These small changes can reduce the risk of hip fracture by 45 per cent

Tuan Nguyen, a world-leading researcher in osteoporosis, has been working in the field since the 1990s. But he was still shocked by what happened to his neighbour five years ago.

His neighbour – a “true, blue Australian” man in his 70s, who loved mowing his lawn – fell over at home and fractured his hip. Three months later, he was dead.

Protecting our bones takes a small effort for a big reward. Credit: Getty

Nguyen’s neighbour was a human example of the sad statistic that between 20 and 30 per cent of hip fracture patients die within one year of the event. This is put down to a number of factors, including complications from the fracture, as well as health issues that may have increased their risk of falling in the first place, like circulatory diseases and dementia.

But it doesn’t have to be this way.

Despite popular belief, bone mineral density loss – which significantly increases the risk of fracture – doesn’t have to be part of the ageing process. As Nguyen and his colleagues discovered in a new paper, minor lifestyle changes can create a ripple effect, substantially reducing the risk of fractures in the community.

For the study, published in the Journal of Bone and Mineral Research, researchers analysed findings from the Dubbo Osteoporosis Epidemiology Study – one of the longest running studies on osteoporosis in the world. Over 30 years, the Dubbo study has followed thousands of adults over the age of 60, looking at fracture incidence and risk factors. Compared with the first group who was studied, the second group increased their bone mineral density by about 3 per cent.

Despite this “very modest” improvement, there was a 45 per cent reduction in hip fractures across the cohort. Nguyen explains that this level of reduction is typically associated with a 10 per cent increase in bone mineral density, meaning these new findings were quite surprising.

A distinguished professor of predictive medicine at the University of Technology in Sydney, Nguyen calls this “The Rose” paradox. British epidemiologist Geoffrey Rose hypothesised that if we can improve a major risk factor, like cholesterol, by a very modest amount, we can substantially reduce the outcomes of cardiovascular disease.

“This is consistent with our data – that a very small increase in bone mineral density translates into a huge reduction in the community,” says Nguyen. “That small improvement can be translated into a huge reduction in fracture risk. That is what we want.”

Professor Cathie Sherrington, who leads the Physical Activity, Ageing and Disability Research Stream at the University of Sydney says, “This is an important paper due to the population health approach being taken to an important health problem.”

The fact that most hip fractures – 60 per cent in women and 70 per cent in men – occur in people who do not have osteoporosis, makes it even more essential for everyone to do what they can to prevent falls. “The good news is that exercise that prevents falls could also prevent these injuries,” says Sherrington. There are other ways to protect our bones too.

Bone mineral density is about 50 per cent modifiable through minor lifestyle changes, Nguyen says. He and his colleagues spoke about these modifications with the second cohort in the study at their assessments every two years.

Research has found a number of “universally applicable” modifications that can lead to a greater reduction in hip fractures.

Exercise regularly and safely

Less than half of Australian adults are sufficiently active, yet previous research has found that elderly individuals allocated into an exercise group had 50 per cent lower risk of fracture than those who weren’t. Balancing exercises, like standing on one leg and embracing your inner flamingo, are important, but we need to do more than that.

Mopping, brisk walking, cycling, swimming and mowing the lawn are all great. But bones love variety, so it can also be helpful to try weight-bearing exercises, as well as activities like dancing, where the body moves in different directions at different speeds. For more suggestions, go to Safe Exercise at Home.

Quit smoking

Smoking stimulates bone resorption (the process where bones are absorbed and broken down by the body) because it restricts oxygen-rich blood in the body, inhibits the absorption of calcium, causes more free radicals and affects hormones. For these reasons, the rate of bone-loss among cigarette smokers is two-fold higher. Nguyen estimates that if all the 12 per cent of daily smokers in Australia quit, hip fractures could be reduced by 20 per cent.

Eat more calcium

Calcium is an essential mineral for maintaining our bone health and can significantly reduce the risk of fractures. But half of all Australians consume less than recommended level of calcium each day (1000-1300mg).

Great sources of calcium

• Dairy milk, yoghurt and cheese (150-305 mg per serve)
• Trout, snapper, mussels, oysters, prawns, canned sardines and salmon (35-300 mg per serve)
• Cucumber, kale, silverbeet, Chinese cabbage, broccoli, rocket, watercress, bok choy and leeks (59-250 mg per serve)
• Almonds, Brazil nuts, hazelnuts, walnuts, sesame seeds and tahini paste (28-75 mg per serve)
• Orange, strawberries, figs, kiwi fruit and dates (16-95 mg per serve)
• Eggs, calcium-set tofu, canned chickpeas and soybeans (21-105 mg per serve)
• Pork chop and chicken (21-105 mg per serve)

Get some vitamin D

Despite our warm climate, 70 per cent of Australian adults do not have adequate vitamin D, which is needed to absorb calcium. Foods including mushrooms, liver, eggs and oysters contain vitamin D. However, sunlight is the best way to get our hit, with one 2022 study suggesting vitamin D supplementation makes little difference.

Between 8am and 9am is a wonderful time to get vitamin D every day, says Nguyen.

Make the most of your health, relationships, fitness and nutrition with our Live Well newsletter. Get it in your inbox every Monday.