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Jan. 21 - Risk of Falling is Overlooked as the Major Cause of Fractures in the Elderly

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 British Medical Journal.

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 osteoporosis drugs to prevent fractures in the elderly is also extremely high. 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 ($55,486). 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.

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.

Source: BMJ

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