A friend recently told me that her elderly mother developed dementia after breaking her spine. Dementia is a risk factor for falls and hip fractures in elderly dementia patients. But similar to the question of which comes first the hip fracture or the fall, the question of which comes first dementia or a significant fall is something to consider.

An individual with dementia is up to three times more likely than a cognitively intact older adult to sustain a hip fracture. This might occur due to several reasons including decreased activity, osteoporosis, vitamin D deficiency, smoking, side effects from drugs given to treat dementia, or unsafe environment.

Eight-six percent of hip fractures occur in individuals over the age of 65 years. Dementia prevalence increases exponentially with age, from 3% among those aged 65 to 74 years to 19% among 75 to 84 year olds and 47% in individuals over the age of 85 years.

There is some evidence that a hip fracture can in turn lead to cognitive decline. In one study, 25 of 26 Alzheimer disease patients with hip fracture had the onset of Alzheimer disease after the hip fracture. The researchers theorize that either the hip fracture brought the dementia to clinical attention or that patients who were marginally compensated prior to the event had further cognitive deterioration.

Whether your concern is staving off dementia or reducing risk of bone fractures, make sure your diet includes plenty of antioxidant-rich fruits and veggies for vitamins and the minerals necessary for maintaining healthy bones. Vitamin B complex is vital to supporting cognition, and most Americans, especially vegetarians, are deficient in vitamin B12. So consider supplementing your diet with a B12 nutritional supplement.

7 ways to protect yourself and your loved ones from bone fractures

1. Protection of the hip with external padding can help in the prevention of hip fracture in individuals with low bone mass or with conditions that make falls inevitable.
2. Low body weight, secondary to poor appetite or poor health, as opposed to intentional weight loss, has been associated with increased hip fracture risk. Nutritional deficiencies can also play a role in hip fracture risk. Make sure you or your loved one is eating a nutritious diet and getting a minimum of 1500 calories each day.
3. Vitamin D deficiency is associated with cognitive decline, dementia and bone loss. Michael F. Holick, M.D., PhD., the world’s leading expert on vitamin D says that 200 million Americans are deficient in this essential vitamin. Through Holick’s research we know that every body cell has a receptor for vitamin D, which is why it is so crucial to overall health. Vitamin D is most commonly known for helping the digestive system absorb calcium and phosphorus. In that way it helps the body build and maintain healthy bones. But it does much more. Adequate vitamin D is necessary for reducing the risk for bone disease. Vitamin D is believed to play a role in the reduction of falls, as well as reducing pain, autoimmune diseases, cancer, heart disease, mortality and supporting cognitive function. 
4. Exercise supports muscle strength, stability and balance, which are all important for preventing falls. If your or your loved one is mobile, implement a regular exercise program, which can be as simple as walking at least 30 minutes three times a week.
5. Stop smoking—Smoking is a risk factor for both cognitive decline and dementia, with a relative risk of 1.79 for Alzheimer disease and 1.78 for vascular dementia. Smoking also has been shown to increase risk of hip fracture in both women and men.
6. Reduce or eliminate soft drinks from your diet. Frequent intake of soft drinks and infrequent intake of fruits and vegetables have been associated with low bone mineral density.
7. And of course, make sure you are getting the recommended daily requirement for calcium, vitamin K, and boron, either through food or supplements.

References

1. Evans DA, Funkenstein HH, Albert MS, et al. Prevalence of Alzheimer’s disease in a community population of older persons. Higher than previously reported. JAMA. 1989;262(18):2551–2556.
2. 24. Melton LJ 3rd, Beard CM, Kokmen E, Atkinson EJ, O’Fallon WM. Fracture risk in patients with Alzheimer’s disease. J Am Geriatr Soc. 1994;42(6):614–619.
3. Holick MF. Vitamin D: the underappreciated D-lightful hormone that is important for skeletal and cellular health. Curr Opin Endocrinol Diabetes 2002;9:87-98.
4. Holick MF. Vitamin D. In: Shils ME, Shike M, Ross AC, Caballero B, Cousins RJ, eds. Modern Nutrition in Health and Disease, 10th ed. Philadelphia: Lippincott Williams & Wilkins, 2006.
5. Slemenda C. Prevention of hip fractures: risk factor modification. Am J Med. 1997 Aug 18;103(2A):65S-71S
6. McNaughton SA, Wattanapenpaiboon N, Wark JD, Nowson CA. An energy-dense, nutrient-poor dietary pattern is inversely associated with bone health in women. J Nutr. 2011 Aug;141(8):1516-23. doi: 10.3945/jn.111.138271. Epub 2011 Jun 8.
7. Høstmark AT, Søgaard AJ, Alvær K, Meyer HE. The oslo health study: a dietary index estimating frequent intake of soft drinks and rare intake of fruit and vegetables is negatively associated with bone mineral density. J Osteoporos. 2011;2011:102686. doi: 10.4061/2011/102686. Epub 2011 Jul 2.