Friday, February 22, 2008

Skinny white women who smoke...

are prime candidates for osteoporosis. And these same skinny ladies who age into frail old ladies (still smoking or not) are prime candidates for broken hips. And here's the story about how they might die.

Mrs. I was my patient, a family friend, and a neighbor. Her husband called me early one morning to say she'd fallen in the bathroom and probably fractured her hip. I hurried right over to wait with them for the paramedics. As I sat and chatted with Mrs. I, she on the tile floor and me perched on the can, I couldn't shake the gloomy thought that there was a high likelihood she'd be dead in several months. Now 92, she'd last made her daily walking trip to the local store at age 90, always with cigarette in hand.

The orthopedist gave us two options: do nothing and she'd see out her days in bed and in pain. Go for a new minimal sort of surgery where a pin could be inserted through the skin into the fracture site under local anesthesia, and she might walk again. No problem with that decision.

Walk she did, and home she went. Unfortunately, as the physical therapist worked with her to once again negotiate the steep stairs in her house, she stumbled and fractured some ribs. The pain put a stop to all her rehab efforts; she moved to a hospital bed in the downstairs office and spent more time in it and less time in a wheelchair. One night, Mr. I again called me. She'd sat bolt upright in bed struggling to catch her breath. A blood clot had probably broken free from her pelvic veins and traveled into her lungs, blocking a blood vessel there. It probably broke up then as her breathing eased rather quickly.

Two weeks later, unfortunately, another clot escaped her pelvis, a big one this time. Her breathing became labored, then stopped altogether.

We all have to go some time, some way. Few live into their 90s, and Mrs. I had lived well. But skinny white ladies who smoke can duck this scenario perhaps with changes in lifestyle choices long before they age.

8 comments:

Mauigirl said...

Unfortunately my mom is one of those skinny old white ladies who smoke. She's been lucky so far - no falls with broken hips. She was fortunate enough to land directly on her rather large nose and broke that when she fell recently, rather than a hip.

My grandmother (also a skinny white smoker) fell at age 84 and broke some ribs and was never quite the same after that - she started to develop mild dementia and died at age 85 of some kind of coronary or vascular event (we didn't do an autopsy).

So far Mom has made it to 89...She has often said she has no regrets about smoking and it's part of her life and she enjoys it and I think if she falls and dies as a result she will still be glad she kept smoking, although she has no desire to go anytime soon!

Ruth said...

Since I started keeping computer records of my community visits in 2000, I have followed over 800 hip fractures for physiotherapy treatment.(my #1 referral dx and unfortunately my bread and butter) Several of my patients have had more than one hip fracture or the very unfortunate combination of a hip and shoulder fracture on the same side. While smokers are at increased risk for osteoporosis, every woman should be screened for the condition (as well as men with risk factors). We now have a falls assessment clinic in town as we try to treat the causes for falls before a fracture occurs. People who come into ER with a wrist, shoulder or compression fracture are assessed by a special team who diagnose and treat osteoporosis. Our public health system puts a lot of money into the treatment of osteoporotic fractures and they are trying to find ways to decrease the frequency of them in the baby boomer generation.

Joan said...

Small boned women will probably develope osteoporosis by 80 regardless of whether or not they smoke. Everyone loses bone as they age; small-boned individuals have less to start with -- common sense. Hey, what're these smokers doin' living till 90!!

JeanMac said...

My Man's mother beat breast cancer in '68 and continues to smoke - look the Devil in the eye, would you? Wrist fracture in '80 and ankle in 90 - yeah, Mom.We have not been able to convince her "it's best not to smoke".

Femail doc said...

MG: Amazing how some people get away with smoking while others don't. Especially in a lung sense. They've identified genetic markers for persons who break down cigarette smoke in a very lung-destroying sort of way. I don't know that anyone has determined who is most at risk for losing bone density to smokes, but they have identified a genetic variant of people most susceptible to the bone-losing properties of coffee. I wouldn't do that test even if it was easily available!

Ruth: I always appreciate your comments from a physiotherapist's point of view. A falls assessment clinic is a great idea; stop it before it starts. And I applaud the Canadian public health system for being so proactive on bone health.

Joan: I agree, small boned women are at risk, smoking or not. I once gave a lecture on osteoporosis, mentioning women size 8 and below at risk. A woman asked "Is that size 8 now or used to be size 8?"

Jean: There's no talking to some people about habits. Hopefully, whatever happens, she'll have no regrets on her choices.

Beverly said...

I am a skinny, white, fair-skinned, blonde woman on heparin. I do not or ever have smoked. I just found out I have osteoporosis. Oh boy...

Mauigirl said...

Femail Doc, my mom must be one of the lucky ones who don't break down the smoke in the destructive way. I agree with you about that coffee gene - I love my coffee too much to find out that it's going to give me osteoporosis! No test for me either! I comfort myself with the fact I'm plump enough to offset the bone loss since it's skinny people who are more prone to it!

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