Hip stress fractures can be an early warning sign of poor bone health. They also provide an opportunity to make improvements in your nutrition, physical activity and lifestyle to prevent further deterioration into full osteoporosis.

In the United States, it is estimated that 340,000 hip fractures occur each year and that by 2040 this number will increase to 500,000. Ninety percent of fractures occur in people who are 65 years and older and three quarters of the patients are women...mostly Caucasian women. The United States has the highest rate of hip fractures in the world.

A hip stress fracture is usually less painful than an actual fracture and may be an early warning sign of poor bone health. It often appears as a pain in the groin or thigh that may increase with activity and persist for hours afterward. It may eventually develop into a persistent pain regardless of the level of activity and extend into the night and disrupt sleep. If the pain is referred to the knee, the person may develop an awkward gait or limp as they try to avoid pain on the injured side.

So what can be done to reduce our risk of hip stress fractures? The formative years of age nine to nineteen are especially important for building a strong skeleton foundation that will last a lifetime. There are many steps that can be taken to reduce the risk of hip stress fractures during these early years and they are the same steps needed to prevent further deterioration into full osteoporosis.

Let's look at the controllable risks first before we look at things that erode our bone health but are not in our control.

CONTROLLABLE RISKS

DIET

While there are millions of people in the world who go to bed hungry and have no choice about what they eat or whether they eat...people in wealthy countries face a different challenge. Often we are deciding whether we will take the time to cook a healthy meal at home or succumb to the fast food that is constantly inviting us from the vending machines, street corners, bill boards and television ads.

Young people with a lot of discretionary cash and a love of hanging around malls are especially at risk. The eating habits of teenagers are particularly important not only because this is a critical period for bone development but it is also the time that eating habits are formed. The most common nutritional challenges that both teens and adults face in North America are as follows:

• Insufficient calcium and vitamin D in a diet will lower the peak bone mass and increase the risk of hip stress fractures later in life. The Recommended Daily Intake (RDI) for a person aged 9-18 years is 1,300 mg.-which is slightly more than what is recommended for pregnant women and for women in menopause. A fast food diet is lacking in exactly these elements.
• A high caffeine intake (over three cups a day) and excessive soda consumption interfere with the absorption of vitamin D and calcium - resulting in decreased bone density.
• Eating disorders, such as anorexia nervosa and bulimia often begin during adolescence and can permanently damage the skeleton.

The movement towards increasing healthy foods in our schools and removing pop and snack vending machines should help to improve our nutrition habits. Calcium and vitamin supplements also provide an inexpensive way of supporting bone building if you believe your diet is not providing the recommended levels of calcium, vitamin D, magnesium and vitamin K.

EXERCISE

Weight-bearing exercises (such as walking, running and jumping) are essential for strengthening bones and muscles and reducing the risk of hip stress fractures. Prolonged bed rest or immobility from an accident or illness can cause bone loss but this loss can usually be recovered before the age of forty. After forty it is much more challenging to improve bone density- but it is still possible with the right amounts of calcium, vitamins and weight-bearing exercise.

SUBSTANCE ABUSE

Smoking and excessive consumption of alcohol can interfere with the normal process of bone building and remodeling, resulting in bone loss. But how exactly are they affecting our bone health?

Smoking has the effect of inactivating estrogen, leaving the smoker with what amounts to an estrogen deficiency. (Estrogen helps prevent osteoporosis by inhibiting the action of osteoclasts, the cells that break down and clear away old bone.) Weight loss associated with smoking also results in a loss of fat cells needed for estrogen production. This accelerated loss of estrogen can result in smokers entering andropause or menopause as much as five years earlier than non-smokers. A more sedentary life (also associated with smoking) further increases the risk of developing osteoporosis.

Alcohol decreases calcium absorption and increases calcium losses through the urine in three ways:

• Alcohol elevates our Parathyroid hormone (PTH levels) causing a strain on our calcium reserves. Continuous elevation of PTH can cause hyperparathyroidism which further depletes the calcium stored in our bones.
• Alcohol also inhibits the conversion of vitamin D into its active form, thus interfering with the absorption of calcium from the intestines.
• Excessive alcohol also increases magnesium excretion in the urine, which in turn makes calcium absorption difficult.

CLUTTERED & UNSAFE SURROUNDINGS

One of the easiest ways to reduce the risk of hip stress fractures is to reduce the risk of falling. In the home it is important to get rid of loose rugs on hardwood; eliminate clutter on the floor; ensure that lighting is appropriate (especially around stairways); add proper handrails to stairways and organize electrical and telephone cords so that they are well out of the way.

A person with good muscle tone, good balance and healthy bones will find the above hazards unpleasant but manageable. But if bone density is low, a fall can easily cause hip stress fractures or even broken bones.

UNCONTROLLABLE RISKS

GETTING OLDER

It is a good thing to get older... given the alternative. But we stop adding to our bone density around the mid to late thirties. That doesn't have to be a problem if we have had good eating habits and enjoyed a healthy lifestyle during our youth. But if we haven't, the risk of hip stress fractures can increase significantly as we age. In addition to the weakening of bones, most of us will lose some of our vision, muscle tone and sense of balance-which increases the risk of falling and fracturing a bone. All of these risks can be mitigated with a good diet and proper fitness, which are habits that we hopefully developed in our youth.

HEALTH DISORDERS

There are a number of medical conditions that can weaken our bones and make us more susceptible to hip stress fractures. Some of these conditions cause a gradual loss of bone health if special steps are not taken. Others increase our risk of falling.

Endocrine disorders (such as hyperthyroidism and gastrointestinal disorders) may interfere with calcium and vitamin D absorption which are essential for bone health. Low levels of sex hormones (testosterone, progesterone and some forms of estrogen) are also associated with a loss in bone density.

Rheumatoid disorders often lead to inactivity and subsequently a loss of both muscle strength and bone mass. Parkinson's disease and multiple sclerosis affect the nervous system and increase the risk of falling. Decreased mental alertness (dementia and depression) also increase our risk of falling and creating hip stress fractures.

And finally, osteoporosis makes our bones more prone to hip stress fractures, even with a relatively minor fall. When doctors order an x-ray or bone scan for a patient who is complaining of pain in the groin and thigh, they may discover that the hip stress fractures are only symptoms of osteopenia or osteoporosis.

GENDER

About 80 percent of hip stress fractures occur in women. The drop in estrogen levels that occurs with menopause accelerates bone loss, increasing the risk of hip fractures as a woman moves beyond menopause. A growing number of doctors are now prescribing progesterone treatment for osteoporosis...as well as calcium and vitamin supplements.

FAMILY HISTORY

A family history of osteoporosis is a strong predictor of low bone mass. A small-boned, slender frame may also put you at increased risk of osteoporosis.

DRUGS

Some medications accelerate bone loss and increase the risk of osteoporosis and hip stress fractures. Medications that may contribute to bone loss include:

• Corticosteroids-such as prednisone
• anticonvulsants
• thyroid medications
• certain diuretics and blood thinners
• proton pump inhibitors (used to reduce stomach acid)

Some drugs may also cause dizziness and affect your balance. These include some blood pressure medications, sedatives, tranquilizers, antidepressants, cold and allergy medications, pain relievers and sleep medications.

There are many steps that can be taken both to reduce and mitigate the risk of hip stress fractures. An osteoporosis prevention program that includes a good diet, exercise and the right calcium and vitamin supplements is a great way of improving bone density and reducing our risk.

To learn about calcium and vitamin supplements that will help to prevent hip stress fractures...visit http://www.osteoporosis-vitamins.com.