Falls + Osteoporosis: Compromised bone strength predisposing to fracture.

Management

Pathophys

RFs

Recurrent falls.

Liver, endocrine abnormalities

Previous Hx

Falls RF

Women-menopause

80+

OCs- Multinucleate, Howship's lacunae. Derived from monocytes

OBs- synthesis and mineralisation. Surrounded by matrix then become osteocytes.

OC activity- RANK (differentiation and activation). Use of cathepsin K protease- degrades elastin, gelatin, collagen.

Age related mass loss secondary to osteoclast activity outweighing osteoblast- Thinning of bone archictecture

Bone protection- Meds (SERMs, BPs), HRT

Falls prevention: Falls/syncope clinic

Improve: home, vision, hearing, bone density, exercise, nutrition

Densumab-Inhibits RANK-L

Bisphosphonates

Specific binding via 2x P groups to Ca2+

Reduce OC activity via recruitment, activation inhibition, increased apoptosis

Enzyme resistant analogues of pyrophosphonate which inhibits bone mineralisation

OC resorb BP-containing bone are inhibited.

Types

Non-N

N-containing (Alendronate)

Analogues of ATP, inhibit ATP-dependent enzyme

Far more potent.

Inhibits farnesyl pyrophosphate synthase.

Prevents synthesis of isoprenoid compounds- Essential for mods of rac, rho, rab

SE- Osteonecrosis of jaw

OT, podiatry

Muscle weakness, Hx, gait, balance, vision

psychotropics, digoxin, diuretics

Intervention0 training, hazard assess at home

Meds review/withdrawal.

Risk falls assessment, education

Falls Stats

Most common injury in older.

1-2% Hip# -30% die, 50% dependent, QoL

30% 65+, 3x institution. ^incidence-age

Only 10% serious, but other sequelae: Wounds, hypothermia, pressure sores, pneumonia.

Distal radius, vertebrae, proximal humerus and femur

Socially

Psych: Fear of falling- biggest loss of QALY

Self imposed activity restriction- inactivity

Dependency and disability, ^^institutionalisation

QALY

Disease burden

Tx benefit

Reducing fear of falling may prove more benefit than less fractures