Please enable JavaScript.
Coggle requires JavaScript to display documents.
Falls + Osteoporosis: Compromised bone strength predisposing to fracture.
Falls + Osteoporosis: Compromised bone strength predisposing to fracture.
Management
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
Analogues of ATP, inhibit ATP-dependent enzyme
N-containing (Alendronate)
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
Intervention0 training, hazard assess at home
Meds review/withdrawal.
Risk falls assessment, education
Pathophys
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
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
RFs
Recurrent falls.
Liver, endocrine abnormalities
Previous Hx
Falls RF
Muscle weakness, Hx, gait, balance, vision
psychotropics, digoxin, diuretics
Women-menopause
80+
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