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CPD: Key questions on falls

Consultant geriatrician Dr Chris Dyer discusses polypharmacy, fracture risk and the role of vitamin D in preventing falls

Learning Objectives

This module will update you on managing falls in primary care, including:

  • Establishing the cause of a fall
  • The role of polypharmacy in falls
  • When to investigate for osteoporosis
  • Assessing a patient’s falls risk

Author

Dr Chris Dyer is a consultant geriatrician at Royal United Hospitals, Bath. Dr Dyer would like to thank colleague Dr Alastair Kerr for his input.

What injuries do falls commonly cause? What would make you investigate for osteoporosis?

Falls from a standing height are now the commonest cause of major trauma. This is related to an increasing population of frail adults. About 10% of falls result in fractures. The most common fragility fractures are wrist, humerus, hip and spine. A wrist fracture implies an arm outstretched to cushion the impact of the fall and intervention after this may prevent a future hip fracture, when such rapid reflex protective mechanisms are lost. Anyone over the age of 75 with a fracture should receive osteoporosis treatment, while younger patients should be referred for a DEXA scan.

If you’re thinking about falls, also think about bone health. Preventing the next fall means preventing a future fracture. Install the FRAX (sheffield.ac.uk/FRAX) or Qfracture (qfracture.org) app on your smartphone or computer. A few clicks and you will discover your patient’s 10-year risk of fracture and whether they should receive osteoporosis treatment. Bisphosphonates take six months to lower risk and so should be offered to all these patients unless in their last year of life.

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Related images

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