A Crystal Ball
Updated: Jan 28, 2020
When I got a call in the middle of the night I knew it wasn’t good. Nana had fallen and fractured her hip.
With time, I will become my grandmother, we are similar in so many ways.
As I took that call and started to consider what I could do to help her and her caregivers, my thoughts also turned to my own future. My heart sank at the notion that only half of women over 80 years who fracture a hip will walk independently after 1 year and up to 6% will die of complications. My Nana is a Caucasian woman of small stature with a very remote smoking history who enjoyed a glass of white wine a few times a week. These are all risk factors for osteoporosis or thinning of the bones. African-American women and heavier women are protected from bone loss and girls who reach a higher peak bone mass in adolescence, generally do better at avoiding thin bones. Coming from a fairly poor, farming family, it was hard to know whether Nana had access to the necessary food sources to develop strong bones. I picture her standing in the kitchen wearing her apron, hair perfectly coiffed (not my usual look on the weekends), preparing Sunday dinners for our extended family. We grew up on “meat and potatoes”, always eating homemade food but never really considering that what we put into our bodies directly affected our bone health.
We know so much more today! Controversies exist about dairy sources of calcium and vitamin D with some experts blaming dairy for allergies and bodily inflammation. Regardless, current recommendations include supplemental calcium and vitamin D for maintenance of strong, healthy bones and more recent studies have also shown additional benefits from these nutrients including lower cancer risk and reduced death from all causes.
Nana was a breast cancer survivor and, by all accounts, appeared a very healthy woman. However, I never saw her exercise and, like many women, she spent most of her time caring for everyone else.
Besides adequate nutrition, supplements (calcium, vitamin D and the required co-factors for proper absorption of these nutrients), weight-bearing exercise like walking and lifting weights will strain the bones enough that they grow stronger in response. Yoga and stretching provide better strength and balance to avoid falls that contribute to fractures in older women.
Dual-energy X-ray absorptiometry (DXA) is recommended to assess the density of the bones for women with risk factors or anyone over the age of 65. Other testing modalities or earlier testing is not, yet, standardized for diagnosis or treatment monitoring. As important as the DXA result, the FRAX calculation (Fracture Risk Assessment, www.sheffield.ac.uk.FRAX) should be reviewed before treatment is started. This is important because it helps predict the risk of incurring a fracture in the next 10 years, based on a number of known risk factors (age, gender, body mass index, history of fracture, smoking, steroid use, alcohol intake, rheumatoid arthritis and other medical problems), and avoids treating too many people with medications that carry inherent risks.
Nana’s doctors had detected her thinning bones some time after menopause and started her on Bisphosphonates. This class of drugs is the first line treatment for women with documented osteoporosis AND an increased 10 year fracture risk. Women have their most rapid bone loss around menopause, associated with decreasing estrogen levels. The FDA has approved certain regimes of hormone replacement therapy (HRT), as preventative treatment for osteoporosis and fracture with the greatest benefit if started immediately after menopause. Nana had breast cancer so was not a great candidate for HRT but might have benefited from Raloxifene that is known to protect from thinning of the bones while reducing the risk of breast cancer. Other treatments include Denosumab, Calcitonin and Parathyroid Hormone but all medications carry pros and cons and need to be individualized after thorough review with a health provider who takes the time to understand your situation.
Nana died within a week of the hip replacement that doctors decided she needed for pain relief. She was 90 years old and now that I have recovered from the loss, I am able to look into the crystal ball that her life provides for my daughters and myself.
Our lives will be forever enriched, not just for knowing her and learning from her calm, compassionate, feminine leadership but, also, because we share her genes and can foretell what our bodies will need today to age gracefully into tomorrow.
Learn about how to protect yourself from bone loss and many other health-related issues that become more prevalent for women over 40 in the Meaningful Menopause on-line program HERE.