Irish Practice Nurses Association - North Dublin Branch Bone Health & Falls Prevention

An

overview of

Osteoporosis,

Bone Health

Falls Awareness & Falls Prevention

Daragh Rodger

Advanced Nurse Practitioner

Care of the Older Adult Community

Report of the

National Steering Group

on the

Prevention of Falls in

Older People and

the Prevention and

Management of

Osteoporosis

throughout LifeFalls strategy

2008

Treatment

Osteoporosis comes from ‘osteo’ meaning bone and the greek word por (passage) ie simply it means porous bone.

Osteoporosis results in loss of bone strength, thus making

bone more fragile and easily susceptible to fracture.

Osteoporosis is classed as a bone density 2.5 or more

standard deviations below normal peak bone mass

(WHO, 2002)

• Normal Bone Density 0 - -1

• Osteopenia -1 - -2.5

• Osteoporosis > -2.5

DEXA SCAN RESULTS

DXA scan

Bone health assessment

Bone health Education

•Diet

•Exercise

•Lifestyle choice

St Mary’s Healthy Ageing Clinic

A T-score compares the patient’s

results with the mean peak bone mass

(thickness of bones) of a large number

of normal females and males between

the ages of 20-40.

A Z-score compares the patient’s

score with their own age group; this

should only be used in the diagnosis

of the spine in children and

adolescents

Bone Density Results – Healthy Ageing Clinic

0

100

200

300

400

500

600

700

2010

Osteoporosis 561

Osteopenia 465

Normal 621

Osteoporosis TreatmentPrevention and Treatment

options

Calcium and Vitamin D are essential for the treatment and prevention of osteoporosis. If it is not acquired in the diet it is necessary to take a supplement. This applies to everyone regardless of DEXA scan result.

Exercise is also an essential component in the treatment and prevention of osteoporosis.

Treatment Options

Anti resorptives – Bisphosphonates decreases bone

resorption

eg. Alendronate – Fosamax 70mg - once a week

Alendronate combined with Vitamn D – Fosavance 5600

– Fosamax 70mg with 5600iu Vitamin D once a week

Ibandronate – Bonviva 150mg – once a month

Ibandronate – Bonviva by IV 3mg – every 3 months

Risedronate – Actonel 35mg – once a week

Risedronate – Actonel 35mg combi( with calcium) one actonel a week and one calcium 500mg for six days of week

Zoledronic Acid – Aclasta – once a year IV infusion

Osteoporosis Treatment

Strontium Ranelate – Protelos – dual action bone agent –

prevents bone loss and it increases bone formation – one 2g

sachet daily

Parathyroid Hormone – Teriparatide – Forsteo

Stimulates bone formation and is given by subcutaneous

injection for a period of 18 Months. It mimics the action of

natural human hormone. It is the most potent anabolic agent.

It is reserved for use of severe osteoporosis and is usually only

prescribed by a specialist physcian.

Denosumab – Prolia – monoclonal antibody

Prevents bone loss and osteoporosis – 60mg subcutaneous

injection 6 monthly

Osteoporosis Treatment

Compliance

• Improved patient education

• Good communication

• Taking into account patient's preferences

• Involving them in treatment decisions may

improve adherence.

• Offering support service – by phone

• Follow up scan to show improvement

Osteoporosis Treatment

Health Promotion

• Health promotion was identified as a key factor for bone health and fracture prevention

• Development of Primary Care multidisciplinary teams was of key importance to improve the prevention and management of osteoporosis

• Primary Care is the appropriate setting to meet 90-95% of all health and personal social service needs.

Strategy to prevent falls and fractures in Ireland’s ageing

population June 2008

Bone

Health

What can we do

Be aware – Community, Residential, Acute care.

Identifying those at risk – Fractures new & old, falls.

Carry out risk assessment for osteoporosis

Refer for further interventions – DEXA, physio, OT.

Provide education on diet, exercise and treatment options

Provide support – compliance with medications

Remember

Bone health is a lifelong process.

Bone health through the ages

1-12yrs 13-22yrs Adult Over 80

years

Peak Bone Mass

Age related bone mass Age related bone loss

Bone Health in the Park

19

www.bonehealth.co20

21

Falls awareness

Impact on Older Adult

• Where we work - Care of the Older Adult – all

settings

• Impact of these figures on our client group

– Loss of independence

– Suffering

– Severe disability

– Depression

– Need for home support

23

• Ageing population

• In 2030 a number of the present day work force will

be over 50 years of age

• In 2030 many of us may/will fall and will be a statistic

• Through education we can help reduce these figures

Real Life Facts

24

Impact on Society

• Loss to family and community

• Cost - Overstretched economy

• Provision of services home care, respite care,

extended care

• Proactive approach required rather than reactive

• Education is key

25

FOREVER AUTUMN

Implementation of a falls awareness

programme for all staff – clinical and

non clinical, illustrating the potential for

falls amongst the older adults in our

care.

Elements included:

• Revision of St Mary’s Falls Prevention

and Management Policy

• New Falls Risk Assessment Tool

• New Falls Risk Symbols

• New Falls Reduction Measures

Key MessageAll staff have a role to play in

reducing the risk of falls – clinical

and non clinical –know your role!

Review of Falls Data from January - June 2013

New Data Measurement Interventions to prevent potential falls

Evidence to staff of benefits of Forever Autumn Programme in action

*Compared to falls data pre Forever Autumn in 2011

Phoenix Park Community

Nursing Unit

33% Reduction*

St Mary’s Hospital 15% Reduction*

Development of an online resource to offer support, guidance and continued education in falls prevention and management across the care spectrum for older adults:-•Acute Hospital Care•Community Care•Intellectual Disabilities Care•Palliative Care•Residential Care

Proactive collaborative approach to falls prevention by providing a platform for continuing engagement

www.foreverautumn.co

www.foreverautumn.co

To promote bone health, falls reduction, falls prevention

and effective falls management

To provide a platform to share the repository of

information to the wider community to enhance

quality care through presentations, articles of

interest, develop special interest groups etc.

www.foreverautumn.co

St Mary’s Community Falls

ServiceThe Falls Service at St Mary’s Hospital is a

consultant Geriatrician led multidisciplinary

service offering the following:– Clinical assessment by Nursing and Medical staff

– Investigations

– Physiotherapy assessment

– Occupational therapy assessment

– Social worker services

– Education & support

Poster Campaign

2013

Prompt patients to ask

about screening for

osteoporosis and will be

placed in key patient

waiting

Areas:-

• A&E department

• Fracture Clinic

• Outpatient clinic

• GP surgery

• Health centre

33

Bone

Health

Further Information

National Osteoporosis Society

International Osteoporosis Foundation

Strategy to prevent falls and fractures in Ireland’s ageing

population June 2008 HSE, DOHC, NCAOP, Irish

Osteoporosis Society