Former United States House Speaker Nancy Pelosi sustained a fall while in Luxembourg this week, leading to her undergoing hip replacement surgery in Germany just days later. Pelosi, age 84, traveled to Europe as part of the 80th anniversary commemoration of The Battle of the Bulge. Apparently, the former House Speaker, who notably continues to wear high heeled shoes, slipped on a marble floor and injured and likely fractured her hip. She was hospitalized, and just a few days later underwent hip replacement surgery.
Such injuries are common at any age, especially on slick surfaces and when in heels, but bone fractures are much more common in older individuals, and especially in females. The hip, which is a ball-and-socket joint at the upper thigh bone, is most likely to be fractured at its uppermost portion, known as the femoral neck. Over 300,000 people per year sustain hip fractures in the U.S. alone, the majority of who are 65 years and older. The injury is extremely painful, and surgical intervention, either with repair or replacement, is almost always indicated.
Hip replacement surgery is often carried out due to chronic hip conditions, such as osteoarthritis or rheumatoid arthritis, chronic wear and tear on the joint from years of stress or strain, or due to childhood chronic hip conditions. It is also performed after chronic or acute injury, the latter of which was the case for Nancy Pelosi. Replacement surgery involves removing the damaged area, typically both the femoral neck and femoral head (the ball portion of the ball-and-socket joint), and replacing it with a metal or ceramic ball and stem structure, providing renewed strength and stability to the damaged bone and/or joint.
A significant risk factor for hip fracture is a condition called osteoporosis, or low bone density. A condition less concerning, although also placing people at risk for fractures is known as osteopenia, also low bone density but to a lesser degree than osteoporosis. Over half of both men and women over age 50 likely have some degree of low bone density. Of these, 1 in 2 women and 1 in 4 men with low bone mass will break a bone if osteoporosis is left untreated.
Common causes of and risk factors for osteoporosis:
- Aging, as bone remodeling declines after age 30.
- Hormonal changes, most notably declining estrogen levels in peri-menopausal women.
- Genetic predisposition, which may include small frame and being caucasian
- Cigarette Smoking
- Lack of exercise
- Poor nutrition
- Excess Alcohol Consumption
- Several chronic medical conditions and use of specific medications
Osteoporosis Prevention and Diagnosis
Adults can, in some cases, prevent osteoporosis, or minimize progression from osteopenia, by maintaining healthy exercise levels routinely, cutting out cigarette smoking and reducing alcohol consumption. Diet, supplement and hormone replacement recommendations should be reviewed and discussed with one’s physician, as these can vary from one individual to another.
Diagnosis of osteopenia or osteoporosis is made by performing a bone mineral density test, also known as a DEXA or DXA scan. This is a series of X-ray studies looking at the bones of the hips and lower back. A score, based on the density of those bones, is given, and that score can indicate the degree of bone mineralization, or density. Low density bones are then determined to be either osteopenic (moderately low density) or osteoporotic (more significantly low density). Currently the US Preventive Task Force recommends bone density screening for women ages 65 years and older, and for both men and women over age 50 with specific risk factors for osteopenia or osteoporosis.
Osteoporosis Treatment
Once a diagnosis of osteopenia or osteoporosis is made, there are several treatment options available to minimize the increased risk of fractures. In addition to certain lifestyle modifications, which may include diet, exercise, certain supplements or hormone therapies, there are multiple medical treatment options that can either halt the progression of bone weakening, or even reverse the effects, leading to some degree of increased bone density over time. These treatments are often discussed with a specialist such as an endocrinologist or rheumatologist, in concert with one’s primary care physician and possibly gynecologist, depending on the treatment option that is best available for each individual’s situation.
Several celebrities, including Ellen DeGeneres and Sally Field, have shared their diagnosis of osteoporosis publicly. Field, who was 59 years old at the time of diagnosis, has made efforts to draw public awareness to the importance of early screening, diagnosis and treatment, even if one is having no symptoms or overt health issues. Fractures in older adults are a significant source of morbidity and mortality, as these injuries can lead to other complications including pneumonia, blood clots and skin ulcers from needing to be hospitalized and at bed rest after an injury.
It is unclear whether or not Nancy Pelosi has underlying osteoporosis as a risk factor for her hip fracture. It is clear, however, that such injuries need to be addressed swiftly, to minimize further complications. But as with many unplanned hospital stays following injury, prevention is always the best medicine.
