1. Falls Prevention 2007 The “Challenge” May 14, 2007 Dr. M. Sugai

2. Falls Prevention – Why me? Rheumatologist Rheumatic Disorders Inflammatory Diseases Musculoskeletal related conditions Osteoporosis/Metabolic Bone Disorders Falls » Skeletal Injury Hospitalization Rehabilitation Morbidity/Mortality HEALTH CARE ECONOMIC IMPACT!

3. Falls Prevention – Who? Seniors Disabled Where are they located? Community Institutional ie., “Everywhere!”

4. How Are They Linked? From a Musculoskeletal Perspective The Skeleton → Fractures → “Osteoporosis”

5. Osteoporosis A disease of aging, resulting in progressive loss of bone mass (bone density) creating an increasing risk of fracture A “Silent” disease Noticeable typically when a “fracture” occurs

6. Osteoporosis The main serious consequence of Osteoporosis is Fracture ….

7. Increasing Bone mass Age (years) 800204060 Women Fetus Childhood, Adolescence Pregancy, Lactation Post-Menopause Aging Stages of Skeletal Evolution

8. NIH Consensus Development Panel on Osteoporosis. JAMA 2001 Compromised Bone Strength Increased Risk of fracture 1.Architecture 2.Turnover 3.Damage Accumulation Microfracture 4.Mineralization Bone Density Bone Quality + Bone Strength = BMD

9. Age as a Risk Factor Age is a significant risk for fracture As we age, Bone Quality & Bone Strength decreases An 80 yr old has poorer quality bone than a 50 yr old, even if they score similar Bone Density readings Therefore the risk of fracture for the 80 yr old is significantly greater

10. Facts In general, approx half of women and one-third of men >60 yrs of age are estimated to have Osteoporosis

11. Facts 3.5 million Canadians are estimated to have Osteoporosis

12. Facts Population trends estimate that the greatest rate of growth will be among the >80 yr olds – at the highest risk for fracture – expected to triple by 2040

13. Facts By 2050, estimated that the population of aged >80 yrs will be largest in Asia, @ 88 million or 57% of the world’s total

14. Common Fractures Usually Osteoporosis Related ~ “Fragility Fractures” Vertebral Hip Other “non-vertebral” Wrist Ankle Ribs

15. Why Do Fractures Occur? Typical mechanism → Falls! Prevent Falls = less fractures, less morbidity, health care costs savings result! EVERYONE WINS!!

16. Can We Change the Course? Yes, at present: We can diagnose & prevent Osteoporosis We can treat Osteoporosis The unmet challenge, at present: We can prevent most falls! Fractures occur because of Falls, not Osteoporosis “Fractures beget Fractures!”

17. Comment: Prevention of Falls Vitamin D may reduce fracture risk by improving muscle function and reducing the risk of falls, not just assisting in Calcium metabolism Bischoff et al. J Bone Miner Res 2003; 18:343 Visser et al. J Clin Endocrinol Metab 2003; 88:5766

18. Prevention of Falls Bischoff et al. JAMA 2004; 291:1999 Meta-analysis of 5 RCT of Vit D in the elderly Vit D reduced risk of falls by 22% vs pts receiving calcium or placebo NNT = 15 pts in order to prevent one person from falling

19. Fracture Prevention With Vitamin D Supplementation Importance of Vitamin D Oral vitamin D supplementation between 700 to 800 UI/d appears to reduce the risk of hip and any non-vertebral fractures in ambulatory or institutionalized elderly persons An oral vitamin D dose of 400 IU/d is not sufficient for fracture prevention Bischoff-Ferrari, H. et al., JAMA 2005;293:2257-64.

20. Recommended Daily Vitamin D Intake Age Group:Vitamin D (iu/d): Women (19-50 yrs)400 Women over 50 yrs800 Pregnant or lactating women (≥18 yrs) 400 Men (19-50 yrs)400 Men >50 yrs800 2002 Clinical Practice Guidelines for the Diagnosis & Management of Osteoporosis In Canada. CMAJ 2002; 167 (10 Suppl):S1-S34.

21. Recommended Daily Calcium Intake Age Group:Daily Calcium (mg/d): Prepubertal Children (4-8 yrs) 800 Adolescents (9-18 yrs)1300 Women (19-50 yrs)1000 Women over 50 yrs1500 Pregnant or lactating women (≥18 yrs) 1000 Men (19-50 yrs)1000 Men >50 yrs1500 2002 Clinical Practice Guidelines for the diagnosis & management of Osteoporosis In Canada. CMAJ 2002; 167 (10 Suppl):S1-S34.

22. The Key† Prevent “Falls” They are preventable Requires awareness & education Patients & their Families Health Care Providers A Huge Challenge!

23. Community Resources Utilized Hospitals – ERD’s, Orthopedics (Consultants, Fracture Clinics), Diagnostic Imaging Dept, Rehabilitation Dept, Social Work, Nursing Family physicians CCAC, Public Health Community Outpatient Programs – Osteoporosis Clinics Pharmacy, Medical/Surgical Supplies Vendors Transportation – Public, Private

24. Increasing The Awareness Hospitals – ERD’s, Orthopedics (Consultants, Fracture Clinics), Diagnostic Imaging Dept, Rehabilitation Dept, Social Work, Nursing Family physicians CCAC, Public Health Community Outpatient Programs – Osteoporosis Clinics Pharmacy, Medical/Surgical Supplies Vendors Transportation – Public, Private

25. Who to Lobby “Community” initiative requiring support from: LHIN Regional Health Services National Advocacy Groups for Seniors, Osteoporosis, Medical/Nursing Associations Local allied providers ~ Osteoporosis Clinics, Hospital Fracture Clinics Local media – Cable TV, Radio, Newspapers, Chamber of Commerce

26. Thanks!