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Osteoporosis prevention, diagnosis and management in postmenopausal women and men over 50 years of age
Approximately 30% of community-dwelling elderly fall each year, with a high risk of injury including osteoporotic fracture, particularly hip fracture, the most common fracture in the very old. There is evidence in community-dwelling elderly1 for group and home-based exercise programs and home-safety interventions for reducing the rate of falls and risk of falling. Multifactorial assessment and intervention programs appear effective in reducing the rate of falls, but not the risk of falling. Tai chi reduces the risk of falling. Overall, vitamin D supplementation does not appear to reduce falls in community-dwelling people, but may be effective in people who have lower vitamin D levels before treatment.
These are the frailest and highest risk population for falls and fracture risk, and the most challenging as falls and fracture risk in this group is usually multifactorial, and the potential to reverse these risks often limited. According to a Cochrane review2 of studies conducted in care facilities, vitamin D supplementation is effective in reducing the rate of falls. Exercise in subacute hospital settings appears effective but its effectiveness in care facilities remains uncertain due to conflicting results, possibly associated with differences in interventions and levels of dependency. There is evidence that multifactorial interventions reduce falls in hospitals but the evidence for risk of falling was inconclusive. Evidence for multifactorial interventions in care facilities suggests possible benefits, but the evidence is also inconclusive.
Multifactorial assessment of falls risk, exercise programs and home-safety interventions are recommended to reduce the rate of falls in community-dwelling people over 75 years of age.
Vitamin D supplementation of elderly people in care facilities is recommended to reduce the rate of falls. Vitamin D supplements given for falls prevention are normally combined with calcium to address the high rates of calcium deficiency also seen in this population.
Osteoporosis-flowchart.pdf (PDF 0.98 MB)