The Osteoporosis Post-Fracture Protocol: How to Stop One Break From Becoming Three

If you’ve had one osteoporosis-related fracture, you’re also at risk for another — and may continue to be at risk for at least a few years.

“A fracture related to osteoporosis should not be viewed as an isolated event,” says Andrea Singer, MD, the chief medical officer at the Bone Health & Osteoporosis Foundation. “It is often a sign that bones require urgent attention.”

While a bone break is a serious event, it’s also an opportunity to prevent future fractures. Here’s what you should do during this important window of time.

Calcium

About 99 percent of the body’s calcium levels are stored in the bone. But your bones aren’t the only part of your body that needs calcium — so do the muscles, heart, and blood. If calcium levels drop too low, the body pulls what it needs from the bones, weakening them and leaving you prone to a fracture.

Your calcium needs vary by age; adults ages 19 to 50 need 1,000 milligrams (mg) while women older than 50 and men over 70 need 1,200 mg.

• Milk and other dairy products
• Leafy green vegetables
• Broccoli
• Tofu
• Nuts and seeds
• Some plant-based milks (these can be fortified with calcium)

Vitamin D

Vitamin D is a fat-soluble vitamin that helps your body absorb calcium and supports healthy muscles, which may help prevent falls.

The amount of vitamin D you need each day depends on your age. Adults younger than 50 need 400–800 international units (IU); adults age 50 and older need 800–1,000 IUs. Your body produces vitamin D naturally when the sunlight hits your skin; then, it’s stored in fat.

Many people don’t get enough D, though. Some may spend too little time outdoors, for example, while some simply produce less vitamin D than others. (It also becomes harder to produce vitamin D with age.)

• Salmon
• Sardines
• Egg yolks
• Cod liver oil
• Swordfish
• Liver
• Some milks and orange juice that are fortified with vitamin D

Your provider may want to check your vitamin D levels, to make sure you are getting adequate amounts. If not, you may want to take a supplement.

Other Nutrients

Besides calcium and vitamin D, your body needs other critical nutrients, says Rachel Fishman Oiknine, MD, a board-certified endocrinologist affiliated with MDVIP in St. Louis. These include:

• Protein Protein-rich foods include meat, poultry, fish, and shellfish; dairy products; beans and lentils; nuts and seeds; firm tofu and tempeh.
• Vitamin K Dark leafy greens are rich in vitamin K (and as a bonus, also high in calcium).
• Magnesium Foods rich in magnesium include spinach, beet greens, okra, tomato products, artichokes, plantains, potatoes, sweet potatoes, collard greens, prunes, and raisins.

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• Phosphorus Phosphorus is found in animal-based protein, nuts, beans, whole grains, and dairy products.
• Vitamin C Vitamin C is found in a wide range of fruits and vegetables, including berries, cantaloupe, tomatoes, peppers, potatoes, broccoli, spinach, and citrus fruits.

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Antiresorptive Medications

Antiresorptive drugs reduce fracture risk primarily by slowing down the rate of bone loss, says Dr. Singer. This allows the natural regeneration process of the bones to occur, increasing a person’s bone density.

Antiresorptive agents are commonly prescribed as first-line therapy for osteoporosis. Of these, a type of medication called bisphosphonates is given first. Bisphosphonates are typically available as an oral medication or an intravenous formulation; they include:

• alendronate (Fosamax)
• risedronate (Actonel, Atelvia)
• ibandronate (Boniva)
• zoledronic acid (Reclast, Zometa)

Another antiresorptive agent, denosumab (Prolia), works differently to build bone density and is given by injection.

Anabolic Medications

While anabolic medications typically lead to faster results, they tend to be reserved for people at a high risk of fractures. Three medications, given via injection, are currently available:

• teriparatide (Bonsity, Forteo)
• abaloparatide (Tymlos)
• romosozumab (Evenity)

Exercise — particularly weight-bearing exercise — can not only help prevent fractures, but it can also speed up recovery after a fracture.

You can start exercising a day or two after an injury, but you’ll need to take it slow at first. Depending on your age and the type of injury you’ve sustained, this may mean simply standing, walking a short distance, or doing some exercises in bed, says James Pang, DPT, a physical therapist and the owner of Pang Physical Therapy in San Diego.

• Walking
• Gentle resistance or strength training
• Balance exercises
• Low-impact aerobics
• Elliptical training machines
• Stair climbing
• Gardening
• Treadmill
• Hiking

Try to avoid any high-impact or high-intensity exercises after a bone break or while you have a higher risk of fracture, though, since you can risk reinjuring yourself. Exercises to avoid right after your fracture include high-impact exercises such as:

• Running or jogging
• Step aerobics and dancing
• High-impact sports, such as basketball and soccer
• Sports with repetitive movements, such as golf, tennis, and bowling.
• High-intensity interval training (HIIT)

“Working with a physical therapist can be very helpful to make sure exercises are safe and appropriate during recovery,” says Bukata. “The goal isn’t to avoid movement, it’s to return to activity safely and build strength over time.”

• Keep the floors clear. Keep clutter off the floor, especially around main pathways in the house. Position electrical cords near the wall or behind furniture, and make sure any carpets and area rugs have skid-proof backing or are tacked to the floor.
• Use good lighting. Make use of motion-sensor nightlights, accessible light switches, and consider swapping standard light switches for illuminated ones, so that you don’t have to grope for them in the dark.
• Wear slippers with traction. Avoid walking around in socks and floppy slippers, especially on hardwood or slick floors.
• Use anti-slip surfaces in the bathroom. Place anti-slip surfaces in the shower and use nonskid mats on the surfaces that could get wet (such as the floor by the bathtub or sink). You may also want to consider using a shower chair or grab bars while bathing.

• Preventing further fractures after you have already experienced a broken bone requires a multipronged approach.
• Good nutrition and a diet high in vitamins and minerals, especially calcium and vitamin D, is essential for healing and building strong bones.
• Medications can be an important component of post-fracture care, as they can slow down bone loss and also build bone.
• Exercise can help to increase muscle strength, improve balance, and decrease the risk of subsequent fractures.