1. Fall Prevention
subtitle

2. Erik B. Eller, MD Undergraduate Education Medical School Education
University of Michigan
Medical School Education
Northwestern University- Feinberg School of Medicine
Residency Training
Northwestern University- McGaw Mecial Center
Fellowship Training- Foot and Ankle
Orthopaedic Associates of Michigan – Grand Rapids
Center for Orthopaedic Research and Education
Foot/Ankle and Fracture specialist

3. Epidemiology
One out of three people over the age of 65 falls each year
In 2013, 2.5 million nonfatal falls treated in ED
Of these, 734,000 were admitted to the hospital
In 2011, 22,900 elderly people died from unintentional falls
In 2012, the direct medical costs of falls were $30 billion
CDC.com

4. Why are falls bad?
Funzypics.com

5. Associated Injury
20-30% of people who fall suffer injuries such as lacerations, hip fractures, and head trauma
In 2000, 46% of fatal falls in the elderly were due to traumatic brain injury
Fall related fractures are twice as common in women as men
In 2010, there were 258,000 hip fractures
95% of all hip fractures are caused by falls
CDC

6. Hip Fractures

7. Hip fracture fixation

8. Morbidity and Mortality Following Hip Fractures
30-day mortality is 9%
17% if acute medical problem
43% if patient develops pneumonia
65% if being treated for CHF
Complications: pneumonia, blood clots, pressure sores
Fixing hip fractures within 48hrs leads to less complications (14.7% vs 33.3%) and a higher likelihood of returning to independent living J Bone Joint Surg Am Jul;90(7):

9. Incentive Spirometer and SCD

10. Osteoporosis
Diagnosis

11. Osteoporosis
Osteoporosis is low bone density as defined on a DEXA scan <2.5 SD
Osteopenia is bone density on DEXA < SD
10% of women over the age of 50yrs have osteoporosis
2% of men over the age of 50yrs have osteoporosis

12. DEXA Scan Who should get a DEXA? Duel Energy X-ray Absorptiometry
estrogen deficiency in women at clinical risk for osteoporosis
evidence of vertebral abnormalities
long term steroid use
patients with primary hyperparathyroidism
the need for monitoring to assess response to approved drug therapies for osteoporosis.
Duel Energy X-ray Absorptiometry
Measure bone density at lumbar spine and hips
Compared to health women
T-score -1 to -2.5 is osteopenia
T-score <-2.5 is osteoporosis

13. Risk Factors for osteoporotic fracture
A maternal history of a hip fracture
Any previous fracture after the age of fifty
Tall height at age of 25
Poor health
Some sedatives and anticonvulsant drugs
The inability to rise from a chair without the use of the arms

14. Treatment and Prevention
Medchrome.com

15. Fall Prevention Regular exercise focusing on leg strength and balance
Evaluate medications that may increase fall risk
Have eyes evaluated regularly to enhance vision
Reduce trip hazards such as loose rugs and ground clutter
Add grab bars in and around bathroom
Railings on both sides of stairways
Improve lighting around home

16. Osteoporosis Treatment
Postmenopausal women with T-scores less than -2.0, regardless of risk factors.
Postmenopausal women with T-scores less than -1.5, with osteoporosis risk factors present.
Treatment
Bisphosphonates
Vitamin D/Calcium
Estrogen

17. Vitamin D and Calcium Recommendations
Life Stage Group
Calcium Recommended Dietary Allowance (mg/day)
Vitamin D Recommended Dietary Allowance (IU/day)
Infants 0 to 6 months * **
Infants 6 to 12 months
1 - 3 years old
700
4 - 8 years old
1,000
600
years old
1,300
years old
years old
years old
years old
year old females
1,200
71+ years old
800
years old, pregnant/lactating
years old, pregnant/lactating
*For infants, adequate intake is 200 mg/day for 0 to 6 months of age and 260 mg/day for 6 to 12 months of age.
**For infants, adequate intake is 400 IU/day for 0 to 6 months of age and 400 IU/day for 6 to 12 months of age.
—Source: Institute of Medicine, December 2010

18. Enhance Physiology
Get adequate calcium and Vitamin D- (1200mg and 800IU)
Perform weight bearing exercises
Get screened and treated for osteoporosis

19. Thank You All!

20. The CORE Institute
Toll-Free:
Thecoreinstitute.com