Citation

Gómez F, Curcio CL, Brennan-Olsen SL, Boersma D, Phu S, Vogrin S, Suriyaarachchi P, Duque G. BMJ Open 2019; 9(7): e027013.

Affiliation

Australian Institute for Musculoskeletal Science (AIMSS), The University of Melbourne and Western Health, St Albans, Victoria, Australia.

Copyright

(Copyright © 2019, BMJ Publishing Group)

DOI

10.1136/bmjopen-2018-027013

PMID

31362962

Abstract

OBJECTIVES: Traditionally, the approach to fracture prevention has focused on increasing bone mineral density while typically lacking a combined clinical approach to falls prevention and vice versa. To resolve this gap, we implemented and evaluated a novel combined model of care to the assessment and prevention of osteoporosis and falls in the outpatients setting. SETTING: Falls and Fractures Clinic (FFC) at Nepean Hospital (Penrith, NSW, Australia). PARTICIPANTS: Pre-effects and posteffects assessment of 106 community-dwelling older patients referred from the community. PRIMARY AND SECONDARY OUTCOME MEASURES: Previous falls and fractures were recorded. Clinical, functional and paraclinical evaluations were performed. A comprehensive multidisciplinary care plan was then tailored based on the presence of risk factors. Six-month follow-ups were performed assessing the incidence of falls and fractures, change in risk factors for falls and level of risk, with the recommended plan.

RESULTS: We report that 97% of patients had a fall in the preceding 6 months, 47.6% of whom experienced a fracture from the fall. Furthermore, 64% of patients had a marked risk for falling by Physiological Profile Assessment (PPA), 90% had intermediate-high 10-year probability of fracture according to FRAX and 78% had sarcopenia. At 6-month follow-up, we observed more than an 80% reduction in falls and recurrent falls, and 50% reduction in fractures. In addition, 65% of patients had reduced PPA and a 57% reduction in 10-year fracture probability.

CONCLUSIONS: In conclusion, we suggest that a multidisciplinary FFC can provide substantial reductions in falls and fractures for high-risk older people, even over a relatively short 6-month time period. The current model of service provision via traditional falls clinics could be significantly improved by encompassing fracture prevention within the multifactorial approach to interventions.

© Author(s) (or their employer(s)) 2019. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.

Language: en

Keywords

falls; falls and fractures clinic; fractures; osteoporosis; osteosarcopenia