Winter Weather, The Elderly, Osteoporosis And Foot And Ankle Fractures – AOFAS Takes A Look At The Connections

February 23, 2009 at 11:00 am Leave a comment

Falls and winter ice
are scary to everyone but especially to the elderly with their
concerns about slipping and falling on an icy patch of ground. The
American Orthopaedic Foot & Ankle Society (AOFAS) is also concerned
about the increased dangers to the elderly with osteoporosis
(progressive bone loss) and the possibility of fractures to the foot
or ankle which often happen from falls on icy surfaces.

Foot and ankle fractures among older individuals happen more
frequently in the winter than any other season, most likely due to
the icy surfaces. AOFAS member Edward C. Pino, MD, of Denver,
Colorado says, “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. 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.” Very often, in older
people, the bone 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.

Since osteoporosis can progress without symptoms for many years, a
stress fracture may be the first sign of osteoporosis. A stress
fracture which occurs, especially 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 your foot and ankle

Risk factors for osteoporosis:

— 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

What are some of the recommendations to help prevent osteoporosis
and its consequences?

Dr. Pino suggests, “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

— Regular program of moderate, regular exercise 3 to 4 times a week

— Include 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

Dr. Pino is a member of the American Orthopaedic Foot & Ankle
Society (AOFAS). Members of the AOFAS are orthopaedic surgeons (MD or
DO) who have extensive training in the diagnosis, non-surgical care
and surgical treatment of the musculoskeletal system, including
bones, joints, ligaments, tendons, muscles, and nerves with a special
interest in the foot and ankle.

To find an AOFAS orthopaedic surgeon in your area, go to


The AOFAS promotes quality, ethical and cost-effective patient care
through education, research and training of orthopaedic surgeons and
other health care providers. It creates public awareness for the
prevention and treatment of foot and ankle disorders, provides
leadership, and serves as a resource for government, industry and the
national and international health care community.

About Orthopaedic Foot and Ankle Surgeons

Orthopaedic foot and ankle surgeons are medical doctors (MD and DO)
who specialize in the diagnosis, care, and treatment of patients with
disorders of the musculoskeletal system of the foot and ankle. This
includes the bones, joints, ligaments, muscles tendons, nerves, and
skin. Orthopaedic foot and ankle surgeons use medical, physical, and
rehabilitative methods as well as surgery to treat patients of all
ages. They perform reconstructive procedures, treat sports injuries,
and manage and treat trauma of the foot and ankle.

Orthopaedic foot and ankle surgeons work with physicians of many
other specialties, including internal medicine, pediatrics, vascular
surgery, endocrinology, radiology, anesthesiology, and others. Medical
school curriculum and post-graduate training provides the solid
clinical background necessary to recognize medical problems, admit
patients to a hospital when necessary, and contribute significantly
to the coordination of care appropriate for each patient.


AOFAS members have the following credentials:

— Completed four years of medical school. The curriculum covers basic
and clinical sciences, surgery, internal medicine, pediatrics, family
medicine and all other medical specialties.

— Completed five years of accredited graduate medical education
(residency training) in orthopaedic surgery.

— Many orthopaedic foot and ankle surgeons also complete advanced
fellowship training in foot and ankle surgery.

— Satisfactory completion of the national medical licensing examination.

— Continuing medical education credits over a specific time period.

— Board certification: Certified by or eligible for examination and
certification by the American Board of Orthopaedic Surgery or the American
Osteopathic Board of Orthopedic Surgery.

— Each member must hold membership in the American Academy of
Orthopaedic Surgeons (AAOS).

When selecting a medical provider to care for your feet and ankles,
be sure to ask him/her about:

— Medical school education

— Accredited residency training

— Areas of practice specialization

— Experience in your prescribed treatment (surgical and/or non-surgical)




Entry filed under: Uncategorized.

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