IF SYMPTOMS PERSIST Dr. Jose Pujalte, Jr. “Lucio.  Nay, not as one would say, healthy; but so sound as things that are hollow: thy bones are hollow…” –  William Shakespeare (1564–1616) English playwright,  Measure for Measure. Act 1 Sc. 2 It’s hard to imagine that a body part that in youth is a source of pleasure and excitement (the pelvis which houses the hip joints), can be a source of pain and disability, in old age. That is of course, if a fracture of the hip occurs. A lot can be done to avoid this catastrophe. What is a Broken Hip? Doctors are quick to label “hip fracture” in most cases where the patient, usually a woman past 65, slips on the floor and lands on her buttocks. The poor woman is unable to get up. A rapid survey of the affected extremity shows that the foot has dropped on its side. The patient also has groin pain and any attempted movement produces exquisite pain. What is commonly called a hip fracture is really a break in the neck of the longest bone of the human body, the femur or thighbone. Body weight is transmitted heavily into the hip joint. It isn’t one of the bones that can be left to heal on its own. In fact, most of them don’t heal. Who is at Risk? Young, active people seldom break their hips. Large and thick muscles, front and back, protect the hip. At risk, are Caucasians and Asians. But as a rule, bones are first strong before they become brittle.  By age, this would be women older than 65 and men older than 70. Women are three times more likely to suffer hip fractures than men. That is because of the fact that women have less estrogen in menopause, thus making osteoporosis or porous bones more likely. Personal habits that accelerate osteoporosis are smoking and alcohol abuse. Inadequate calcium intake or decreased ability to absorb calcium are risk factors, too. Older people with senile dementia (Alzheimer’s) and those with poor balance and poor vision can also slip and fall. What is Done? The worst thing the family can do is to downplay the incident and put Lola in bed. It’s a problem that won’t go away. In fact, the longer the patient stays lying down, the more reasons she can expire. She is now in a position, literally, to develop pneumonia, bed sores, atrophy of the muscles, and depression. Co-existing hypertension, heart disease, and diabetes will worsen in a condition of forced inactivity. The best thing to do is to bring the patient to the emergency room. The orthopedic surgeon has two options, both surgical: one is to insert pins or screws upon putting the bone back in alignment or two, to replace the head of the femur with a metal implant. The objective is to sit the patient up and then to regain mobility. Prevention is Still Best. At about age 35, peak bone mass is reached. This is the point where human bone is strongest. As the person ages, bone density diminishes slowly to about 30-50% from the original in women and from 20 to 30% in men. Therefore, one strategy is to keep bones strong as long as possible. Daily calcium intake recommendations are:

• 11 – 24 years – 1,200mg
• Pregnant/nursing women – 2,000mg
• Before menopause – 1,000mg
• Menopausal/post-menopausal women NOT taking estrogen – 1,500mg
• Menopausal/post-menopausal women taking estrogen – 1,000
• Middle-aged men – 1,000mg

Combine calcium with Vitamin D (400 IU a day) for better absorption and incorporation into bone. Make the Home Safe. Finally, there are practical tips to prevent falls in the home. In the bathroom, put a slip-resistant rug under the shower. If balance is poor, get a shower chair or stool. Don’t grab a towel rack to pull yourself up. It can’t handle the weight and you will just lose your balance. Climbing the stairs, use the handrail. Do not carry a package that obstructs your view. When the phone rings, do not rush. Try to put things like telephones and remotes within reach. In the living room, keep furniture arrangement simple and easy to walk through. Fasten carpets or rugs – it’s easy to trip on them. Do not leave toys and other objects scattered on the floor. In the kitchen, mop away leftover food and drink spills on the floor. Preventing hip fractures is no graduate school subject. It just takes common sense. Avoiding surgery and hospitalization, and a lower quality of life also make sense. email  [email protected]