Caitlin Whyte (Host): Hip fractures can be a big upset to not only the person that suffers from one, but for their family and loved ones as well. And in this busy holiday season, we tend to see more hip fractures come in our doors.

So, today, we are going to talk all about preventative actions people can take to avoid hip fractures. With us is Dr. Jeff MacLean, a Trauma Fellowship-trained orthopedic surgeon.

This is Hello Healthy. I'm your host, Caitlin Whyte. So doctor, your philosophy I've heard is the best hip fracture is the one that you don't get. To start off our episode today, can you briefly describe what you mean by that?

Dr. Jeff MacLean: Yeah, of course. So, hip fractures are one of the most common injuries in Orthopedics in adults over age 50. And unfortunately, the result of having a hip fracture is that the vast majority of people will experience some degree of functional decline in their life after sustaining a hip fracture, meaning it's hard to bring people 100% back to the same activity and functional level they were at before they broke their hip. And when we can't get somebody fully recovered from an orthopedic injury, it becomes increasingly important to prevent that injury from occurring in the first place.

Host: Gotcha. So, we're heading into the holiday season here, I guess we are kind of in the midst of the holiday season. But that's a particularly busy time and it's a busy time for hip fractures. So, why is that and how can we stay safe with our families during these busy seasons?

Dr. Jeff MacLean: Yeah. You know, the prevention of hip fractures really falls into two categories. The first one is what should I be doing over age 50, particularly over age 65 in my daily life to prevent them in general? And then, the other is this increased spike that we tend to see in and around things, particularly the holidays between Thanksgiving and Christmas. And so, the general advice about hip fractures is that staying active, doing weight-bearing exercises, getting our bone density checked over age 65 and taking calcium and vitamin D supplements are good ways to help ensure good bone health, as we pass 50 years of age and onwards.

And when it comes to the holidays, it really gets into the second area that we focus on in terms of preventing hip fractures. And that's about the fall prevention. So, one of the toughest things in life as we get a little older is that, number one, we don't like to recognize that there are things that we maybe can't do or, better put, shouldn't do that we used to do on a regular basis, things like cleaning out the gutters, things like getting stuff out of the attic. We also have an increasingly harder time asking people to do things for us. We just don't want to be a burden. When it comes to the holidays, we're getting out mixing bowls and holiday decorations from places that we had tucked away. And one of the most frequent, occurrences is a fall from a step stool or a ladder, something that was completely avoidable if we just didn't do it in the first place.

And so, the most important thing to remember around the holidays is don't ruin your holiday with a fall. So, ask somebody else who's a little bit more stable, a little bit less prone to low bone density or fragile bones to do that heavy lifting, hard work, and holiday decorating. And change your role from the person that used to do it all to the person that directs it being done.

Host: I love that. Love that advice. That makes me think though, doctor, especially in these winter times. If we're traveling up to the northeast or maybe we're heading to a snowy area, a wet area, how does weather, especially in these later months of the year, affect those at risk?

Dr. Jeff MacLean: For sure. I started my training on the East Coast. And of course, wintertime is a really difficult time for everybody with mobility issues and even those without. The big difference is, you know, in our 20s and 30s, when we fall down, we bruise our skin and we bruise our egos. In our 60s and 80s, when we fall down, we injure our heads and we break our hips. And so, the consequences change a lot.

The way to kind of mitigate these risks is, number one, to slow down; number two, to use assistive devices. And so, if you're going to a snowy climate, if you're headed up to Tahoe and that's not your normal place to be, first of all, go to the sports store and get the little cleats that go for your shoes that give you better grip. Number two, grab your cane, grab a walker, slow down, take your time, enjoy the scenery, and don't worry about what you look like using a cane or walker. Because I can assure you that there isn't another human being out there that's looking at you and thinking, "Oh my gosh, look at her with a walker. She looks so old." That is a perception that people have that just doesn't meet a reality. But if you are getting around in a wheelchair or barely able to stand, you're going to wish that back when you had the choice, you were using that walker or cane just for a little added insurance. So, it's an ounce of prevention in order to prevent months or years of recovery.

Host: Speaking on those travels, those gatherings, maybe we ourselves aren't the person that's at risk of a fracture, but maybe we're traveling with older parents or we're heading to an older aunt's house or something like that, how can we, as the more able-bodied individuals then, make sure our loved ones are staying safe and maybe nudge them in the direction of using their devices and things like that?

Dr. Jeff MacLean: Of course. You could imagine, and almost every household has had this struggle at some point with some family member in which, you know, it really becomes more of an argument. And so, what I recommend in these settings is start by just setting a baseline that you're going to be there for assistance and that you're going to take things slow and not open it up to a discussion. So, we leave for the airports early. We just tell our family members that we're going to be using the airport transportation when we get there, not asking if they want to, but just stating that we're all going to do that. And then, we just bring the walker and we bring the cane and we make sure that the older individuals aren't trying to wheel around luggage or take care of kids while the family's doing all these things. We check our bags. And we take it slow.

It's always a hard thing to push somebody to use this right in the spur of the moment. So, kind of bringing it up ahead of time and just mentioning that the whole reason for doing this isn't because the person's unable to get around without a walker or a cane or some sort of balance aid, but that it's kind of like wearing a seatbelt in a car. We don't put that seatbelt on, because we know we're about to get into an accident. We put that seatbelt on because we can never predict when it's going to happen and we wouldn't want to suffer the consequences of not having it. So in order to not ruin the holidays, in order to make the trip more fun for everybody, we just kind of put it out there in a positive light and reinforce that we're there to help. We're going to support a family traveling with us. We're here to make their lives easy so that everybody can have fun and not have any worries.

Host: You know, I'm also thinking about if I'm the one hosting and maybe I'm prepping for some folks that might be at risk of falls, how can I get my house in order? What things could I maybe change or move around to help with those bigger crowds that we might be seeing?

Dr. Jeff MacLean: Absolutely. One of the biggest myths is, you know, patients will often say to me, "Hey, all right, I hear your point, doctor. I will use my walker whenever I head out to the grocery store or whenever I'm going to the doctor's office." But the reality is that the vast majority of falls resulting in a hip fracture occur within the home. And in your own familiar surroundings, it can still happen. But in unfamiliar surroundings, it's really an increased risk. And so, the two big pieces of advice are to keep a clutter-free walkway and to keep the lights on.

So, what that means is area rugs, clutter on stairs, we got packages and suitcases and bags and multiple people living in a smaller space during these holidays, but we really want to keep the travel areas open and wide and then, move the bedside table, the the lamp with a long cord, the removable throw rug that's got a big lip to it. Those are things that the people not familiar with your house aren't necessarily going to recognize to lift their feet at the right time.

And then, especially in the evenings and at nighttime, and for those getting up to use the bathrooms in the middle of the night, we want to keep a well-lit area. So, keep the hallways, keep the bathrooms lit, have a motion-detective night lights, and that'll go a long way to help prevent falls when you're living or traveling to an unfamiliar place for the holidays.

Host: Wonderful. Well, doctor, anything that we didn't cover that you think people should be aware of or just should know while we head into, again, this holiday season and caring for loved ones at risk of hip fractures?

Dr. Jeff MacLean: Yeah. The only thing I'd say is, again, activity is life. As we get older, the more active we stay, the more mobile we stay, the lower our risk for a hip fracture because our bones stay stronger. And so, we can tolerate the occasional fall much better if we stay active. And then, number two is talk with your primary care doctor, talk with your orthopedist. You know, routine bone density screening for women over age 65 and for men and women in high risk groups is something that is very difficult for us to remember to do and gets missed a lot and can help us prevent hip fractures.

So in the meantime, enjoy the holidays, enjoy the family, stay safe, and try to stay home and out of the hospital.

Host: Well, thank you so much, doctor, for the holiday help and for sharing these tips with us today.

Find out more about us online at dignityhealth.org/stockton/ortho. You can also find more interesting and informative podcasts in our podcast library, and be sure to share them with your loved ones. This has been Hello Healthy, a Dignity Health podcast. I'm Caitlin Whyte.