Bad falls. No breaks. Why?

huessysignoret
0 Recommendations

I'm a postmenopausal woman with osteoporosis. Due directly to various medications I've been prescribed (Neurontin, Inderil, Imiprimine (sp?), I've suffered a number of bad falls -- out of bed, down stairs, in the driveway, a plunge out of a hotel shower, entering a store -- which could have been expected to break a bone in a normal person (and I did break bones as a child and reckless downhill skier.) But -- nary a fracture. Can anyone tell me why I've been so lucky? (All those bad drugs, by the way, have been dumped, and my balance is excellent now.)

I realize that BMD is not the whole story, but what about my bones (with a BMD of -2.43) has saved me?

Thanks for any insight any one can give me!

13 replies

Tom-WI

Hi Pam,

Well it sure does sound as though you've been lucky! Not that it's lucky to have suffered all those spills, but not to have fractured. I'm wondering if your bone structure is more normal than your density i.e. better quality than quantity. Of course there isn't any practical way to determine that short of a bone biopsy.

Glad to hear your balance is better now. Hope you are getting some relief from your other pain problems.

Tom

sdivas

Sometimes it's the way we fall .... sometimes it is the impact and the surface on which we may fall. I would certainly work on balance exercises in order to prevent falls. Even if your balance is excellent, a good physical therapist can give additional balance exercises; balancing closing eyes; balancing on a bosu ball; balancing on a foam roller, balancing sideways, front and back ... none of which I would advise doing on your own without working with a physical therapist. With balance, we never attain excellence as we always have something new to learn in order to help us prevent falls.

huessysignoret

I don't think my point has exactly gotten across. The many falls I've had were definitely due to prescription drugs; the falls were a major indicator that something was definitely wrong with those drugs for me. I have fallen in many different positions and on many different surfaces (including concrete!) Sure, I may fall again even though I'm not taking the "bad" drugs anymore. My real question, though, is why none of these falls, despite my unfavorable BMD reading, have resulted in a fracture. I've read that BMD is not the be-all and end-all in predicting fractures, but what else is there? What might there be about my bones that has, so far, protected me from a fracture? I've read that bone quality is important, apart from BMD, but what does that mean? Can somone explain?

(Also, this is neither the time nor the place, but since none of the falls resulted in a fracture, some of them do make for very funny stories. I thank my lucky stars [and bones] that I came through them okay.)

huessysignoret

Thanks, Tom -- you have understood that I wasn't asking how to prevent falls, but why my falls hadn't caused fractures. Let's assume I fell in the worst possible position on the worst possible surface with the hardest possible impact (prettty close to true!). What characteristics of bone would keep one with low BMD from breaking? Are some bones pock-marked like swiss cheese inside, while others, even if thin, are still smooth and flexible? I'm just trying to understand what factors other than BMD influence the likelihood of fracture.

windblown

Hi: I agree with Tom and Sandi... Since dxa's only tell you part of the story about your bones, you could be someone that has a better quality of bone, *even though* your density is low. Since there isn't a test, as yet, to measure bone quality, you could just be very lucky and have bones that are strong--meaning the remaining bone you have even with loss of density, may be very strong. You could have a bone biopsy *if* you really wanted to know about the total condition of your bone, but insurances won't pay for it to test for osteo. If you've had back surgeries, they may have already done a biopsy as part of the surgery. I know I had one, but I've also had 7 fusions with frax's so they did the biopsy to see if some other disorder was present.

Do some reading on bone quality and strength. Most of these involve breaking the bones of rats to see how much force it takes to break their bones even with loss of density.

I hope this helps some, and by the way, the only drugs you've taken that I'm familiar with is the Inderal and Neurontin--which I took for high BP, and Neurtontin for nerve pain. I no longer take it, but it never made me dizzy or unstable so it just goes to show how unique we all are and how we react very differently to these meds. I only took one dose of the Neurontin, because it made me extremely dizzy, double vision, halos around all things in my sight, loss of peripheral vision, loss of feeling in hands and feet, and other things; so now it's listed in my history as an extreme allergy to this med, and I'll NEVER take it again, plus it's really for epilepsy, and is rx'd off label for nerve pain.

Continued good luck and I hope you don't have any more spills on hard surfaces. Have you tried entering your info into the FRAX calculator? This algorithm will calculate you probability of frax's taking in to consideration things likes family history of previous frax, lifestyle choices, etc. Check it out if you haven't. The Drs are suppose to be using this in conjunction with dxa to give the patient a more accurate idea of fracture risk since dxa's alone have never been the *sole* predictor for this. There's also many other bone disorders that play a role and maybe you don't have those, like arthritis, scoliosis, rheumatoid arthritis, celiac, ddd, etc. there's too many to list.

When you use the FRAX calculator make sure you have your *femoral neck* score for the hip--not the total hip score--since the tool needs this t-score.

http://www.shef.ac.uk/FRAX/


Good luck...

huessysignoret

Dear Windblown -- now THAT was very helpful! I didn't know about the FRAX calculator, my doc didn't tell me about it, and he hasn't taken a femoral neck score. I feel as if I'm wandering around in a wasteland where the only folks who are wise are on the Inspire team. Thank you so very much!

Pam

sdivas

Hello, I'm sorry if I didn't give you the answer you were seeking. I did understand your question, but there really isn't an answer for why you have been fortunate not to fracture. All it takes is one fall where a person may fracture, so I feel it is a good idea to do whatever we can to minimize and avoid a fall. As for the FRAX tool, I will add the information I received when attending the Clinian meeting. Please check my Clinician blog if interested. Thanks. Sandi

huessysignoret

Sandi -- I think my reaction to your response sounded snippy. I'm so sorry -- I didn't mean it to at all. I realize that just because I've had some bad falls and been lucky doesn't mean I should jump off a cliff just to see how lucky I really am! I try to follow all the advice for proper sitting, standing, walking, etc., to avoid a fall, and am happy to say that now that I'm not on any drug that impairs my balance, I haven't fallen. As I understand it, though, something as simple as a sneeze or cough could actually cause a fracture. Looking, as always, for the silver lining, I have come up with this -- lifting heavy garbage bags, trying to reach for things off too-high shelves, shopping for 40-lb. bags of dog food, and moving heavy furniture around are OUT. Husband no longer expects it.

I really was just curious as to why some bones with "bad" DEXA scans nonetheless don't break. Is density not the whole story? Are some bones actually flexible? The feedback I've been getting suggests that some of this is a mystery.

I apologize again if my answer was impolite. I ought to read things over before sending. You've been a great source of information and help, and the last thing I wanted to do was insult you. Forgive me?

Tom-WI

Huessy,

If you have the book "The Myth of Osteoporosis", there is a good illustration of bone structure on page 41, which shows the difference between a weakened bone and a strong one, cross-section wise. I believe you avoided taking bisphosphonates, and perhaps this also avoided weakening your trabecular bone structure.

If you don't have this book, you may want to get it or see if your library has it. It's not very big, but quite interesting.

Tom

huessysignoret

Thank you! Very helpful, and just what I was looking for.

Pam

raindancer

I am following this thread with great interest as I have had several hard falls over the past several years, I did not have an x ray of my wrist after a bad one last summer and it finally healed with a weird looking raised ridge..and darned if I didn't fall about 5 weeks later[just when it seemed to be feeling better] and hurt all the exact same places AGAIN!!! I did hit my hip, knee and shoulder really hard each time I fell as well but used my wrist to try to break my fall.

As I have mentioned before, I had Gullain Barre' about 24 years ago which left me with foot drop and almost totally numb feet and legs about halfway to my knees as well...add this to the fact that I am always in a hurry and live on a rural acreage with lots of tree roots, rocks, bumpy lawns..well you get the idea.

I also had a really bad fall about 4 years ago on a hardwood floor plus several other klutzy tumbles and to date..still have no fractures [unless my wrist had a break last summer].

I am working on some balance exercises, and trying to slow down and look where I am going, need to move my heavy mixing bowls from the top shelf in my cupboard and make some other adjustments to make my life less accident prone, but after being able to carry 50# bag of dog food on my shoulder, or a 5 gallon bucket of water in each hand for 30 years, it's tough to slow down!

Best to all and thanks for great posts...
Paula

sdivas

Hello, an apology isn't necessary. Please don't give it another thought as I didn't interpret your reply as snippy. I'm in the -3 range for both hips and spine and didn't realize how complicated this disease is until I attended the Clinician meeting. I wish after attending the Clinician meeting, I could give the community members information on the right way to deal with bone loss so none of us would have to be concerned, but unfortunately I didn't come away with the answer. Most doctors take the course of action that they are familiar with and have given results. There isn't any one right way. We all do the best we can. Personally, I don't place much on FRAX because I like to stay in the moment .... if there is a possibility that I may fracture, there is also the possibility that I will not fracture. There is much ahead in the field of osteoporosis, that for me to worry about a FRAX prediction seems like a waste of my energy ... and depending on the way doctor's use FRAX and interpret FRAX to patients may induce additional fear .... but as I said, that is my unprofessional opinion. I feel every day is an opportunity for a new start. I recently spoke to a woman with bone loss that is unable to continue with her dance classes which sent her into depression until she realized she could sit in a chair, tap her feet and continue to participate in the tap dance class. Sometimes we have to make adjustments or find alternatives so we are smart and don't cause ourselves additional bone loss as you are doing. Thanks for your kind post. Sandi

huessysignoret

I like your attitude!

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