Falls and Fractures An Introduction Sarah Leyland Senior Nurse and Helpline Manager National Osteoporosis Society
Definitions Osteoporosis is a systemic skeletal disease characterized by low bone mass and microarchitectural deterioration of bone tissue, with a consequent increase in bone fragility. [1] atraumatic fracture fracture as a result of minimal trauma usually from standing height Fragility fracture associated with osteoporosis
Aims Explain the links between falls and fractures in older people Describe the impact of falls and impact of falls related fractures Emphasise the need to integrate falls prevention with osteoporosis assessment and treatment to reduce incidence of fracture
Falls and fractures the links Falls are common in older people and have serious outcomes fracture one of most serious 30% aged 65 or over who live in the community fall each year, increasing to 45 % in those aged 80 and above, 1,2 Half of fallers will have a further fall within the next 12 months Recurrent falls are associated with increased mortality, increased rates of hospitalisation, curtailment of daily activities and higher rates of institutionalisation 5 Annually, between 10 and 25 % of fallers sustain a serious injury, up to 6 % of falls culminate in a fracture 3,4 10-20% of institutional falls result in an osteoporotic hip fracture Nearly all hip fractures in older people are the result of a fall
What makes a fragility fracture likely? Fragility fractures Poor bone strength Risk of falling (except fractures in the spine) Impact of fall
Incidence per 10,000/year 400 - Fracture incidence increases Men with age 400 - Women 300 - = Hip fracture = Vertebral fracture = Forearm fracture 300-200 - 200-100 - 100-0 - 50-54 55-59 60-64 65-69 70-74 75-79 80-84 85+ Age group 0-50 - 54 55-59 60-64 65-69 70-74 75-79 80-84 85+ Age group Harvey N, Cooper C. Osteoporosis Rev 2005; 13: 1-6
Increase in falls risk with age Slow responses Medical conditions Risk of falling Postural instability Frailty Medications Enviroment
Decrease in bone strength with age Bone architecture Bone size Mineralisation Bone strength Bone mass Skeletal geometry Bone turnover
Fall related fractures personal costs of hip fracture Admitted to nursing home Restricted driving & shopping Difficulty with daily activities Unable to walk independently Cooper. 1997 0 20 40 60 80 100 % affected
Hip fractures health and social services costs Every year in the UK: 300,000 osteoporotic fractures Hospital and social care costs for hip fracture alone are more than 2.3billion per year in the UK (approx. 6 million/day)
How can the risk of fragility fractures be reduced? Drugs, including vit D Fragility fractures Flooring, hip protectors Poor bone strength Falls (except fractures in the spine) Impact of falls lack padding Lifestyle: Exercise Healthy eating Sunlight Healthy pregnancy No smoking/alcohol Other interventions for falls prevention
Falls prevention strategies and osteoporosis drug treatments are effective and endorsed by expert and government guidance NICE Falls guideline BGS/AGS Falls guideline NICE Osteoporosis Technology Appraisals QOF indicators for osteoporosis Integrated falls and osteoporosis service recommended by expert and government guidance
National Service Framework for Older People ) Standard 6: DOH(2001)
The Care of Patients with Fragility Fracture BOA/ BGS (2007) All patients presenting with fragility fracture should be assessed to determine their need for anti-resorptive therapy to prevent future osteoporotic fractures. All patients presenting with a fragility fracture following a fall should be offered multidisciplinary assessment and intervention to prevent future falls.
Prevention package for older people DOH (2009)
Summary Older people are at risk of painful and disabling fractures especially of the hip.this is explained by their increase in falls risk and bone fragility as they age. An integrated approach to fracture prevention is needed to both improve bone health and reduce falls risk.