Bone health. Kirstie Stenhouse, NHS Forth #ACFALLS2018 #SPSP10

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1 Bone health Kirstie Stenhouse, NHS Forth

2 At the end of this session you will: Click Be to able edit to Master identify text if the styles individuals you work with are at risk of fragility Second fractures level Third level Be able - Fourth to support level an individual to improve their bone health and decrease their chance of sustaining a fragility fracture Be able to identify who would benefit from more specialist assessment of their bone health

3 Why should we think about bone health? Click to edit Master text styles Second Patientlevel Reduce Third harm level and mortality It s not the falling but the landing that hurts! Scottish Patient Safety Programme Fracture prevention should not be polarised into either falls prevention or improving bone health camps. Rather the ideal strategy should be on optimising bone health, especially in those with bone fragility, in addition to implementing measures to prevent falls. European Union Geriatric Medicine Society

4 Osteoporosis is a progressive systemic skeletal disease characterised by low bone mass and micro-architectural Click to edit Master text styles Third level deterioration of bone tissue, resulting in increased bone fragility and susceptibility to fracture.

5 What is a fragility fracture? Click to edit Master text styles standing Third height level or less. A fragility fracture is a type of pathological fracture that occurs as result of normal activities, such as a fall from

6 Click to edit Master text styles Third level

7 Who is at risk of fragility fractures? Click Write to down edit Master many text risk styles factors as you can in 30 seconds! Watch Third the level following clip and tick as many off your list as you can. - Fourth level

8 Who is at risk of fragility fractures? Age Click to edit Master text styles Third level Race Early menopause GI conditions Kidney disease Liver disease Autoimmune disorders Parkinsons disease Cardiovascular disease Previous fracture Dementia Cancer Steroids Antidepressants Anticonvulsants Aromatase inhibitors Prostate cancer drugs

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10 QFracture Click to edit Master text styles Third level

11 Other quick assessments Click Ask patient to edit height Master at text 25 years stylesold Ask Second patient level height now A difference Third level in 4cm indicates osteoporotic fracture Rib to pelvis finger test

12 Dual Energy X-ray Absorptiometry (DXA scan) Click No need to edit to get Master undressed text styles It is Second not a tunnel level It is quick Third level The staff - Fourth are lovely level

13 Click to edit Master text styles Third level

14 Medications Bisphosphonates (alendronic acid) Taken once per week, on the same day each week Taken on an empty stomach with a full glass of water Keep upright for 30 minutes afterwards No other food, drink or medications for half an hour afterwards Click to edit Master text styles Third level No calcium tablet within 4 hours Think about home care packages can family assist. Reduces chance of fracture by half Compliance is a major issue Must be taken correctly 80% of the time to be effective

15 Calcium and vitamin D Click Supplements to edit Master text styles Chewable, Third level caplet or dipersable Calcium side effects include constipation and nausea Vit D only if dietary calcium intake good

16 What can YOU do to reduce the risk of fracture? Consider who is at risk of fracture Click to edit Master text styles assessment Third level Facilitate correct compliance with bone health meds Find out about local referral pathways for specialist fracture risk Have conversations with individuals and their family about bone health and lifestyle choices Find out which services locally support individuals in lifestyle choices and signpost to them Look after your own bones!

17 Further training and information Lots of information and free booklets from the National Osteoporosis Society Click to edit Master text styles National Osteoporosis Society e-training Third level foundation and advanced modules Learn pro modules NHS Scotland Information on the implications of osteoporosis for moving and handling activities with older people in acute care