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Transcript of a chat with Dr. Suzanne Salamon

M&M: Is there a link between osteoarthritis and eventual hip fracture and how can a patient lower the risk?

Dr. Suzanne Salamon: Hi,M&M, The main link between osteoarthritis and eventual hip fractures is that in general, both happen in older age. Osteoarthritis is a disease of the joints, where hip fractures generally happen to people with osteoporosis, which is a disease of the bones. Your question about how to lower the risk is so important. To build up bones, one should take in calcium and vitamin D, if there are no contraindications, exercise and get a bone density scan to be sure one doesn't have osteoporosis. If there is osteoporosis, there are medicines to take to help strengthen the bone.

tina: Does breaking a hip when you are an elderly person always result in having a hip replacement?

Dr. Suzanne Salamon: No, not always.It depends where the hip gets broken. Sometimes they can be repaired with hardware such as plates and screws.An orthopedic doctor would advise you at the time of the fracture as to what is the best option.

helper: My grandmother recently came home from the rehab center after a hip replacement. What are some helpful items I can bring for her? Are there doctor-recommended pillows? Activities that I can do with her to help -- like swimming, walking, etc.?

Dr. Suzanne Salamon: I think it's wonderful that you want to spend time with her. As you saw in the article, the time after surgery can be a very lonely time for people. Your presence is probably her best medicine.You could speak with her physical therapist about exercises you might do with her to regain her strength.

lovemymom: thank you for chatting today! riveting articles on this! so, how can i help my mom, in her 60s, avoid such an injury? she uses a treadmill daily but has a bum knee. thank you for your time!

Dr. Suzanne Salamon: A person in their 60's should have a bone density scan if they haven't already had one. This will help determine how strong the bones are at this time.In general, if there are no contraindications, to prevent osteoporosis and bone fractures, one should take 1200-1500 mg/day of calcium in divided doses as well as at 600-800 i.u. of vitamin D.Stretching and weight training exercises also help build stronger bones. Of course, consult your doctor before starting these.

Carol: Is it part of standard practice to incorporate mental healthcare after hip surgery in older people since depression seems to be a common effect? Is there any discussion about making mental healthcare part of the recovery process?

Dr. Suzanne Salamon: We are beginning to see how important one's mental health is patients' physical recovery.Being aware that this is a common post-op problem is the best medicine for preventing depression. While it is currently not standard practice to incorporate mental health services after surgery, friends and family members can play a big role in helping to recognize depression and alerting the patient's providers.

Mags: My 65-year old mother just fell and fractured her hip (on an icy brick porch) and she had screws put in. Can you tell me anything about the longterm prospects for surgery like this? Is this a permanent solution? Does she risk hip replacement down the road?

Dr. Suzanne Salamon: Research shows that someone who has broken 1 hip is at increased risk for breaking another. Therefore it is very important, after a hip fracture, to be sure that one doesn't have osteoporosis by getting a bone density scan and starting treatment if necessary.

mark: What are your thoughts about Fosamax?

Dr. Suzanne Salamon: Fosamax is a medicine that helps make bones stronger. It is for people with a diagnosis of osteoporosis. It is taken once a week on an empty stomach with a large glass of water and then nothing to eat or drink for 30 minutes. One must also be taking daily calcium and vitamin D. While there are some side effects, research has shown that it can be helpful in making bones stronger.

Mags: Does smoking impact bone density?

Dr. Suzanne Salamon: Great question, Mags.There are several risk for osteoporosis and decreased bone density. Some of them are smoking, family history of osteoporosis,being thin,low calcium intake, sedentary life style.

mark: My aunt has been prescribed Merck's Fosamax for osteoporosis, but I've read lots of reports about serious side affects, do you prescribe this for your patients?

Dr. Suzanne Salamon: I do prescribe Fosamax when indicated because the effects of osteoporosis and hip fracture are so devastating. However, there are potential side effects of Fosamax, which I advise my patients to be on the lookout for.

Wendy: My mother has had two hip replacement surgeries, and is ok. but I am wondering if it is an inherited risk? I am in my 50s and am beginning to feel aches in my hip bones -- exercise has helped, but am I at a higher risk than the norm?

Dr. Suzanne Salamon: Hi, Wendy,As mentioned, family history of osteoporosis, which makes it more likely to break a hip, is definitely a risk factor. One is never too young to start taking care of one's bones.See above recommendations for calcium and vitamin D.

henry: What about younger people who break their hips. I broke mine in my 20s and am now in my 40s. Is there anything I can do to ensure I never need a hip replacement?

Dr. Suzanne Salamon: Young people can break even healthy hips with enough trauma. However,anyone with a prior hip fracture might want to speak with their doctor about getting a bone density scan to be sure their bones are strong.

Tom N.: What kind of a role did you play in the recent three-part Boston Globe series on hip fractures in older people?

Dr. Suzanne Salamon: Here at BIDMC I am part of team of geriatricians who provide consultation to the orthopedic surgeons as well as patients undergoing hip surgery, such as the patients in the article.

Hippie: Hi, what's the difference between hip and knee replacements?

Dr. Suzanne Salamon: One difference is that knee replacements are generally done because of pain caused by degenerative changes such as arthritis. Although this is also sometimes the case with hip replacements, hip replacements are also done when the hip is broken.

anewme: Hi Dr. Salamon, My 87 yr old Mother has OA in her hips and degenerative disease. Last winter she had a fall, luckily did not hurt her hips. She has been experiencing a lot of hip pain lately, and groin pain, and has been using NSAIDs and heat. She feels that there isn't anything more besides surgery. Are there other meds that could help her?

Dr. Suzanne Salamon: Hi, Anewme, I'm glad to hear that she didn't break her hip. She has many complicated medical issues similar to many of the patients in our geriatric practice.There may be other options besides surgery. This is one of our challenges as geriatricians, to look at all the issues confronting the older patient and put together the best care plan for that individual.

Dr. Suzanne Salamon: Thanks, Everyone, for the great questions. Stay healthy!

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