In the realm of what’s important for you to know about aging and menopause, one of the greatest risks to your long-term independence and well-being is one that we least talk about, think about, or do anything about: falls. Consequently, one in four adults over the age of 65 will experience a fall within the year. And the fallout (forgive me, I’m just trying to keep things light) could be life-altering.
Falls are not just embarrassing, like the TikTok reels you scroll through late at night. They can be the source of permanent disability or even death. Falls that result in head injury are one of the more common causes of dementia in the elderly. Head trauma is one of the top five reasons for cognitive decline. And for reasons that are not entirely clear, women’s brains are more susceptible to damage after head trauma. Even if you are mentally vibrant and young at heart, here is the reality: 95 percent of hip fractures are due to falls, and a hip fracture is often the first medical event in a cascade ultimately leading to death.
Women make up three-quarters of all hip fractures, most likely because we make up a disproportionate share of those with osteoporosis. Osteoporosis is a systemic disorder that causes bones to become brittle and weak, leading to an increased risk of fractures, particularly in the spine and hips. Women are four times more likely than men to develop osteoporosis and your risk steadily increases after age 50.
Can hormone therapy help with bone loss during menopause?
In the year before your final menstrual period, and continuing for about five years after, bone loss accelerates (after that, bone loss continues, albeit at a slower pace). But this isn’t something you’re likely to notice or even think about until you experience a fracture. A study led by Juan Blumel, published in the September 2022 issue of the journal Menopause, followed a group of midlife women for 30 years. The purpose of the study was to see which health-risk factors were more predictive of death. They found that a personal history of a fracture was more predictive of dying within the study period than a history of cardiovascular disease, diabetes, and hypertension. This should underscore how important osteoporosis and fall prevention are. So, if you have a family history of hip fractures or other risk factors, including rheumatoid arthritis, smoking, and alcoholism, or if you have had a fracture (and I don’t mean from a ski or car accident), ask your doctor about getting a bone density test. There is also an online tool called FRAX that will estimate your fracture risk in the next 10 years based on your age, gender, BMI, alcohol and medication intake, and smoking habits.
Hormone therapy is FDA-approved for the prevention of osteoporosis, not treatment. If you are a smoker or have had an early menopause, your risk of osteoporosis is increased. The earlier you start hormone therapy after menopause, the more bone density you save. Remember, the goal is to preserve your bone density, not to try to regain it later.
Are white women at a higher risk of developing osteoporosis than Black women?
There is a misperception in the medical community that Black women don’t get osteoporosis. This is a dangerous myth that can prevent Black women from getting the information, screening, and treatment they need. While Black women do have a lower incidence of osteoporosis, it is not that being Black lowers one’s risk, it is the size of one’s bones that matters. Smaller bones are at greater risk for osteoporosis than larger bones. Thus, a thin Black woman with small bones carries the same risk of developing osteoporosis as a similarly sized white woman. So, be wary if your doctor says you are not at risk simply because of your race. When in doubt, just get a bone density test.
What is not commonly known is that Black women are more likely to suffer ill effects from hip fractures. In fact, Black women are more likely to die or be permanently disabled within the first year of a hip fracture than white women. Why are hip fractures so dangerous? Because of the high likelihood of complications that ensue from them, such as an increased risk of blood clots, pneumonia, and progressive, debilitating weakness. Hip fractures are one of the most common reasons for older people’s loss of independence. They can cause older menopausal women who are otherwise healthy and vibrant to lose their independence and require in-home or inpatient nursing care. Almost any significant fall injury can lead to temporary or long-term loss of function, autonomy, and dignity.
I know that sounds grim, but let this be an incentive for you to avoid the pitfalls that could lead down this road. Hopefully, you are decades away from having to deal with these issues. But whether you are or not, don’t turn away; get serious about what you can do to reduce your fall risk. If you are fortunate enough to still have parents, this information will be helpful for them as well. The simplest way to avoid trauma-associated dementia or a loss of independence, which may lead to death? Don’t fall! As your own primary caregiver, your goal always is to confront issues before they happen, not after.
How to prevent falls and bone loss due to menopause
Time feels like it speeds up as we age, and the changes can come at a rapid clip too. The more you can anticipate those changes, the better off you’ll be. God willing, we will all live to be old one day. And you know by now that I never give you bad news unless I’ve got some good news to share. The take-home message is that many falls are indeed preventable, and yes, there are things you can do to minimize your risk. You can start by becoming hyperaware of the three most common contributors to heightened fall risk: impairment due to medication (or overmedication); vision problems (stay on top of your annual eye screenings and any resulting prescriptions and visual aids); and muscle weakness.
Also, incorporate these tips on how to reduce your risk of falling into your daily life:
- Check your medications and their interactions with your doctor (antihypertensive medications and diuretics are notorious for causing weakness, dehydration, and fainting).
- Secure loose rugs, keep pathways in your home and office unobstructed (pay special attention to extension cords and chargers).
- Use nightlights if you frequently get up to go to the bathroom at night.
- If you use bifocals, be aware that when descending stairs, your depth perception is compromised because when you look down, you are likely looking through the reading portion.
- Get your eyes checked annually. Your vision naturally changes with age.
- Walk, don’t run, down stairs. Counting stairs as you go helps you pace yourself safely.
- Never walk down stairs with your arms full. Always hold the handrail, even if you don’t need to (and especially if you’re wearing slippers, mules, or high heels).
- Avoid walking while you are on your phone. While you are talking, you are not situationally aware.
- Check your footwear. Only you know for sure when you should give up those Manolos, and for goodness’ sake, toss those flip-flops. There are plenty of options to keep you cute and safe. (It’s never too late to become a sneakerhead.)
- Stay off ladders or footstools unless you have a spotter. Better still, have a young person reach what you need, just like you used to for your mom. (There’s no shame in that game.)
- Apple and Google watches have fall-prevention and fall-detection features (and their competitors won’t be far behind). A sudden change in your motion metrics will trigger a loud alarm to alert those around you, followed by a series of displays that require your responses. Without them, the watch will automatically call 911 and your emergency contact if you specified one.
Excerpted from Grown Woman Talk by Sharon Malone, MD. Crown Publishing Group, 2024.
