Winter Weather, the Elderly, Osteoporosis and Foot and Ankle Fractures...

Three views of the normal adult foot
©AAOS, When Your Body Aches, NY,NY Walker & Co, 2003
Injury radiograph of a 59 year old patient with documented osteoporosis, which demonstrates open, comminuted ankle fracture
Image courtesy of David H. Kim, MD
Immediate post-operative x-ray
Image courtesy of David H. Kim, MD
AOFAS takes a look at the connections 
(ROSEMONT, IL - Februrary 18, 2009) 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 orthopaedist.
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
About the AOFAS
The AOFAS promotes quality, ethical and cost-effective patient care through the education, research and training of orthopaedic surgeons and other health care providers. The Society creates public awareness for the prevention and treatment of foot and ankle disorders, provides leadership, and serves as a resource for government and industry as well as the national and international health care communities.​
About Orthopaedic Foot and Ankle Surgeons
Orthopaedic foot and ankle surgeons are medical doctors (MD and DO) who specialize in the diagnosis and treatment of musculoskeletal disorders and injuries of the foot and ankle. Orthopaedic foot and ankle surgeons use medical, physical and rehabilitative methods as well as surgery to treat patients of all ages. Relying on four years of medical school training, five years of post-graduate training and often a fellowship in foot and ankle care, orthopaedic foot and ankle surgeons perform reconstructive procedures, treat sports injuries, and manage and treat trauma of the foot and ankle.
Jennifer Hicks
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