Secondary fracture prevention: Drug treatment,fall prevention and nutrition requirements

In view of the high imminent risk for subsequent fractures, evaluation as early as possible after the fracture will result in early decisions about drug treatment, fall prevention and nutritional supplements.Drug treatment includes anti-resorptive and bone forming agents. Anti-resorptive therapy with broad spectrum fracture prevention and early anti-fracture effects are the first choice. In patients with multiple or severe VFs, the bone forming agent teriparatide should be considered.Adequate calcium and vitamin D are needed in all patients, together with appropriate nutrition, including adequate protein intake.     

Nonpharmacologic interventions. Exercise,fall prevention,and role of physical medicine

Musculoskeletal changes that are related to osteoporosis can be prevented, challenged, or reduced with implementation of proper rehabilitation programs. The nonpharmacologic interventions recommended here are evidence-based and have resulted from controlled trials and studies.     

Older patients with distal forearm fracture. A challenge to future fall and fracture prevention

BACKGROUND AND AIMS: Falls and fractures in older people are a common health problem. Patients with distal forearm fracture are at risk of sustaining new fractures. The aim of this work was to describe the characteristics of this patient group. METHODS: Sixty women and six men, mean age 68 years (50-86), with a recent fall-related distal forearm fracture, filled in a questionnaire about medical history, previous falls and fractures. Handgrip strength on the non-fractured side, one-leg standing, walking tests, and test of vibration sensation were measured and a video-nystagmoscopy was performed. RESULTS: One-third of the subjects had fallen during the last year, and one-third had had previous fall-related fractures during the last 10 years. Half of the patients took medication and were examined for chronic ailments regularly. Handgrip strength, balance and walking capacity declined with age and were similar to reference values. In three patients, the vibration sensation value was above the threshold value. Fifty patients (76%) had nystagmus, but no relationship between fall direction, physical performance and nystagmus was found. CONCLUSIONS: Although apparently healthy, many patients exhibited risk factors for new falls and fractures. Our recommendation is that these patients should be screened for fall and fracture risk and be targeted for preventive measures, besides fracture treatment. Physical therapists must play a major role in increasing and maintaining general physical functions in this patient group.     

Knowledge of medicine required for the exercise cure for prevention of fall and fracture in elderly people

The typical medicine constituting elderly people cause of a fall is the anxiolytic and hypnotic drugs of Benzodiazepines. The danger of the fall by the prolonged action type or the medicine with a strong line relaxation action is suggested especially. Moreover, anti-depressant drugs and anti-hypertensive drugs with alpha-adrenaline interception action also causes orthostatic hypotention, and induces a fall. In elderly, there are many complications and there is a tendency for combined use medicine to increase in number. Since the danger of fall increases in proportion to the number of medicines, much more cautions are required of the elderly people who have taken two or more medicines.     

Prevention of fall and fracture

Many programs to prevent falls were designed for intervention in fall risk factors. Several meta-analyses, based on many randomized, controlled trials and conducted for the purpose of evaluating the efficacy of these interventions, have been published recently. According to these studies, multifactorial fall risk assessment and management, as well as muscle strengthening and balance retraining, succeeded in reducing falls by approximately 10-38%. Only New Zealand trials were found to decrease even injurious falls, with reduction of moderate or serious injuries by 35% using fall prevention. However, there was no significant difference between the two groups when looking at only serious injuries such as fractures. Thus, fall prevention can prevent falls, but not fractures at present.     

The basic idea and exercise program of "fall and fracture prevention school" for elderly people

With the arrival of an aging society in Japan, accidents among elderly people involving falls and bone fractures are on the increase. Efforts to prevent such accidents are strongly required, so the concept of a "fall and fracture prevention school" is spreading. The aims of these classes are to make elderly people aware of the condition of their bodies and to improve deteriorating physical ability through exercise programs, since the latter is the cause of such falls. In conducting an exercise program for the elderly, it is important to make it enjoyable as well as safe.     

Effects of risk-based multifactorial fall prevention on postural balance in the community-dwelling aged: a randomized controlled trial

The purpose of the study was to assess the effects of 12-month risk-based multifactorial fall prevention program on postural control of the aged. Five hundred and ninety-one (97%) eligible subjects were randomized into an intervention group (IG) (n=293) and a control group (CG) (n=298). The effects of the program were measured on standing, dynamic, and functional balance. In standing balance, the velocity moment of semi-tandem standing decreased in IG (median change -0.54 mm(2)/s) but increased in CG (+3.84 mm(2)/s) among all women (p=0.011) and among the women aged 65-74 years (-1.65 mm(2)/s and +2.80 mm(2)/s, correspondingly) (p=0.008). In a dynamic test, performance distance tended to decrease in IG (-26.54 mm) and increase in CG (+34.10mm) among all women (p=0.060). The women aged 75 years or over, showed marginally significant differences between the groups as regards changes in performance time (-2.66 s and -0.90 s) (p=0.068) and distance (-92.32 mm and +76.46 mm) (p=0.062) of the dynamic balance test in favor of IG. Men showed no significant differences in the changes between the groups in any balance measures.     

Implementation of Models of Care for secondary osteoporotic fracture prevention and orthogeriatric Models of Care for osteoporotic hip fracture

As the world's population ages, the prevalence of osteoporosis and its resultant fragility fractures is set to increase dramatically. This chapter focuses on current frameworks and major initiatives related to the implementation of fracture liaison services (FLS) and orthogeriatrics services (OGS), Models of Care designed to reliably implement secondary fracture prevention measures for individuals presenting to health services with fragility fractures. The current evidence base regarding the impact and effectiveness of FLS and OGS is also considered.     

eHealth interventions for HIV prevention

The rapidly changing media landscape and proliferation of new technologies creates vast new opportunities for HIV prevention. The fast growth of the relatively new eHealth field is a testament to the excitement and promise of these new technologies. eHealth interventions in HIV prevention tested to date include computer- and Internet-based interventions; chat room interventions; text messaging interventions; and social media. The current article provides a brief review of these types of interventions in HIV prevention, including their unique advantages and evidence of efficacy. Implications for future research in the eHealth HIV prevention field are discussed.     

Home safety and fall prevention.

In conclusion, the majority, or at least a large proportion, of accidental injuries in the elderly are preventable with careful medical and environmental evaluation and intervention. A vigorous diagnostic, therapeutic, and preventive approach is appropriate in all older patients who fall in addition to those at a high risk of falling. Any intervention that can make inroads on this major cause of death and disability in the elderly population will clearly have major impact.     

Funding of community-based interventions for HIV prevention

Since the start of the HIV epidemic, community responses have been at the forefront of the response. Following the extraordinary expansion of global resources, the funding of community responses rose to reach at least US$690 million per year in the period 2005–2009. Since then, many civil society organisations (CSOs) have reported a drop in funding. Yet, the need for strong community responses is even more urgent, as shown by their role in reaching the Joint United Nations Programme on HIV/AIDS (UNAIDS) Fast-Track targets. In the case of antiretroviral treatment, interventions need to be adopted by most people at risk of HIV in order to have a substantial effect on the prevention of HIV at the population level. This paper reviews the published literature on community responses, funding and effectiveness. Additional funding is certainly needed to increase the coverage of community-based interventions (CBIs), but current evidence on their effectiveness is extremely mixed, which does not provide clear guidance to policy makers. This is especially an issue for adolescent girls and young women in Eastern and Southern Africa, who face extremely high infection risk, but the biomedical prevention tools that have been proven effective for the general population still remain pilot projects for this group. Research is especially needed to isolate the factors affecting the likelihood that interventions targeting this group are consistently successful. Such work could be focused on the community organisations that are currently involved in delivering gender-sensitive interventions.     

HIV epidemiology and prevention interventions

Several presentations at the 2007 Conference on Retroviruses and Opportunistic Infections focused on the underlying factors driving the HIV epidemic in selected regions of the world and on selected populations. The conference also provided updated data on 1 of 2 successful adult male circumcision efficacy trials to prevent HIV acquisition, and a review of 1 of 2 unsuccessful efficacy trials of the microbicide cellulose sulfate. Presentations also focused on strategies to prevent HIV acquisition through pre-exposure prophylaxis, treatment of sexually transmitted diseases, and prevention of mother-to-child transmission through breastfeeding.     

Fall prevention strategy for elderly women wishing to attend community fall prevention programs

AIM: Fall prevention programs for community-dwelling elderly people are carried out as part of disability-postponing programs in Japanese municipalities. This study examined how to design a fall prevention program for community health fair based on the characteristics of fall prevention strategies adopted by community-dwelling elderly women before attending community fall prevention programs. METHODS: One hundred and four community-dwelling elderly women (71.7 +/- 6.3 years old) who were attending community fall prevention programs for the first time were asked about their strategies for fall prevention. Age, regular attendance at outpatient programs, the Tokyo Metropolitan Institute of Gerontology Index, and Timed Up&Go were determined as factors related to whether or not the women had strategies for fall prevention. RESULTS: Sixty-four participants had their own strategies for fall prevention. Multiple logistic regression analysis showed that age (OR = 1.10, 95% CI:1.00-1.21) and regular attendance at outpatient programs (OR = 4.77, 95% CI:1.75-12.98) were significantly related to having fall prevention strategies. Timed Up&Go (OR = 1.42, 95% CI: 0.95-2.13) had a weak relationship to having such strategies (P = 0.085). The most common strategy was behavior such as lifting the toe when walking (n=38, 59.4%), followed by doing regular exercise (n=16, 25.0%). Few of the participants modified their environment (n=2, 3.1%). CONCLUSION: Community fall prevention programs for community-dwelling elderly women can motivate participants to develop interdisciplinary and comprehensive practices for fall prevention.     

The role of exercise in fall prevention for older adults

This article reviews the evidence for the effectiveness of stand-alone exercise interventions and multifactorial intervention strategies that include exercise in lowering fall incidence rates and/or fall risk among older adults residing in the community, acute, subacute, and long-term care settings. Stand-alone exercise programs that emphasize multiple exercise categories are effective in reducing fall rates and fall risk in community-residing older adults, and may also be effective when conducted for a sufficient duration with older adult patients in subacute settings. In contrast, multifactorial fall risk reduction programs that include exercise as a component and are delivered by a multidisciplinary team are more effective in lowering fall rates in long-term care settings.