Risk of falling is overlooked as the major cause of fractures in the elderly-Shifting the focus from osteoporosis to falls

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Public release date: 17-Jan-2008

http://www.eurekalert.org/pub_releases/2008-01/bmj-rof011608.php

Contact: Emma Dickinson

edickinson@...

44-9

BMJ-British Medical Journal

Risk of falling is overlooked as the major cause of fractures in the elderly

Shifting the focus in fracture prevention from osteoporosis to falls

An elderly person's risk of falling is too often overlooked when trying

to prevent them from getting serious fractures, for instance of the hip

or wrist, according to an article published in this week’s BMJ.

The Finnish authors says studies show that if the focus were to be

switched to how at risk someone is of falling, rather than whether they

have the bone disease osteoporosis, then considerably more fractures in

elderly people could be prevented. However, many important publications

completely overlook falling as a risk factor and it is still very poorly

recognised and assessed by doctors.

Dr Jarvinen and colleagues say current fracture prevention methods have

serious limitations. At the moment an individual is screened to see

whether they have osteoporosis, and is then treated accordingly with

medication. Yet the test which determines whether someone has the

disease is flawed. It assesses bone mineral density (BMD) and can often

either over and under-estimate that density. BMD is therefore a poor

predictor of whether a person is likely to suffer a fracture and is of

little diagnostic value to a GP.

The cost of using drugs to prevent fractures in the elderly is also

extremely high. For example the researchers calculated that 577

postmenopausal women would have to be treated with osteoporosis drugs

(known as bisphosphonates) for one year to avert one hip fracture, at a

cost of about £120,000. Among a high risk population (women over 80),

for whom drug prevention would theoretically be most effective,

prevention of one hip fracture costs about £28,500. Yet 80% of hip

fractures would still occur.

The authors say falling is the major cause of nine in ten hip fractures

and drug therapy would not prevent more fractures because the drugs

cannot be expected to work on fall-related risk factors. Eight in ten

fractures also occur in people who do not even have osteoporosis.

The authors go on to say it is important for GPs to identify at-risk

individuals and assess their needs. Current evidence-based

recommendations for preventing falls include regular strength and

balance training, taking Vitamin D and Calcium supplements and an

assessment of the possible hazards in the homes of at-risk people. There

is evidence that fall prevention efforts can reduce the incidence of

falls by up to 50% in the elderly.

--

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