Femoral Family

Guest blog post by Suzanne Morris
Medical writer: Concrete Medical Writing

What? I remember simultaneously saying it and realizing how scripted it sounded. “Mom broke her leg,” my sister repeated. She didn’t know any more than that - she’d heard briefly from our dad, who, with our mother, had traveled to Lisbon for a week’s stay before the family was to gather in Colorado for the 2017 holidays. Only in piecing together the subsequent abbreviated reports from my dad did I then realize that this was likely a pathologic fracture - my mother had been diagnosed with osteoporosis years prior to their travel. Upon entering a hotel dining room, her femur spontaneously fractured.

By Christmas Day, my sister and I were able to chat with our Lisbon hospital bed-bound mother, relieved that she had benefitted from Portuguese generosity (strangers with hospitalized family members had thought to also bring our mother holiday goodies). She was to remain bed-bound for over a month before being released to travel back to the US. Not long after arriving home, it was discovered that her contralateral femur was bowed with a hairline fracture, indicating the prophylactic insertion of a rod (which was recommended and performed.)

My mother is now getting around well, taking routine walks around her neighborhood for exercise, but is (understandably) hesitant to travel. Having earned a master’s degree in nutrition, she has been aware of the importance of calcium in women’s diets and urgently conveyed this to us when we were still children. So she was well-informed when she first received a diagnosis of osteoporosis. She was treated with a bisphosphonate but was one of the rare patients who experienced what is considered a low-risk, atypical femoral fracture (AFF) following long-term bisphosphonate therapy. (Panagiotis, 2017). Her treatment has since been adjusted, and she is hopeful that her current therapy will improve her bone density.

Recently, I learned that I have osteopenia, I am now doing what I can to avoid progression to osteoporosis. Namely, I focus on low-impact weight-bearing and stretching exercises six days a week and eat a varied diet high in beans, vegetables, fruits, and nuts. There is the additional comorbidity factor of my having rheumatoid arthritis, which is a prognostic factor in osteoporosis development. There is also the coffee addition, which I am still working on. But given the multitude of factors that point to likely future osteoporosis and fracture, I realize that I am going to have to bring some heavy healthy lifestyle reinforcements.

Suzanne Morris lives in Orlando, Florida and Mom Judith lives in Denver, Colorado.

References

Anagnostis P, Paschou SA, Mintziori G, et al. Drug holidays from bisphosphonates and denosumab in postmenopausal osteoporosis: EMAS position statement, Mauritas. 2017 Jul;101:23-30.

National Osteoporosis Foundation website accessed Sep 14, 2019.

Interested in sharing your story? Click here!

My Osteoporosis Story: Liz Alhand

Guest blog post by Liz Alhand

I have always been mindful of my health. I have worked in healthcare for over 40 years - first as a nurse, and later as a healthcare executive. I am passionate about health and have consistently made lifestyle choices that I thought were helping me maintain healthy bones. I was taking regular calcium supplements and made an effort to add Vitamin D to my diet as well.

Despite this, in 2006, I fractured my ankle from a fall on an uneven surface. Three years later, I fractured my other ankle the same way. Both times I visited an orthopedic surgeon, and no one on my healthcare team, including myself, thought it was strange that I had experienced multiple fractures from these seemingly low-impact falls. It wasn’t until a few years ago -- when I broke my hip -- that my primary care physician saw cause to refer me for a bone density test and Vitamin D blood test. The test revealed that I had progressed from osteopenia to osteoporosis which was likely related to entering menopause. And that’s when my journey back to bone health really began.

My primary care physician referred me to an endocrinologist who put me on a medication called TYMLOS. Because of my fracture history, I was considered to be at high risk for subsequent fracture. Every medication has its risks and benefits, and my providers helped me determine the treatment path that was right for me. In addition to my daily TYMLOS injection, I participated in physical therapy to help treat my hip after surgery. I decided to extend that physical therapy and focus on exercise that was beneficial to my bones—including weight-bearing exercise. I continued to make sure there was plenty of calcium—and Vitamin D to absorb that calcium—in my diet. 18 months later, my quality of life has drastically improved. I walk for an hour at least four times a week. I have not had any more fractures. And, after a year and a half of being diligent about my osteoporosis treatment, my latest scan showed that my bone density has increased by 50 percent.

I want to share my story with others because I was in the healthcare field, and yet I did not make the connection between my fractures and postmenopausal osteoporosis. The orthopedic surgeons that treated my fracture didn’t either. Osteoporosis and Vitamin D insufficiency are silent diseases, ones with often no visible symptoms until a fracture occurs—and even then can go undiagnosed. We are instructed to use sunscreen to prevent cancer, but never told that some sunshine is needed to gain Vitamin D, which is instrumental in the absorption of natural and supplemental calcium. It is so important for women to learn their risk and proactively bring postmenopausal osteoporosis up to their physicians if their physicians are not bringing it to their attention. We can and should make lifestyle changes to benefit our bones, but we need to be our own healthcare advocates too. Osteoporosis was never on my radar because I was very active and had taken calcium supplements since I was 20 years old. I made healthy lifestyle choices, and I took my vitamins. I honestly never thought osteoporosis could happen to me because I was so healthy. That’s why I want others to understand how important it is that we know what red flags to look for, that we be our own healthcare advocates and request a bone density scan -- a painless, quick test that provides baseline understanding for whether we have osteoporosis, or osteopenia, which is low bone density. I was lucky to eventually find a provider who connected the dots between my fractures and their root cause, but if I had known more about osteoporosis, I would have requested a bone density and Vitamin D test much sooner.

I will be forever thankful to the compassionate, skilled healthcare professionals who helped me manage my osteoporosis and regain my health. Osteoporosis is a disease that can not only rob us of healthy bones, but quality of life too. That’s why it’s so important we empower ourselves to learn how to reduce our risk, be our own healthcare advocates, and treat osteoporosis early. In doing so, we can protect our ability to live our best life.

This story is part of a support initiative called Voices of Osteoporosis: Stories of Hope and Inspiration. If you have experienced osteoporosis as a patient or caregiver, we invite you to share your story. Your story could inspire others to learn how to protect their ability to live their best life and stay bone strong. Click here to learn more.