September 1, 2013
By Jonathan Sackier
“That which does not kill us makes us stronger,” stated Friedrich Nietzsche. And the reverse is true—making oneself stronger reduces the chance of a premature journey across the river Styx. Specifically, keeping your skeleton strong. As many people age, bones become less dense, surrounding muscle melts away, and natural agility diminishes—a dangerous combination leading to falls, fractured hips, lots of pain, grief, cost, and in some cases, death.
Falls are a major cause of fatal and nonfatal injuries in older people, and although diminishing in recent years, around 300,000 Americans over age 65 require an emergency operation each year to treat hip fracture, one of the most commonly damaged areas. And up to one third of them will die within a year of their tumble. Just as staggering can lead to a fall, you will be staggered at the statistics; total days in the hospital for women with hip fractures surpass those for patients with heart attack, diabetes, breast cancer, and lung disease. This is a national epidemic.
I used to go to really hip joints; with age, I think about getting a new hip joint. The femur (thigh bone) has an angled neck and a ball-shape top, which slots into the acetabulum, a cartilaginous cup in the pelvis. The femoral head has a tenuous blood supply and if a fracture occurs here, the bone cannot be held together with screws and the whole kit and caboodle has to be replaced. Usually an orthopedic surgeon will chop off the top of the thigh bone and pop a shiny new metal head and neck assembly into the femur—and maybe a plastic cup into the pelvis. Voilá, new hip joint! Recovery is usually pretty swift, and if all goes well, one can be back at work in no time. The FAA also says no problem as long as you present admission, operative, and discharge summaries to your AME with no waivers required. If taking medications, these have to be named.
However, avoiding this unplanned hospital holiday is preferable and taking a moment to think about how not to behave might save one a lot of grief. Wear sensible shoes, keep an eye out for uneven surfaces, and don’t try feats that were a breeze when you were younger.
An insidious factor making hip fracture more likely in the event of a fall is osteoporosis. or low bone density. About 9 million people in the United States are deemed to have this problem, with a further 48 million having low bone mass close to having osteoporosis. Often just a function of aging, it is more common in women after menopause, but men are not immune. Transplant patients or those taking certain medications such as steroids also are at risk. Silent until it declares itself with a fracture or reduced height—the shrinking grandmother syndrome—this bad boy puts a lot of people in hospital. Diagnosis is made by a simple DEXA scan (Dual Energy X-ray Absorptiometry) that evaluates bone density, the result is expressed in a T-score (sometimes a Z-score).
Nothing to do with golf, bone “thickness” is compared to a group of healthy people your age; an arbitrary scoring system is described where minus 1 and above is good, minus 1 to minus 2.5 means osteopenia (lacking bone and heading for osteoporosis)—and minus 2.5 and beyond, welcome to Club Osteoporosis. The good news is that there are a range of drugs, which, when taken in concert with exercise, can help improve the situation. The better news is that all commonly prescribed meds are OK with the FAA, although some require a status report and the absence of adverse side effects. Check out Pilot Protection Services and AOPA’s medical database online (www.aopa.org/members/databases/medical/druglist.cfm).
One can mitigate the risk of a hip fracture or other similar problems by avoiding cigarettes; remaining active, especially with weight-bearing exercise; eating well; ensuring calcium and vitamin D are well represented in the diet; being respectful of reduced athleticism with age; and having regular checkups. Women after menopause and men at risk should consider regularly scheduled checkups for osteoporosis. At a recent medical conference, I saw and have been helping build awareness for Impactwear’s clever new invention—hip protectors built into underwear for active adults (www.impactwear.com). Utilizing materials science, these simple devices can turn the consequence of a fall from a fractured hip to mere bruised pride. Check out a video demonstration online (http://youtu.be/3u77PSSEp0E).
When younger, we would cheer the Rolling Stones, when older, we fear kidney stones. Responsible pilots: take ownership of bone health before it becomes a problem. Mick Jagger may not have been able to get satisfaction but if you keep your T-score healthy, you will.
Dr. Jonathan sackier will be a featured speaker at the 2013 AOPA Aviation Summit in Fort Worth, Texas.
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