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Risk of
falling is overlooked as the major cause of
fractures in the elderly
Newswise — An elderly person's risk of
falling is too often overlooked when trying
to prevent them from getting serious
fractures, for instance of the hip or wrist,
according to an article published in this
week’s BMJ.
The Finnish authors says studies show that
if the focus were to be switched to how at
risk someone is of falling, rather than
whether they have the bone disease
osteoporosis, then considerably more
fractures in elderly people could be
prevented.
However, many important publications
completely overlook falling as a risk factor
and it is still very poorly recognised and
assessed by doctors.
Dr Jarvinen and colleagues say current
fracture prevention methods have serious
limitations. At the moment an individual is
screened to see whether they have
osteoporosis, and is then treated
accordingly with medication.
Yet the test which determines whether
someone has the disease is flawed. It
assesses bone mineral density (BMD) and can
often either over and under-estimate that
density.
BMD is therefore a poor predictor of whether
a person is likely to suffer a fracture and
is of little diagnostic value to a GP.
The cost of using drugs to prevent fractures
in the elderly is also extremely high. For
example the researchers calculated that 577
postmenopausal women would have to be
treated with osteoporosis drugs (known as
bisphosphonates) for one year to avert one
hip fracture, at a cost of about £120,000.
Among
a high risk population (women over 80), for
whom drug prevention would theoretically be
most effective, prevention of one hip
fracture costs about £28,500. Yet 80% of hip
fractures would still occur.
The authors say falling is the major cause
of nine in ten hip fractures and drug
therapy would not prevent more fractures
because the drugs cannot be expected to work
on fall-related risk factors. Eight in ten
fractures also occur in people who do not
even have osteoporosis.
The authors go on to say it is important for
GPs to identify at-risk individuals and
assess their needs. Current evidence-based
recommendations for preventing falls include
regular strength and balance training,
taking Vitamin D and Calcium supplements and
an assessment of the possible hazards in the
homes of at-risk people.
There is evidence that fall prevention
efforts can reduce the incidence of falls by
up to 50% in the elderly.