Osteoporosis and Falls: Problems Overlooked by the Portuguese Medical Community

Authors

  • Vítor Brás da Silva Polo de Medicina Física e de Reabilitação do Hospital Curry Cabral. Lisboa, Portugal
  • Sílvia Boaventura Barbosa Polo de Medicina Física e de Reabilitação do Hospital Curry Cabral. Lisboa, Portugal
  • Jorge Rodrigues Polo de Medicina Física e de Reabilitação do Hospital Curry Cabral. Lisboa, Portugal
  • Marta Amaral Silva Polo de Medicina Física e de Reabilitação do Hospital Curry Cabral. Lisboa, Portugal
  • Ana Catarina Miguéns Polo de Medicina Física e de Reabilitação do Hospital Curry Cabral. Lisboa, Portugal
  • Luís Horta Polo de Medicina Física e de Reabilitação do Hospital Curry Cabral. Lisboa, Portugal
  • Pedro Soares Branco Polo de Medicina Física e de Reabilitação do Hospital Curry Cabral. Lisboa, Portugal

DOI:

https://doi.org/10.25759/spmfr.312

Keywords:

Accidental Falls/economics, Accidental Falls/ prevention & control, Health Care Costs, Osteoporosis/ complications, Osteoporosis, Postmenopausal/complications, Risk Assessment

Abstract

Introduction: The prevalence of osteoporosis keeps rising, causing morbidity and mortality associated with osteoporotic fractures to increase; these are mostly caused by falling, with the fracture of proximal femur having the higher socioeconomic impact. Our aim was to characterize the preventive and therapeutic measures of osteoporosis and falls in inpatients with fracture of the proximal femur.

Material and Methods: We carried out a one-year long retrospective cross-sectional study in 65+ year-old women with a recent fracture of the proximal femur, who were admitted to an orthopedic unit; we used a questionnaire specifically developed for this purpose and the individual clinical charts.

Results: We evaluated 100 patients with fracture, mostly caused by a fall, indoor, at daytime, and on regular floor; 76% of which reported history of falling and 42% previous history of osteoporotic fracture. Of all the patients that met the criteria for treatment, only 5.3% were undergoing treatment. A statistically significant association was found between the occurrence of falls and (1) osteoporotic fractures and (2) the implementation of fall-preventive measures.

Discussion and Conclusion: our results corroborate the importance of falls and osteoporotic fractures in health. We estimate the total direct costs for this sample in 1.34 M€ for the first post-fracture year. If all patients (and not only 5.3%) were to be treated, the consequent fracture risk reduction could cut these costs in, at least, 40%-45%.

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References

Rodrigues AM, Canhão H, Marques A, Ambrósio C, Borges J, Coelho P, et al. Portuguese recommendations for the prevention, diagnosis and management of primary osteoporosis - 2018 update. Acta Reumatol Port. 2018;1:123-144.

Hernlund E, Svedbom A, Ivergård M, Compston J, Cooper C, Stenmark J, et al. Osteoporosis in the European Union: Medical management, epidemiology and economic burden: A report prepared in collaboration with the International Osteoporosis Foundation (IOF) and the European Federation of Pharmaceutical Industry Associations (EFPIA). Arch Osteoporos. 2013;8(1-2):1-115.

Branco JC, Rodrigues AM, Gouveia N, Eusébio M, Ramiro S, Machado PM, et al. Prevalence of rheumatic and musculoskeletal diseases and their impact on health-related quality of life, physical function and mental health in Portugal: Results from EpiReumaPt - a national health survey. RMD Open. 2016;2(1):1-12.

Marques A, Lourenço, da Silva JAP. The burden of osteoporotic hip fractures in Portugal: costs, health related quality of life and mortality. Osteoporos Int. 2015;26(11):2623-2630.

Pereira JTS. Custos directos e indirectos das fracturas osteoporóticas da anca em Portugal continental; 2014 [consultado 2018 Nov 20]. Disponível em: https://estudogeral.uc.pt/ bitstream/10316/37302/1/Custos%20directos%20e%20indirectos%20das%20fracturas%20osteoporoticas%20da%20anca%20em%20Portugal%20continental.pdf

Cauley JA. Public Health Impact of Osteoporosis. Journals Gerontol Ser A Biol Sci Med Sci. 2013;68(10):1243-1251.

Marsh D, Åkesson K, Beaton DE, Bogoch ER, Boonen S, Brandi ML, et al. Coordinator-based systems for secondary prevention in fragility fracture patients. Osteoporos Int. 2011;22(7):2051-2065.

Branco PS. Avaliação e modificação do risco de queda em idosos com recurso à Posturografia Dinâmica Compoturizada. Faculdade de Ciências Médicas, Universidade Nova de Lisboa Lisboa; 2013 [consultado 2018 Nov 24]. Disponível em: https://run.unl.pt/bitstream/ 10362/10526/1/Branco%20Pedro%202013.pdf

Direção-Geral da Saúde. Orientação técnica para a utilização da absorsiometria radiológica de dupla energia (DEXA). 2008:1-3.

Florence CS, Bergen G, Atherly A, Burns E, Stevens J, Drake C. Medical Costs of Fatal and Nonfatal Falls in Older Adults. J Am Geriatr Soc. 2018;66(4):693-698.

Branco PS. Avaliação e Modoficação do Risco de Queda em Idosos com Recurso à Postugrafia Dinâmica Computorizada. Rev da Soc Port Med Física e Reabil. 2012;21(1):16-23.

Moniz-Pereira V, Carnide F, Machado M, André H, Veloso AP. Falls in Portuguese older people: Procedures and preliminary results of the study biomechanics of locomotion in the elderly. Acta Reumatol Port. 2012;37(4):324-332.

Close J, Lord S, Menz H, Sherington C. What is the role of falls? Best Practice & Research Clinical Rheumatology 2005;19(6):931-935.

Marques A, Ferreira RJO, Santos E, Loza E, Carmona L, da Silva JAP. The accuracy of osteoporotic fracture risk prediction tools: a systematic review and meta-analysis. Ann Rheum Dis. 2015;74(11):1958-1967.

Marques A, Mota A, Canhão H, Romeu JC, Machado P, Ruano A, et al. A FRAX model for the estimation of osteoporotic fracture probability in Portugal. Acta Reum Port. 2013;38(2):104-112.

Kling JM, Clarke BL, Sandhu NP. Osteoporosis Prevention, Screening, and Treatment: A Review. J Womens Health (Larchmet) 2014;23(7):563-572.

Black D, Delmas P, Eastell R., Reid I, Boonen S, Cauley J, et al. Once-Yearly Zoledronic Acid for Treatment of Postmenopausal Osteoporosis. N Engl J Med. 2012;356:1809-1822.

Papapoulos SE, Quandt SA, Liberman UA, Hochberg MC, Thompson DE. Meta-analysis of the efficacy of alendronate for the prevention of hip fractures in postmenopausal women. Osteoporos Int. 2005;16(5):468-474.

Cummings SR, San Martin J, McClung MR, Siris ES, Eastell R, Reid IR, et al. Denosumab for prevention of fractures in postmenopausal women with osteoporosis. Obstet Gynecol Surv. 2009;64(12):805-807.

McClung MR, Geusens P, Miller PD, Zippel H, Bensen WG, Roux C, et al. Effect of Risedronate on the Risk of Hip Fracture in Elderly Women. N Engl J Med. 2001;344(5):333-340.

World Health Organization - Regional Office for Europe [http://www.euro.who.int/en/health-topics/disease-prevention/nutrition/a-healthy-lifestyle/body-mass-index-bmi] Consultado 2018 Dez 4. Disponível em: http://www.euro.who.int/.

Downey CL, Young A, Burton EF, Graham SM, Macfarlane RJ, Tsapakis EM, et al. Dementia and osteoporosis in a geriatric population: Is there a common link? World J Orthop. 2017;8(5):412.

Kenny RA, Rubenstein LZ, Tinetti ME, Brewer K, Cameron KA, Capezuti EA, et al. Summary of the updated american geriatrics society/british geriatrics society clinical practice guideline for prevention of falls in older persons. J Am Geriatr Soc. 2011;59(1):148-157.

Kanis JA, Borgström F, Compston J, Dreinhöfer K, Nolte E, Jonsson L, et al. SCOPE: A scorecard for osteoporosis in Europe. Arch Osteoporos. 2013;8(1-2):1-63.

Rodrigues AM, Eusébio M, Santos MJ, Gouveia N, Tavares V, Coelho PS, et al. The burden and undertreatment of fragility fractures among senior women. Arch Osteoporos. 2018;13(22):1-14.

Darbà J, Kaskens L, Pérez-Álvarez N, Palacios S, Neyro JL, Rejas J. Disability-adjusted-life-years losses in postmenopausal women with osteoporosis: a burden of illness study. BMC Public Health. 2015;15(324):1-10.

Javaid MK, Kyer C, Mitchell PJ, Chana J, Moss C, Edwards MH, et al. Effective secondary fracture prevention: implementation of a global benchmarking of clinical quality using the IOF Capture the Fracture® Best Practice Framework tool. Osteoporos Int. 2015;26(11):2573-2578.

Eisman JA, Bogoch ER, Dell R, Harrington JT, McKinnler RE, McLellan A, et al. Making the First Fracture the Last Fracture : ASBMR Task Force Report on Secondary Fracture Prevention. 2012;27(9):1-8.

Dionyssiotis Y, Skarantavos G, Papagelopoulos P. Modern rehabilitation in osteoporosis, falls and fractures. Clin Med Insights Arthritis Musculoskel Disord 2014;12(7):33-40.

Leslie WD, Morin SN. Osteoporosis epidemiology 2013: implications for diagnosis, risk assessment, and treatment. Curr Opin Rheumatol. 2014;26(4):440-446.

United Nations Department Of Economic and Social Affairs. WHO Global Report on Falls Prevention in Older Age. Community Health (Bristol). 2007:53.

Published

2019-06-30

How to Cite

1.
Brás da Silva V, Boaventura Barbosa S, Rodrigues J, Amaral Silva M, Miguéns AC, Horta L, et al. Osteoporosis and Falls: Problems Overlooked by the Portuguese Medical Community. SPMFR [Internet]. 2019 Jun. 30 [cited 2024 Nov. 21];31(2):15-23. Available from: https://spmfrjournal.org/index.php/spmfr/article/view/312

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