[Health in the 100-Year Life Era] Winter Uninvited Guest, Slip and Fall Fractures on Icy Roads

Hip Fractures Make Walking Difficult and Cause Complications
Osteoporosis Treatment Cuts Risk by Half

Professor Shin Dong-wook, Department of Family Medicine, Samsung Seoul Hospital.

The season with the highest incidence of fractures is winter. This is because falls increase due to slipping on icy roads. Fractures in younger age groups usually occur from major impacts such as accidents, but as people age, fractures caused by significant falls become much more common. As we age, joints deteriorate, muscle strength decreases, and balance worsens, making it easier to fall. The impact from a fall that would not break bones when young can easily fracture bones in those with weakened bones.

The areas where fractures from falls commonly occur are the wrist, spine, and hip joint. When falling, trying to catch oneself with the hands can lead to wrist fractures. If the spine is impacted, compression fractures that flatten the lumbar or thoracic vertebrae often occur. Elderly women often walk hunched over with a cane because of multiple spinal fractures. Wrist or spinal fractures may cause discomfort and pain for several months but generally do not threaten life.

However, hip joint fractures (femoral neck fractures) in the hip area can cause serious problems. Walking becomes impossible, so most patients require surgery. After surgery, limited mobility can lead to systemic complications such as pressure sores, pneumonia, and pulmonary embolism, resulting in a mortality rate of up to 20% within one year. Even after surgery, patients must undergo rehabilitation for several months, and even with recovery, about 30-40% of patients experience some degree of walking disability.

So, how can we prevent falls and fractures during winter?

First, avoid slippery areas as much as possible. It is best to refrain from unnecessary outings when roads are slippery, and even when going out, avoid shaded areas where ice is likely to form. Consider replacing outdoor exercise with indoor activities such as using a gym facility, riding a home exercise bike, or walking up apartment stairs and taking the elevator down.

Second, wear shoes with non-slip soles and gloves when going outside. Walking with hands in pockets makes it harder to maintain balance if slipping occurs, increasing the risk of serious injuries such as hip fractures or head injuries from falling backward. It is advisable to take shorter steps than usual.

Third, as the weather gets colder, muscles and ligaments become stiffer, so it is good to warm up and do light stretching before going out. Regular exercises like yoga or Pilates that enhance muscle and ligament flexibility and improve balance are helpful.

Lastly, it is important to maintain strong bones. Bones are strongest around age 30, after which bone mass decreases by 0.5% to 1% annually. In women, bone loss accelerates after menopause, decreasing by 3-5% annually for several years immediately after menopause. As a result, osteoporosis prevalence is much higher in women than men: about 15% in their 50s, 40% in their 60s, and nearly 70% in those over 70. Hormone suppression therapy for breast or prostate cancer, or surgery for stomach cancer, can also significantly weaken bones.

Osteoporosis has no symptoms, so it can only be diagnosed through bone density testing. If osteoporosis is present, treatment with oral medications or injections that prevent bone loss can reduce fracture risk by about half. Supplementing calcium, vitamin D, and protein, as well as weight-bearing exercises like walking or jogging, can help maintain bone density to some extent. However, for those with osteoporosis, these measures alone are insufficient for prevention, so medication treatment is essential.

Dongwook Shin, MD, Professor, Department of Family Medicine, Samsung Medical Center