The study documents a general change of position on osteoporosis (definition, diagnosis, aim of treatment). Taking into consideration a multifactorial nature of bone fragility in osteoporosis we do ...not diagnose "osteoporosis" but a total, individual 10-year fracture risk (AR-10) on the basis of independent and self-sufficient risk factors. These are: advanced age, prior fragility fracture, parental history of proximal femur fracture, low BMI, low bone mass, glicocortycosteroids treatment, rheumatoid arthritis, smoking, overuse of alcohol. The treatment should be implemented in persons burdened with a fracture risk higher than a population risk. The intervention threshold is a result of an agreement and a result of work of various working groups of experts. According to Johnell AR-10 below 8% does not require a therapeutical intervention; above 14% justifies the treatment independently of BMD measurement. AR-10 between 8% and 14% is an indication for BMD measurement precising fracture risk. The aim of the treatment is to decrease fracture risk. It combines a limitation of fracture risk factors effects including fall prevention and improvement of bone quality with applying pharmacotherapy. This study highlights that a bone mineral measurement, so far accepted as a criteria for diagnosis of osteoporosis or its exclusion should not be made in aim of diagnosis but to evaluate an absolute fracture risk. Spinal X-rays are performed in aim to diagnose vertebral fractures, which mean a multiple increase of risk of further fractures. The principles of low bone mass differential diagnosis and current possibility of pharmacological treatment are also described. Guidelines for fall avoidance in fracture prevention are described.
Currently a wide range of drugs efficient in osteoporotic fractures are on disposal. Bisfosphonates are the most important group, which are currently administered in a weekly dosage: Alendronate dose ...70mg and Risedronate - 35mg. Since few months a therapy once a month with Ibandronate 150mg is also available. Apart from antyresorptive therapy there are also other groups of medications. Strontium Ranelate not only decreases bone resorption but also increases bone formation. Parathyroid hormone subcutaneous strongly promotes bone formation. Denosumab given subcutaneous once in half a year elevates bone mineral density. Hormone Replacement Therapy is not applied in prevention of osteoporotic fracture, however, it is still in use in treatment of disorders of menopause. In countries with correct health policy the doctors have complete possibility to adjust appropriate medications according to the patient's health state.
Falls are one of the most devastating health problems of elderly people. The identification of causes of falls helps to establish proper prevention strategies.
The study was based on a group of ...community-dwelling, independent women aged over 50 years. The frequency of falls was calculated on the basis of a retrospective analysis of 1326 cases. 100 women were chosen for a telephone questionnaire to identify causes and consequences of falls. The average age was 63.9 (SD 8.6) and the average BMI was 27.6 (SD 5.4).
Approximately 31% of 1326 women reported at least one fall a year. In the year preceding the questionnaire 62% of the participants reported one fall, 26%--two falls, 8%--three falls and 5%--four and more falls. In the surveyed group of 100 women 72% of falls occurred outdoors, which is 2.5 times more often than at home (28%). 68% of falls occurred between 12 pm and 6 pm. Summer is the season of the highest occurrence of falls (37%). In winter, the frequency of outdoor falls increases, whereas during summer the frequency of falls happening in and outdoors does not differ. The most frequent cause of falls, both in and outdoors, was slipping. Other important risk factors include: hypnotic drugs, walking impairments, balance deficit, vertigo, analgesics. Most of the falls had various intrinsic and extrinsic causes.
We found that 30% of women aged over 50 years falls at least once a year. Both at home and outside falls resulted from slipping. For almost 80% of falls as a consequence of an injury. The majority of falls had intrinsic and extrinsic origins.
Population aging makes osteoporotic fractures (OP) an increasingly serious healthcare problem. It is estimated that there are approximately 2,200,000 people with an osteoporotic fracture in Poland, ...and according to the NFZ (National Health Found) report 126,100 new fractures were registered in 2018, including 34,700 fractures of the proximal femur (PFF). Surgical treatment of OP fractures is difficult due to local conditions and the general health condition of the patients. Reduced bone strength makes it difficult to achieve permanent bone fixation and union.The current "Guidelines for the prevention, diagnosis and treatment of osteoporotic bone fractures" is an update of the 2017 version (previous versions: 2007, 2012) taking into account the progress made in this area of knowledge and practice. The latest principles of conduct have been created on the basis of contemporary world standards and publications. The recommended methods of treating fractures will be discussed: of the PFF, distal end of the radius, proximal end of the humerus and the spine. Particular attention has been paid to the management of patients with PFF, because the average age - 80 years causes that an average of 29.4% of patients in Poland die within a year after the fracture (data from the National Health Fund). After sustaining a fracture, the risk of a consecutive one increases 210 times, so the surgeon is required not only to treat the fracture, but also to implement fracture prophylaxis. The study will also present the principles of diagnosis and treatment of osteoporosis.The presented guidelines were adopted in August 2022 as an official document of the National Consultant in the field of Orthopedics and Traumatology of the bone and joints system and the President of the Polish Society of Orthopedics and Traumatology. The leading author was Prof. dr hab. med. Edward Czerwiski.
