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Osteoporosis and Falls

New College Tutorial


Matt Schiller
matt@unsw.edu.au

Osteoporosis
Definition
Pathogenesis
Estrogen deficiency
Senility
ACCESS mneumonic

Morphology
Thin, sparse trabeculae
Widening of central canals
Vertebrae and neck of femur most affected
(corresponds with most common complications)

T score vs. Z score

Treatment
Guidelines

BMD T Score Without fracture With fracture


Normal
Osteopenia
Osteoporosis

>-1 SDs
-1 to -2.5 SDs
<-2.5 SDs

Treat

Treat
Treat

Treatment Options
Mechanism
Hormone
replacement
therapy (HRT)

Indication

Adverse effects

Around menopause Increased risk of


certain cancers and
Postmenopausal
CVD with long-term
symptoms
use
SERMs
Mimic estrogen in bone Later postmenopausal (Protect against certain
years
tissue (inhibits
cancers)
osteoclast activity)
Bisphosphonates Bind to calcium in bone Later
Pain with
and prevent
postmenopausal
swallowing
reabsorption
years
Upper GIT effects
(antagonise action of Women over 75
years where main
osteoclasts)
concern is hip
fracture
PTH analogue
Promotes bone
Severe osteoporosis and Dizziness
formation (in pulsatile fractures
Headache
administration)
Nausea
Calcium and
Prevent excessive
Over 65 years
resorption
Calcium or Vitamin
Vitamin D
D deficiency
supplementation
Estrogen inhibits
osteoclast activity

Imperative to Treat
Imperative to treat increases with:
Increasing age.
Declining BMD.
Prior fracture.
Family history of osteoporosis.
Risk factors for bone loss.
High levels of bone remodelling markers.
Lean body.

Prevention in Young Individuals


Maintaining good nutrition
Adequate sunlight exposure to allow Vitamin D synthesis
Maintaining a healthy weight range and avoiding extreme
leanness
Avoiding loss of menstruation
Regular weight-bearing exercise
Avoiding smoking
Limiting alcohol intake
Monitoring medications that increase bone loss (e.g.
glucocorticoids) and avoiding prolonger therapy and/or
high doses where possible

Risk Factors for Falls


Medical
conditions
Stroke
Incontinence
Parkinsons
disease
Dementia

Environmental

Medications

Poor footwear
Home hazards
Inappropriate
spectacles

Sensorimotor and
balance

Psychoactives
Polypharmacy

Psychosocial and
demographic

Muscle weakness
Impaired vision

Reduced peripheral
sensation

Impaired balance
(including vestibular
function)

Sensorimotor and Balance


Deterioration with Age

Muscle strength
Visual acuity
Contrast sensitivity
Depth perception
Control of sway
Reaction time
Vibration sense
Proprioception
Tactile sensitivity
Vestibular function

History of falls
Depression
Advanced age
Living alone
ADL limitations
Female gender
Inactivity

Fall Prevention
Strength and balance training in high risk
populations
High level balance exercise in group or home
settings
Multidisciplinary assessment of high risk
populations
Expedited cataract surgery
Comprehensive geriatric assessment in
nursing homes

Fracture Complications
Early
Haemorrhage
Nerve damage
Visceral injury

Intermediate

Wound infection
Osteomyelitis
Compartment syndrome
Rhabdomyolysis
DIC and thromboembolism

Late

Limitation of movement
Osteoarthritis
Impaired bone growth
Avascular necrosis