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Falls Prevention 2007 The “Challenge” May 14, 2007 Dr. M. Sugai
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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!
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Falls Prevention – Who? Seniors Disabled Where are they located? Community Institutional ie., “Everywhere!”
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How Are They Linked? From a Musculoskeletal Perspective The Skeleton → Fractures → “Osteoporosis”
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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
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Osteoporosis The main serious consequence of Osteoporosis is Fracture ….
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Increasing Bone mass Age (years) 800204060 Women Fetus Childhood, Adolescence Pregancy, Lactation Post-Menopause Aging Stages of Skeletal Evolution
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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
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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
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Facts In general, approx half of women and one-third of men >60 yrs of age are estimated to have Osteoporosis
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Facts 3.5 million Canadians are estimated to have Osteoporosis
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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
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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
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Common Fractures Usually Osteoporosis Related ~ “Fragility Fractures” Vertebral Hip Other “non-vertebral” Wrist Ankle Ribs
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Why Do Fractures Occur? Typical mechanism → Falls! Prevent Falls = less fractures, less morbidity, health care costs savings result! EVERYONE WINS!!
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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!”
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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
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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
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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.
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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.
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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.
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The Key† Prevent “Falls” They are preventable Requires awareness & education Patients & their Families Health Care Providers A Huge Challenge!
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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
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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
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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
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Thanks!
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