Philip J. Goscienski, M.D.
August 2005
Let's face it. Exercise is a drag. Sometimes it's painful, or at least uncomfortable. Forget that last phrase. It's always uncomfortable. On the other hand, a hip fracture - or any other type of fracture - is painful, too. And sometimes fatal. Nearly a quarter of oldsters who sustain a hip fracture die within a year.
Falls occur with frightening frequency. If all Americans maintained the Stone Age lifestyle with a couple of hours a day of walking, lifting, throwing, pulling, pushing and carrying, fractures would occur infrequently and almost always because of a fall from a height or a severe blow to the body.
Seniors break bones in the course of a relatively minor injury such as a fall from a sitting or a standing position because of osteoporosis, which is a generalized weakness of bones. That's not due to a calcium deficiency, which leads to softening of the bones, a condition called osteomalacia. In almost all cases, softening of bones occurs when the supply of vitamin D is inadequate so that the body cannot absorb calcium. The childhood form of osteomalacia is called rickets. It was a common childhood disease prior to the 1930s.
In osteoporosis the entire framework of the bone becomes lighter and thinner. Multiple factors are involved and simply increasing one's intake of calcium is a fruitless endeavor. The clearest proof of this comes from unmechanized societies in which the average intake of calcium is barely a third of that which nutritionists recommend. In spite of that, fractures of the hip and spine are rare among those groups.
Millions of years of evolution have made the skeleton much more than a framework to which muscles are attached and which keeps us from collapsing into a soft pile of skin and internal organs. The skeleton is a blood factory for the cells that carry oxygen, a storehouse of infection-fighting white blood cells, and a small fat repository. It makes elements that cause our blood to clot when it's supposed to and keeps our system from acid overload. As a storehouse of calcium it maintains blood levels of that mineral within a narrow range of normal. Too much or too little calcium in the blood leads to serious malfunction of the muscles that power our limbs and the all-important muscle bundles that form the heart.
Muscles that lie dormant waste away. That's what happens to the arm or leg that is kept in a cast for several weeks. After all, why should the body maintain a mass of tissue that doesn't earn its keep? This concept, which I call bioeconomics, applies to the skeleton as well. If muscle does not pull against bone, that bone will become smaller and lighter. It would be wasteful of the body to nourish thick, strong bones that don't carry a load. The result of inadequate physical activity is a light, fragile skeleton that simply gives way under sudden stress.
Except for swimming, all exercise helps to build stronger bones. The best form of physical activity is resistance exercise such as weight-lifting. Only two or three 30-minute sessions per week of a properly designed exercise program will significantly lower your risk of fractures. It's not a matter of finding time. You'll have plenty of that while waiting for your hip fracture to heal.
Philip J. Goscienski, M.D. is the author of Health Secrets of the Stone Age, Better Life Publishers 2005. Contact him at drphil@stoneagedoc.com.