Geriatric Fractures and Bone Health

In today's discussion, Dr. Michael Milshteyn talks about orthopedic surgery, particularly in conjunction with geriatric fractures and overall geriatric bone health.
Geriatric Fractures and Bone Health
Michael Milshteyn, MD
Michael Milshteyn, MD SPECIALTIES include Orthopedics, Surgery - Orthopedics.

Caitlin Whyte: As we age, well, unfortunately our bodies change and the older we are, the more fragile we tend to get. So today, we are talking about orthopedic surgery, geriatric fractures, and bone health. Joining us for this conversation is Dr. Michael Milshteyn, an orthopedic surgeon at McLaren Health.

This is McLaren's In Good Health, the podcast from McLaren. I'm Caitlin Whyte. All right, Dr. Milshteyn, why do seniors seem to experience broken bones more easily than younger adults?

Dr. Michael Milshteyn: As we age our bone density decreases. When we're young, it takes a lot more force like a car accident to cause a fracture. When we're elderly, just like a small fall would cause a fracture just as serious as it would in a motor vehicle accident if given a young person's age.

Caitlin Whyte: So are there certain medical conditions or environmental situations that would increase the likelihood of a fall?

Dr. Michael Milshteyn: Sure. There's a lot of medical conditions that make people more predisposed to fall, like impaired muscle function or arthritis, imbalance issue, muscle weakness, things like that. Even a very low blood pressure can cause a person to fall. Environmentally, there's a lot of things around the house that cause people to fall. Slippery or wet surfaces, like a bathroom, poor lighting or cluttered pathways in their house that create tripping hazards. Anything like that would be a major environmental risk for a senior to have a fall and then cause a fracture.

Caitlin Whyte: Now, what are the most common fractures in seniors? What do you see a lot?

Dr. Michael Milshteyn: I see a lot of both fractures to the upper and lower extremity, like shoulder fractures, wrist fractures are very common. Spine fractures are common. Even pelvis fractures are common. And the thing that people associate more with senior fractures are hip fractures, which are very common as well. But basically any fracture, either upper or lower extremity, are very, very common in the elderly in varying severities.

Caitlin Whyte: Now, why do these geriatric fractures take longer to heal than what we might see again in a younger patient?

Dr. Michael Milshteyn: It's more about that elderly patients are just more unhealthy. They have more medical conditions like diabetes or high blood pressure that cause decreased healing and longer healing times. And then things like nutrition, elderly people tend to be more malnourished than younger individuals. And so that causes also less ability to heal because we need both our nutrition and our health and all the factors that need for bone healing together to work and really appropriately have good bone healing and good function after that bone healing happens.

Caitlin Whyte: Now, aside from slower healing times, do these fractures in geriatric patients pose other health risks?

Dr. Michael Milshteyn: They do. Just having a fracture in itself increases you to having another fracture. People that, for instance, have hip fractures are two and a half times more likely to have another type of fracture throughout their life. It's very common to have one hip fracture and then within a year have another one. So having these fractures is really our first sign for a lot of times that we need to really start the preventive strategies in these patients more aggressively to help them avoid another fracture, because this can lead to significant functional deficits and their ability to function independently.

Caitlin Whyte: Of course, it would always be best to just prevent a fall or a fracture in general. I mean, what can we do to reduce the likelihood of these incidents happening?

Dr. Michael Milshteyn: Some of them are medical and some of them are environmental. You know, the medical factors we have are medications that prevent bone health decline or increase the bone density of a patient. Environmental are really taking care of some of those things around the environment, like making bars in the shower or decreasing the amount of throw rugs in a patient's home, decreasing the tripping hazards. So both the environmental and medical factors really play a strong role in decreasing the chance of an elderly person sustaining a fall and then sustaining a fracture.

Caitlin Whyte: And of course, I mean, fractures happen. So what does typical treatment look like? Is surgery going to always be required?

Dr. Michael Milshteyn: That's really a wide question because it really depends on the severity and the place. A lot of wrist fractures and shoulder fractures, for instance, can be treated non-operatively in a cast or in a sling and just take time to heal.

However, some things like a hip fracture or a fracture around a total hip or a total knee, which a lot of our elderly patients have, almost always require surgery. So it's really dependent on the type of fracture, where it is and how severe it is, because at the end of the day, we really just want to restore function. And if we can do that without surgery, that's usually our number one choice, but unfortunately, sometimes we just cannot restore function of that patient without performing surgery.

Caitlin Whyte: Great. Well, wrapping up here, what advice can you share for seniors listening regarding, you know, reducing the likelihood of or the consequences from these geriatric fractures?

Dr. Michael Milshteyn: I think there's a lot seniors can do. I think having active conversations with their physicians about their bone health on their yearly checkups, whether that be bone density, whether that'd be medications or vitamin supplementation, like vitamin D and calcium. I think that really working with their family about what are their fall risks and is their environment safe for them.

There's a great resource for preventing falls in the elderly that the Academy of Orthopedic Surgeons puts out and it's readily available on the website amongst the other sources to really help families discern that. Having an active lifestyle, we know that patients that are more physiologically healthy, and strong are less likely to fall and sustain fractures.

And lastly, really nutrition, making sure that they're eating right, eating enough calories. Elderly, we find a lot of times are malnourished. They're not eating the right amount of food for them, whether that's due to financial circumstances or other circumstances, they're just not getting enough calories to sustain their muscle mass, which having an increased muscle mass decreases the chance of falls.

Caitlin Whyte: Well, Dr. Milshteyn, is there anything we missed in our conversation about fractures?

Dr. Michael Milshteyn: I think that again, I would encourage all elderlies to really broach that question with their family and their health providers about how can they prevent falls, because it is really a major risk factor to their health if they sustain a fracture, especially one that needs surgery.

Well, thank you so much for your time today, Dr. Milshteyn. To learn more about Dr. Milshteyn or submit a question, visit That's slash M-I-L-S-H-T-E-Y-N. If you enjoyed this podcast, find more just like it by checking out our past episodes and be sure to give us a like and a follow if you do. This is McLaren's In Good Health, the podcast from McLaren. I'm Caitlyn Whyte. Thanks for being with us.