the times | Tuesday August 11 2020 1GT 5

body&soulhealth

6 At least three million

people in the UK have

osteoporosis, and half of

all women and one in five

men over 50 will have at

least one fragility fracture

during their lifetime.

6 The risk of breaking

a bone due to osteoporosis

starts to increase

significantly in middle

age and doubles for every

decade over 50.

6 Women are more likely

to be affected, as are

those with a family

history of osteoporosis or

hip fracture.

6 An early menopause in

women (certainly before

the age of 45) and low

testosterone in men

increase the risk, as does

taking long-term steroids,

and other conditions such

as rheumatoid arthritis,

eating disorders, bowel

disease and anything that

causes prolonged

immobility.

6 For more information

on the causes, diagnosis

and management of

fragility fractures and

osteoporosis visit the

Royal Osteoporosis

Society at theros.org.uk.

Fragility

fractures:

the facts

health

Dr Mark Porter

Bike injuries, like Simon Cowell’s, are

serious, but falls can be more worrying

that applies to you. You can’t do

anything about your age or family

history, but there are important

lifestyle factors that you can modify.

Smoking and drinking increase the

risk of sustaining a fragility fracture

(if you drink more than 14 units a week

your risk increases by 40 per cent).

Healthy bones require regular exercise

and a good source of basic building

blocks via healthy diet. And to make

the most of any calcium you consume

you also need vitamin D — something

that is often deficient, particularly in

older people who don’t get out into

the sun often.

We rarely give our bones a second

thought until they let us down, but

our skeleton is constantly changing,

like our skin and muscles, and benefits

from attention in much the same way.

A fragility fracture is the skeleton’s

cry for help. Please don’t ignore it.

follow-up they need, even if they live

outside the catchment area (lots of

falls happen away from home,

particularly at this time of year).

A typical pathway may involve

assessment of risk (using an online

calculator such as the Frax fracture

risk assessment tool) and/or arranging

a special x-ray (a Dexa scan) to

measure bone density. If bones are

found to be worryingly “thin”, there

are a number of medical options —

ranging from calcium and vitamin D

supplements to medication (eg

bisphosphonates such as alendronic

acid) — that may help to delay or

even reverse progressive weakening.

And people who fall regularly should

be referred to a falls clinic to see if

their mobility can be improved and/or

aids supplied.

Individuals can do their bit too.

First, by asking if their fracture

warrants further investigation. Second,

while all our bones get weaker with

age, a process that starts in our

thirties, some people are more at risk

than others (see below), so be aware if

fragility fracture in the years leading

up to their hip fracture, and had

their underlying osteoporosis been

picked up earlier, interventions

such as medication to strengthen

their bones might have avoided

the problem.

Nice estimates that about a

quarter of hip fractures in the UK

(equivalent to more than 20,

a year) could be prevented by

better investigation and follow-up

of people with fragility fractures.

And better prevention has

significant benefits for the

individual and society.

The prognosis after a hip

fracture is poor. About one

in five patients never recover

and die as a direct or indirect

result of their injury. And

half of those who do survive

will be left with some form of

long-term disability, many

of whom will never live

independently again. Hip

fractures exact a considerable

toll on NHS resources too,

accounting for about 70,

emergency admissions a year into

hospitals in England alone, costing

£1.5 billion a year.

Most NHS hospitals have access

to some form of specialised

pathway that ensures patients seen

in emergency departments receive the

I

have never met Simon Cowell,

but he is the fifth person “I

know” who has broken a bone

in a cycling accident since the

start of the pandemic. My

skeletal biking toll includes

three wrists, a collarbone and,

according to reports of Cowell’s

accident, at least one vertebra. All very

unpleasant, but high-impact fractures

like these, paradoxically, often don’t

worry doctors as much as those

sustained in a simple slip or fall.

Breaking your wrist in a cycling

accident is unlucky. However, doing

so after tripping over the dog in the

kitchen is often the first sign of an

underlying long-term problem.

According to a recent review by the

National Institute for Health and Care

Excellence (Nice), in a typical year

half a million people are treated in

UK hospitals for fragility fractures —

bones that have broken after a slip,

trip or fall from standing height —

typically of the wrist, upper arm/

shoulder, spine and hip. While it is

possible for a perfectly healthy person

to break a bone in such a fall, in the

over-50s it often indicates underlying

osteoporosis (“thinning of the

bones”) and should never be

ignored.

In an ideal world anyone

with a suspected fragility

fracture should be referred

for a follow-up investigation

to look for osteoporosis

and treated

accordingly to

prevent recurrent

fractures. However,

in reality too many

people slip through

the net and are

neither properly

investigated nor

treated, only being

picked up once

they present with

a second or even

third broken bone.

Unfortunately,

subsequent fractures

tend to be more

severe. The most

dangerous is

a broken hip.

About half

of those

affected

will have

had at

least one

“herald”

If you have a health problem,

email drmarkporter

@thetimes.co.uk

Half a million

people a year are

treated for a

fragility fracture

chemical sunscreen was applied.”

The study was published in The

Journal of the American Medical

Association this year and showed that

the six active ingredients tested were

absorbed into the body, with some

elevated beyond the FDA’s threshold

of concern for three weeks after

application. The chemicals tested

were avobenzone, oxybenzone,

octocrylene, homosalate, octisalate

and octinoxate.

“Some of these chemicals have

potentially toxic properties, although

obviously they are being used in tiny

doses and we don’t know exactly what

the effects could be,” she adds. “I

choose to use a physical, or mineral

SPF, which sits on the surface of the

skin as a physical barrier. They use

either zinc or titanium dioxide and

can leave a white sheen on the skin,

but I still prefer them as an option.”

That said, Perry warns: “The

niceties of the distinction between

physical and chemical sunscreens

aren’t as important as making sure

you remember to apply something

regularly. Experiment until you find

one that feels comfortable on your

skin — you are far more likely to

use it.”

Khan suggests using an SPF powder

if regular reapplication over make-up

is a problem. “I would also incorporate

a prescription-grade vitamin C serum

as some studies indicate that vitamin

C, an antioxidant, can help to enhance

the protection from sunscreen.”

What about the fact that we need a

certain amount of sun exposure to

keep our vitamin D levels topped up?

Research has suggested that there

may be a link between having low

levels of vitamin D and dying from

coronavirus. “You can get all the

vitamin D you need from exposing

your arms for 20 minutes three times

a week,” Perry says. “I’m not anti-sun.

Going out and exercising regularly will

be more beneficial for your overall

health than sitting at home.”

He advises always protecting your

face. “Your face gets constant exposure

year-round, so you should always

prioritise it for SPF, whereas your

limbs are likely to be covered

up for much of the time.”

Perry says it’s important to

remember, even with so many things

to preoccupy us, that one bad summer

or even a single episode of skin

damage can be the difference between

developing serious skin disease or not.

“We all know the feeling when you

forget your bottle of sun cream and

think you’ll just chance your luck, but

sometimes that’s how the worst burns

happen. The weather can change so

much over the course of a single day.

I’d advise avoiding direct sunlight

when it’s really hot. Buy a hat, apply

sunscreen regularly.”

The fact that many of us will

not be going abroad makes little

difference. “People sometimes think

they don’t need to bother as much

with sun cream in Norfolk as they

would in Italy,” Perry says. “It has not

become an automatic habit for many,

as it has in hotter countries like

Australia. But the truth is that the

ozone layer is thinning, our climate

is changing, and if you go out on a

sunny day, the UV index in the UK

is relatively high. It’s very simple —

if you leave the house for anything

you should be wearing sun cream

and you need to reapply. Buy more

than one bottle and keep them in

your car, your handbag, wherever

you might need them.”

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Simon Cowell has broken his back

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