Falls Prevention 2007

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

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!

Falls Prevention – Who? Seniors Disabled

Where are they located? Community Institutional

ie., “Everywhere!”

How Are They Linked? From a Musculoskeletal

Perspective The Skeleton → Fractures →

“Osteoporosis”

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

Osteoporosis The main serious consequence of

Osteoporosis is Fracture ….

Increasing Bonemass

Age (years)

800 20 40 60

Women

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Stages of Skeletal Evolution

NIH Consensus Development Panel on Osteoporosis. JAMA 2001

Compromised Bone Strength

Increased Risk of fracture

1. Architecture2. Turnover3. Damage Accumulation

• Microfracture4. Mineralization

BoneDensity

BoneQuality +Bone

Strength =

BMD

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

Facts

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

Facts

3.5 million Canadians are estimated to have Osteoporosis

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

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

Common Fractures Usually Osteoporosis Related ~

“Fragility Fractures” Vertebral Hip Other “non-vertebral”

Wrist Ankle Ribs

Why Do Fractures Occur? Typical mechanism → Falls!

Prevent Falls = less fractures, less morbidity, health care costs savings result! EVERYONE WINS!!

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!”

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

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

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.

Recommended Daily Vitamin D Intake

Age Group: Vitamin D (iu/d):

Women (19-50 yrs) 400

Women over 50 yrs

800

Pregnant or lactating women (≥18 yrs)

400

Men (19-50 yrs) 400

Men >50 yrs 8002002 Clinical Practice Guidelines for the Diagnosis & Management of OsteoporosisIn Canada. CMAJ 2002; 167 (10 Suppl):S1-S34.

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 yrs 1500

Pregnant or lactating women (≥18 yrs)

1000

Men (19-50 yrs) 1000

Men >50 yrs 1500

2002 Clinical Practice Guidelines for the diagnosis & management of OsteoporosisIn Canada. CMAJ 2002; 167 (10 Suppl):S1-S34.

The Key† Prevent “Falls”

They are preventable Requires awareness & education

Patients & their Families Health Care Providers

A Huge Challenge!

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

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

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

Thanks!