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Posted: February 05, 2008

Elderly Falls Overlooked as Major Cause of Fractures; Safeguards Needed

Too much focus is placed on the dangers of osteoporosis in triggering broken bones in our elderly, when the real attention should be paid to an elderly person's risk of falling and suffering a serious fracture, according to an article published in the British medical journal BMJ.
The Finnish authors say studies show that if the focus were switched to how at-risk someone is of falling, rather than whether they have the bone disease osteoporosis, considerably more fractures could be prevented in the elderly. However, many important medical publications completely overlook falling as a risk factor and it is still very poorly recognized and assessed by doctors, the authors report.
Dr. Teppo Jarvinen and colleagues write that current approaches to preventing broken bones in the elderly have serious limitations. Currently, they say, 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 because it assesses bone mineral density (BMD) and can often either over- and under-estimate that density, they report.
As a result, Jarvinen’s team concludes, BMD is a poor predictor of whether a person is likely to suffer a fracture and is of little diagnostic value to a physician treating an elderly person.
They add that 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 $235,000. Among an especially high-risk population of women over age 80, for whom drug prevention would theoretically be most effective, prevention of one hip fracture costs about $56,000 -- yet 80% of hip fractures would still occur despite these efforts.
The authors say falling is the major cause of 9 in 10 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 10 fractures also occur in people who do not even have osteoporosis, they add.
The researchers go on to say it is important for general physicians 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, the BMJ article notes.

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