Anti-Fall Measures in Osteoporosis

Hitesh Gopalan UEditor, www.orthopaedicprinciples.com , Clinical Asst Professor, MOSCMM, Cochin

Visiting Lecturer, Centre for Evidence Based Orthopaedics,McMaster University, Canada

Risk Factors for fractureH/o fracture

Female Sex

White Race

Advanced Age

Dementia

Risk factors for fractureCurrent Cigarette Smoking, Alcoholism

Low Body weight

Oestrogen deficiency, Early menopause

Impaired Eyesight

Inadequate physical Activity

PreventionFalls

Secondary Osteoporosis

Prevention of Primary Osteoporosis

Methods to prevent FallsNocturia: Modify Diuretic Use

Sedative-hypnotic drugs

Orthostatic Hypotension

Prevention of FallsAlcohol Abuse

Avoid stocking feet on wood floors

Check carpet condition periodically

Grab Bars in Toilets

Eliminate exposed wires

curtain strings

slippery rugs

mobile tables

Prevention of FallsAdequate lighting in paths

Vision: Depth Perception

Neurological Disease: Stroke, parkinsonism

FRAXGeographic regionRaceSexWeightHeightPrior fragility fracture

FRAXParent with hip fractureGlucocorticoid use (≥5 mg/day of prednisone

for ≥3 mo ever)Rheumatoid arthritisSecondary osteoporosisCurrent smokingAlcohol intake (≥3 or more drinks/day)

FRAXhttp://www.shef.ac.uk/FRAX/index.htm.

Risk for fracture

Adequate care

10 year probability of fracture

BMD not essential

Peak Bone MassAttained by age 25

Correct Menstrual dysfunction, Amenorrhea

Body Weight

Lane JM, Riley EH, Wirganowicz PZ: Osteoporosis: Diagnosis and treatment. J Bone Joint Surg Am 1996;78: 618-632.

ExerciseMuscle Strengthening

Habit

Impact Loading

Balance Training

ExerciseLow-Moderate levels

Bone mass= Muscle mass

Excessive Exercise: Female athlete triad

ExerciseJogging

Brisk Walking

Stair Climbing

Not recommended: Lifting heavy weights, sit-ups

Endurance TrainingSwimming, Long distance running

Not effective in improving BMD

DietAdequate dietary Calcium

800- 1200mg/day

Tai Chi47 % in fall incidence

Can be practiced by elderly

Province MA, Hadley EC, Hornbrook MC, et al: The effects of exercise on falls in elderly patients: A preplanned meta-analysis of the FICSIT trials. JAMA 1995;273:1341-1347.

Hip ProtectorsThickness of buttock muscle and fat pad(75%

of energy can be absorbed)

Protector Pads

Bulky appearance

Hip Protector Pad

Prevention of Falls in the Elderly Trial(PROFET)Reduction of Medication

Getting up after fall

Education in prevention of falls

Close J, Ellis M, Hooper R, et al. Prevention of falls in the elderly trial (PROFET): a randomised controlled trial. Lancet 1999;353:93-97

Secondary OsteoporosisCushing’s SyndromeThyrotoxicosisHypogonadal statesGastrectomyLiver DiseaseRA, Ank SponOsteogenesis Imprefecta

Evidence- Alendronate

Does Alendronate Interfere with fracture Healing?NO

Quality of the evidenceLevel I• 2 randomized controlled trialsLevel IV• 1 case seriesNo classification• 14 trials in animals

Calcitonin

VEGF-A