Once Is Enough:
A Guide to Preventing Future Fractures

So, you've broken a bone. Only those who have experienced a fracture can truly understand how painful and debilitating it can be. Recovering from the fracture should be your first priority. However, you and your doctor will also want to determine whether this fracture is a symptom of an underlying disorder, osteoporosis, that puts you at greater risk for future fractures. If you are over age 50, there is a very good chance your fracture is related to osteoporosis. This fact sheet will help you better understand the relationship between fracture and osteoporosis, so you can take action now to strengthen and protect your bones.

Many people are unaware of the link between a broken bone and osteoporosis. Osteoporosis, or "porous bone," is a disease characterized by low bone mass that makes bones fragile and more prone to fractures, especially of the hip, spine and wrist. Osteoporosis is called a "silent disease" because bone loss occurs without symptoms. People typically do not know that they have osteoporosis until their bones become so weak that a sudden strain, twist or fall results in a fracture.

Osteoporosis is a major public health threat for an estimated 44 million Americans. In the U.S. today, approximately 10 million people already have the disease and almost 34 million more are believed to have low bone mass, which leaves them at increased risk for osteoporosis. Of the 10 million Americans estimated to have osteoporosis, eight million are women and two million are men.

One in two women and one in four men will have an osteoporosis-related fracture in their lifetime. The National Osteoporosis Foundation estimates that at least 90 percent of all hip and spine fractures among older white women can be attributed to osteoporosis. Moreover, women near or past menopause who have sustained a fracture in the past are twice as likely to experience another fracture. Unfortunately, only 5 percent of patients with osteoporotic fractures are referred for an osteoporosis evaluation and medical treatment.

The Osteoporosis Evaluation

I've already had a fracture. Is it too late to talk to my doctor about osteoporosis?
It is never too late. Ideally, you should talk to your doctor during your recovery about whether you might be a candidate for an osteoporosis evaluation. But even if your fracture has healed, you can be evaluated and begin taking steps to protect your bones now.

What kind of doctor should I see about getting an osteoporosis evaluation?
There are many different kinds of physicians who can evaluate and treat osteoporosis. Start with your primary care physician or the doctor treating your fracture. He or she will likely be able to conduct the evaluation and may then refer you to a specialist -- such as an endocrinologist or rheumatologist -- if you require treatment.

What does an osteoporosis evaluation involve?
One thing your doctor will do is ask about your medical history and lifestyle to determine whether you have risk factors for osteoporosis. Some of the factors that increase the risk of developing osteoporosis include: personal or family history of fractures; low estrogen or testosterone levels, because hormones play a role in bone health; and the use of certain medications, such as glucocorticoids or anti-seizure medications, that may contribute to bone fragility. Your doctor also may want to test your blood or urine, and may suggest that you have a bone mineral density (BMD) test.

What is a bone mineral density test? Is it painful?
A BMD test is a painless way to measure the density of your bones in various parts of your body. Several different types of BMD tests are available. The most widely used is dual energy x-ray absorptiometry (DXA). The DXA test is popular because it can be used to measure bone density at multiple sites - the spine, hip and wrist, which are the most common sites for osteoporotic fractures. The test is safe and easy, taking only 15 minutes or less to complete. For a DXA test, you will be asked to lie on a table while a machine above you measures your bone density.

Some private insurance plans will cover BMD tests ordered by your physician. Medicare also may pay for a BMD test under certain circumstances for women and men aged 65 or older. Your physician and his or her office staff can help you determine if Medicare will cover a BMD test for you.