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