Although the track of osteoporosis is not necessarily privileged in the event of a fracture of the shoulder, it should be explored when the person concerned has fallen from his height and is over 50 years old. In this case, a bone densitometry is essential, in order to measure the bone resistance and to predict the risk of new fractures.
- In the event of a fracture of the humerus after a fall from its height, bone fragility should be suspected
- Fracture of the humerus multiplies by three to four the risk of breaking the neck of the femur in the following years
- It usually takes a year for drug treatment of osteoporosis to be effective
Bone disease often referred to as “silent”, osteoporosis usually occurs in some people over the age of 50, especially women. However, it is rarely detected in time; for example, if a 65-year-old woman slips and breaks her shoulder – also called the humerus – the trail of osteoporosis will not be systematically explored. “It’s not normal to break from its height: you have to suspect bone fragility”alert to why doctor Professor Karine Briot, rheumatologist at Cochin Hospital in Paris.
The healthcare professional is categorical: normally, the humerus bone is resistant to trauma equivalent to a fall from its height. Thus, in the event of a fracture of the shoulder when one fell while walking or sliding, it is advisable to consult his doctor, to evoke osteoporosis, and to ask to pass a bone densitometry. “It’s a test that measures bone strength, the quality and quantity of bonecontinues the expert. This will tell if there is bone fragility; this is essential”.
An increased risk of fracture at two years
In addition to diagnosing osteoporosis, bone densitometry can predict the risk of new fractures, particularly of the neck of the femur, vertebrae, humerus and pelvis. “The risk is increased at two years”, assures Dr. Karine Briot, specifying that the fracture of the humerus multiplies by three to four the risk of breaking the neck of the femur in the following years. Concretely, this means that, if we really want to prevent the second fracture, we must perform a bone densitometry in the months, or even weeks, following the first.
Apart from osteoporosis, it is possible that the examination reveals osteopenia, that is to say a moderate bone demineralization, which can evolve into osteoporosis if it is not corrected. “Bones like the neck of the femur, the humerus, a vertebra and the pelvis are really very resistant: even if the bone density is not very low and in the thresholds of osteopenia, it is necessary to take into account the antecedent of fracture and still ask the question of treating the bone fragility”explains the rheumatologist.
“If the bone density exam has improved a lot, we can discuss a break”
According to her, as soon as a patient with a humerus fracture presents with osteopenia, treatment is essential. Currently, the most used in first intention is the class of bisphosphonates. “You have to start it quite quickly because, to modify the bone architecture, the bone mass, it takes a certain timeexplains Dr. Karine Briot, specifying that it is generally a year. We are therefore not protected during the first six to nine months”.
The risk: waiting too long, then observing a fracture when you have started a treatment, telling yourself that it is not effective and no longer resenting it. In reality, the treatment had simply not had time to bear fruit. Nevertheless, if the management of osteoporosis is done for life, it does not necessarily go through medication all the time. For example, in the context of a fracture of the humerus, it is possible to make an assessment after three years of treatment. “If the bone density exam has improved a lot, we can discuss a break”assures the rheumatologist.
Thus, monitoring continues, but only through regular consultations and examinations. “Sometimes we resume treatment later, either because we have had another fall, or because the bone mass has deteriorated, or because we have a new risk factor…”concludes Dr. Karine Briot.
.
