Reducing the incidence of falls

Patients with osteoporosis may suffer fractures with only minimal trauma. It is estimated that 2-5% of falls will result in a fracture.

In an american study, 301 elderly patients at risk of falling underwent assessment and falling risk modification, whilst controls received standard treatment. Over 1 year 35% of the intervention group had falls compared with 47% of controls. In a british study of 397 patients, intervention resulted in a 67% reduction in falls. Neither of these studies were sufficiently powered to look at fracture incidence.

Strategies to avoid falls are aimed at identification of risk factors associated with falling and avoiding them (1):

• educating the person regarding the risk of falling and prevention strategies
• avoid sedatives where possible, including alcohol and also review the medication and if needed make necessary modifications
• individualized exercise programs
• treatment of underlying diseases e.g. - postural hypotension or cardiovascular disease
• reduction of environmental hazards e.g. - shoes with nonskid soles, placing nonslip mats under rugs, removing any nonessential throw rugs in the home or clutter on the floors, and installing grab bars in the tub, shower (2)
• occupational therapy/physiotherapy/multidisciplinary team assessment

Reference:

• (1) The Royal Australian College of General Practitioners 2010. Clinical guideline for the prevention and treatment of osteoporosis in postmenopausal women and older men
• (2) Mauck KF, Clarke BL. Diagnosis, screening, prevention, and treatment of osteoporosis. Mayo Clin Proc. 2006;81(5):662-72