient — until something goes awry. You first need
to understand why keeping your bones strong and healthy is so
Early detection and preventive treatment before fractures occur is
the vital key to treating osteoporosis.

Osteoporosis is somewhat similar to high blood pressure (hypertension).
For instance, if you have high blood pressure, you may
not know it, because people rarely experience any symptoms from
an elevated blood pressure. Untreated hypertension causes damage
to blood vessels over many years. But if high blood pressure is
diagnosed early, its devastating consequences (stroke and heart
disease) can be prevented.

When you develop a fracture from osteoporosis, it’s likely that you
have had the problem for years. In other words, by the time you
have an osteoporotic fracture, bone is already quite fragile. You
can lose bone at the rate of 5 percent per year (for example during
menopause) and not experience any pain at all. So unless you discover
you have osteoporosis at an early stage, before you have any
symptoms, you’ll already have weak bones at the
time of your first symptom, which can be a devastating and even
life-threatening fracture.

Don’t get the impression that as soon as a fracture occurs, no treatment
can help. Studies have shown that bone density can improve
even at later stages, and fracture rates can be reduced. A recent
estimate by the Office of the Surgeon General reports that by the
year 2020, nearly one-half of Americans will be at risk for developing
fractures, if doctors don’t make changes in their approach to
early diagnosis and treatment of osteoporosis.

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