Winter Weather presents Osteoporosis and Foot and Ankle Fracture Danger for Older Workers

Falls and winter ice can be dangerous, especially to older workers, who have special concerns about slipping and falling on an icy patch of ground. The American Orthopaedic Foot & Ankle Society (AOFAS) also is concerned about the increased dangers to older workers with osteoporosis (progressive bone loss) and the possibility of fractures to the foot or ankle, which often happen from falls on icy surfaces.

“Although it is hard to precisely correlate inclement weather with fractures, any orthopedic surgeon will tell you that unfortunately, snowy and icy weather increases the number of fractures from falls,” says Edward C. Pino, MD, of Denver, Colo., an AOFAS member. “Since osteoporosis reduces the strength of bones, a slight fall may result in a fracture, and a significant fall may result in a fracture that is difficult to treat either surgically or non-surgically. Therefore, the combination of icy conditions with osteoporosis can lead to significant orthopedic injury.”

One common type of fracture is the stress fracture, which is a crack in a bone often resulting from "overuse." In older people, the bone sometimes is abnormal as a result of osteoporosis. While a stress fracture may occur as a result of overuse, if the bone quality is very abnormal, a fracture can occur from normal usage. This is sometimes called an “insufficiency fracture,” as the quality of bone that is present is insufficient to prevent a fracture with normal activities.

Pain, swelling and sometimes bruising are the most common signs of a fracture in the foot. A stress fracture that occurs without a history of overuse should be further evaluated. If there are risk factors present for osteoporosis (see table below) or other bone diseases, then a bone-density measurement should be obtained from a foot and ankle orthopaedist. Risk factors for osteoporosis include:

• Female
• Age (over 55)
• Family history
• Race (white, Asian)
• Small skeletal frame
• Low calcium diet
• Sedentary lifestyle
• Smoking and/or alcohol use
• Estrogen deficiency
• Exercise-related amenorrhea (cessation of menstruation)
• Early menopause
• History of previous fractures
• Steroid use

Pino suggests these recommendations to help prevent osteoporosis and its consequences: “We should teach our children that our bones are like a savings account. If we eat right and exercise throughout our lives, we can slow down the natural osteoporosis that comes with aging and help prevent fractures as we get older. It is never too late to take care of our bones – exercise is key – but especially as we get older we should supplement this with calcium and in some cases other medications. The right combination is best discussed with your family physician.”

Preventative measures include:

• Adequate calcium in the diet. The National Academy of Sciences recommends 1200 mg per day for men and women over 50.
• 400 – 1000 mg per day of Vitamin D
• A regular program of moderate, regular exercise three to four times a week that includes weight-bearing exercise such as walking, jogging, hiking, climbing stairs, dancing, treadmills and weight-lifting.
• Balance training, such as Tai Chi, yoga and the Feldenkrais Method.

More information on the aging work force

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