Fall
Prevention
SUBTITLE
Erik B. Eller, MD
▪ Undergraduate Education
▪ University of Michigan
▪ Medical School Education
▪ Northwestern University- Feinberg School of Medicine
▪ Residency Training
▪ Northwestern University- McGaw Mecial Center
▪ Fellowship Training- Foot and Ankle
▪ Orthopaedic Associates of Michigan – Grand Rapids
▪ Center for Orthopaedic Research and Education
▪ Foot/Ankle and Fracture specialist
Epidemiology
▪ One out of three people over the age of 65
falls each year
▪ In 2013, 2.5 million nonfatal falls treated in
ED
▪ Of these, 734,000 were admitted to the
hospital
▪ In 2011, 22,900 elderly people died from
unintentional falls
▪ In 2012, the direct medical costs of falls were
$30 billion
Why are falls bad?
Associated Injury
▪ 20-30% of people who fall suffer injuries such as lacerations, hip
fractures, and head trauma
▪ In 2000, 46% of fatal falls in the elderly were due to traumatic
brain injury
▪ Fall related fractures are twice as common in women as men
▪ In 2010, there were 258,000 hip fractures
▪ 95% of all hip fractures are caused by falls
Hip Fractures
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Hip fracture fixation
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Morbidity and Mortality Following Hip Fractures
▪ 30-day mortality is 9%
▪ 17% if acute medical problem
▪ 43% if patient develops pneumonia
▪ 65% if being treated for CHF
▪ Complications: pneumonia, blood clots, pressure sores
▪ Fixing hip fractures within 48hrs leads to less complications
(14.7% vs 33.3%) and a higher likelihood of returning to
independent living J Bone Joint Surg Am. 2008 Jul;90(7):1436-42
Incentive Spirometer and SCD
Osteoporosis
DIAGNOSIS
Osteoporosis
▪ Osteoporosis is low bone density
as defined on a DEXA scan <2.5
SD
▪ Osteopenia is bone density on
DEXA <1.5-2.5 SD
▪ 10% of women over the age of
50yrs have osteoporosis
▪ 2% of men over the age of 50yrs
have osteoporosis
DEXA Scan
▪ Who should get a DEXA?
▪
▪
▪
▪
▪
estrogen deficiency in women at clinical risk for osteoporosis
evidence of vertebral abnormalities
long term steroid use
patients with primary hyperparathyroidism
the need for monitoring to assess response to approved drug therapies for
osteoporosis.
▪ Duel Energy X-ray Absorptiometry
▪ Measure bone density at lumbar spine and hips
▪ Compared to health women
▪ T-score -1 to -2.5 is osteopenia
▪ T-score <-2.5 is osteoporosis
Risk Factors for osteoporotic fracture
▪ A maternal history of a hip
fracture
▪ Any previous fracture after the age
of fifty
▪ Tall height at age of 25
▪ Poor health
▪ Some sedatives and
anticonvulsant drugs
▪ The inability to rise from a chair
without the use of the arms
Treatment and
Prevention
Fall Prevention
▪ Regular exercise focusing on leg strength and balance
▪ Evaluate medications that may increase fall risk
▪ Have eyes evaluated regularly to enhance vision
▪ Reduce trip hazards such as loose rugs and ground clutter
▪ Add grab bars in and around bathroom
▪ Railings on both sides of stairways
▪ Improve lighting around home
Osteoporosis Treatment
▪ Postmenopausal women with T-scores less than
-2.0, regardless of risk factors.
▪ Postmenopausal women with T-scores less than
-1.5, with osteoporosis risk factors present.
▪ Treatment
▪ Bisphosphonates
▪ Vitamin D/Calcium
▪ Estrogen
Vitamin D and Calcium Recommendations
Life Stage Group
Calcium
Recommended
Dietary Allowance (mg/day)
Vitamin D
Recommended
Dietary Allowance (IU/day)
Infants 0 to 6 months
*
**
Infants 6 to 12 months
*
**
1 - 3 years old
700
**
4 - 8 years old
1,000
600
9 - 13 years old
1,300
600
14 - 18 years old
1,300
600
19 - 30 years old
1,000
600
31 - 50 years old
1,000
600
51 - 70 years old
1,000
600
51 - 70 year old females
1,200
600
71+ years old
1,200
800
14 - 18 years old, pregnant/lactating
1,300
600
19 - 50 years old, pregnant/lactating
1,000
600
*For infants, adequate intake is 200 mg/day for 0 to 6 months of age and 260 mg/day for 6 to 12 months of age.
**For infants, adequate intake is 400 IU/day for 0 to 6 months of age and 400 IU/day for 6 to 12 months of age.
—Source: Institute of Medicine, December 2010
Enhance Physiology
▪ Get adequate calcium and Vitamin D- (1200mg and 800IU)
▪ Perform weight bearing exercises
▪ Get screened and treated for osteoporosis
Thank You All!
The CORE Institute
:
866.974.2673
▪ Toll-Free
▪ Thecoreinstitute.com