Читать книгу Synopsis of Orthopaedic Trauma Management - Brian H. Mullis - Страница 83

A. Decreasing fall risk—use of proper ambulatory aids, correction of poor visual acuity (cataract surgery), proper illumination of rooms, removal of obstacles to ambulation (remove clutter), rubber soled shoes to improve grip, skid-proof backing on rugs and carpets, use of a bath mat, install bathroom bars, readily accessible flashlight in the bedroom.

B. Dietary supplementation of calcium and vitamin D.

C. Fragility fractures

1. Important to recognize that BMD is one data point used to assess risk of fracture.

2. Original studies correlating BMD with risk of fracture calculated relative risk.

3. The WHO Fracture Risk Assessment Tool (FRAX) is a 12 question survey assessing key risk factors that is used to predict the chance of one sustaining an osteoporosis-related fracture in the next 10 years.

4. Fragility fracture risk factors are listed in ▶Table 10.1.

5. Following a fragility fracture (low-energy spine fracture, hip fracture, distal radius fracture, proximal humerus fracture, pelvic ring injury, sacral insufficiency fracture) the following labs should be ordered:

a. Serum calcium.

b. Parathyroid hormone.

c. Thyroid-stimulating hormone, free T4.

d. 25-hydroxycholecalciferol (vitamin D).

Table 10.1 Risk factors for fragility fracture

• Age more than 65 years	• Excess alcohol consumption (over 3 units/day)
• First-degree relative with fractured hip	• History of falls
• Current tobacco use	• Glucocorticoid use
• Menopause prior to age 45 years	• Hyperthyroidism
• Lifelong low calcium intake	• Chronic lung disease
• Poor vision despite correction	• Endometriosis
• Minimal weight-bearing exercise	• Malignancy
• History of fragility fracture	• Chronic hepatic or renal disease
• Self-report health as “fair” or “poor”	• Hyperparathyroidism
• Weight less than 127 pounds	• Vitamin D deficiency
• Amenorrhea	• Cushing’s disease

6. Consider a consultation to a dedicated metabolic bone clinic for ongoing management of bone health following discharge.

7. Order a physical therapy consultation for home safety evaluation to minimize the risk of falls.