Non-Pharmacological Interventions towards Preventing the Triad Osteoporosis-Falls Risk-Hip Fracture, in Population Older than 65. Scoping Review

Osteoporosis leads to increased risk of falls, and thus an increase in fractures, highlighting here hip fractures, that result in high mortality, functional disability, and high medical expenditure. The aim is to summarise the available evidence on effective non-pharmacological interventions to prevent the triad osteoporosis/falls risk/hip fracture. A scoping review was conducted consulting the Scientific Electronic Library Online (Scielo), National Institute for Health and Care Excellence (NICE), Cumulative Index to Nursing & Allied Health Literature (CINAHL) y PubMed.databases. Inclusion criteria were articles published between 2013 and 2019, in Spanish or English. In addition, publications on a population over 65 years of age covering non-pharmacological interventions aimed at hip fracture prevention for both institutionalised patients in long-stay health centres or hospitals, and patients cared for at home, both dependent and non-dependent, were included. Sixty-six articles were selected and 13 non-pharmacological interventions were identified according to the Nursing Interventions Classification taxonomy, aimed at preventing osteoporosis, falls, and hip fracture. The figures regarding the affected population according to the studies are alarming, reflecting the importance of preventing the triad osteoporosis, falls risk, and hip fracture among the population over 65 years of age. The most effective interventions were focused on increasing Bone Mineral Density through diet, exercise, and falls prevention. As a conclusion, primary prevention should be applied to the entire adult population, with special emphasis on people with osteoporosis.

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Occupational Therapy Interventions in Adults with Multiple Sclerosis or Amyotrophic Lateral Sclerosis: A Scoping Review

International Journal of Environmental Research and Public Health ◽

10.3390/ijerph18041432 ◽

2021 ◽

Vol 18 (4) ◽

pp. 1432

Author(s):

Luis De-Bernardi-Ojuel ◽

Laura Torres-Collado ◽

Manuela García-de-la-Hera

Keyword(s):

Multiple Sclerosis ◽

Amyotrophic Lateral Sclerosis ◽

Occupational Therapy ◽

Scoping Review ◽

Adult Population ◽

Falls Prevention ◽

Targeted Interventions ◽

Therapy Interventions ◽

Occupational Therapy Interventions ◽

Lateral Sclerosis

This scoping review aims to describe occupational therapy interventions carried out with multiple sclerosis (MS) and amyotrophic lateral sclerosis (ALS) patients in occupational therapy. A peer review of the literature was conducted in different databases: Pubmed, Scopus, Web of Science and Embase, and in some occupational therapy journals. A search of the literature published was carried out before December 2019. The inclusion criteria were as follows: (1) articles evaluating the intervention of occupational therapy in MS or ALS including experimental, randomized, nonrandomized and exploratory studies; (2) written in English or Spanish; (3) adult population (over 18 years old). The initial search identified 836 articles of which we included 32 divided into four areas of intervention: fatigue-targeted interventions, cognitive interventions, physical interventions and others. Only 16 studies were carried out exclusively by occupational therapists. Most occupational therapy interventions are aimed at fatigue and physical rehabilitation. The majority of the studies in our review included MS patients, with little representation from the ALS population. These interventions have shown an improvement in perceived fatigue, manual dexterity, falls prevention and improvement in cognitive aspects such as memory, communication, depression and quality of life in the MS and ALS populations.

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Healthcare utilisation and cost expenditures for pneumonia in individuals with diabetes mellitus in the USA

Epidemiology and Infection ◽

10.1017/s0950268819000979 ◽

2019 ◽

Vol 147 ◽

Author(s):

K. Liu ◽

G. C. Lee

Keyword(s):

Diabetes Mellitus ◽

Adult Population ◽

Healthcare Utilisation ◽

Population Based ◽

Medical Expenditure ◽

Inpatient Setting ◽

Cross Sectional ◽

Panel Surveys ◽

Increased Risk ◽

The Usa

AbstractPneumonia is one of the leading causes of hospitalisations among adults in the USA. Individuals with diabetes mellitus (DM) have been associated with increased risk for pneumonia and complications including death. The objectives of this study were to (1) compare the prevalence and healthcare utilisation patterns for pneumonia in individuals with and without DM, and (2) identify risk factors for pneumonia in those with DM. We performed a retrospective, cross-sectional analysis of the US adult population using Medical Expenditure Panel Surveys (MEPS) data from 2014. Overall, the data represented 24 million individuals with DM and 218 million without DM in the USA. The population-based rate for a pneumonia event was 34 per 1000 persons for individuals with DM and 19 per 1000 persons without DM. Compared to the non-DM group, individuals with DM were treated 1.8x, 2.6x and 1.4x more in the ED, hospital and outpatient, respectively. Furthermore, the average cost per pneumonia event was significantly higher among individuals with DM compared to non-DM in the inpatient setting ($11 931 vs. $7751; P < 0.001). Among individuals with DM, female sex, DM complications, smokers and administration of pneumococcal vaccines were significant factors associated with a pneumonia event.

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Associations Between Bone Impact Microindentation and Clinical Risk Factors for Fracture

Endocrinology ◽

10.1210/en.2019-00415 ◽

2019 ◽

Vol 160 (9) ◽

pp. 2143-2150 ◽

Cited By ~ 4

Author(s):

Pamela Rufus-Membere ◽

Kara L Holloway-Kew ◽

Adolfo Diez-Perez ◽

Mark A Kotowicz ◽

Julie A Pasco

Keyword(s):

Risk Factors ◽

Hip Fracture ◽

Clinical Risk Factors ◽

Material Strength ◽

Mineral Density ◽

Clinical Risk ◽

Increased Risk ◽

Vitamin D Levels ◽

Prior Fracture ◽

Impact Microindentation

Abstract Impact microindentation (IMI) measures bone material strength index (BMSi) in vivo. However, clinical risk factors that affect BMSi are largely unknown. This study investigated associations between BMSi and clinical risk factors for fracture in men. BMSi was measured using the OsteoProbe in 357 men (ages 33 to 96 years) from the Geelong Osteoporosis Study. Risk factors included age, weight, height, body mass index (BMI), femoral neck bone mineral density (BMD), parental hip fracture, prior fracture, type 2 diabetes mellitus (T2DM), secondary osteoporosis, smoking, alcohol consumption, sedentary lifestyle, medications, diseases, and low serum vitamin D levels. BMSi was negatively associated with age (r = −0.131, P = 0.014), weight (r = −0.109, P = 0.040), and BMI (r = −0.083, P = 0.001); no correlations were detected with BMD (r = 0.000, P = 0.998) or height (r = 0.087, P = 0.10). Mean BMSi values for men with and without prior fracture were 80.2 ± 6.9 vs 82.8 ± 6.1 (P = 0.024); parental hip fracture, 80.1 ± 6.1 vs 82.8 ± 6.9 (P = 0.029); and T2DM, 80.3 ± 8.5 vs 82.9 ± 6.6 (P = 0.059). BMSi did not differ in the presence vs absence of other risk factors. In multivariable models, mean (± SD) BMSi remained associated with prior fracture and parental hip fracture after adjusting for age and BMI: prior fracture (80.5 ± 1.1 vs 82.8 ± 0.4, P = 0.044); parental fracture (79.9 ± 1.2 vs 82.9 ± 0.4, P = 0.015). No other confounders were identified. We conclude that in men, BMSi discriminates prior fracture and parental hip fracture, which are both known to increase the risk for incident fracture. These findings suggest that IMI may be useful for identifying men who have an increased risk for fracture.

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Mortality following hip fractures in men with prostate cancer.

Journal of Clinical Oncology ◽

10.1200/jco.2013.31.6_suppl.49 ◽

2013 ◽

Vol 31 (6_suppl) ◽

pp. 49-49

Author(s):

Mieke Van Hemelrijck ◽

Hans Garmo ◽

Karl Michaelsson ◽

Andreas Thorstenson ◽

Pär Stattin ◽

...

Keyword(s):

Prostate Cancer ◽

Hip Fracture ◽

Hip Fractures ◽

Absolute Risk ◽

Reference Population ◽

Cox Proportional Hazards ◽

Risk Category ◽

Mineral Density ◽

Risk Of Death ◽

Increased Risk

49 Background: Rapid loss of bone-mineral density is a known side-effect of androgen deprivation therapy (ADT) for prostate cancer (PCa). Hip fractures are also independently associated with risk of mortality. To our knowledge few population-based observational studies have yet investigated the risk of dying following fractures among men with PCa. We aimed to assess skeletal-related events and mortality in more detail by specifically studying the link between hip fractures in PCa men and risk of death. Methods: PCBaSe Sweden 2.0 is based on the National Prostate Cancer Register and contains age and county matched men free of PCa. We selected all men (n=14,205) who had been hospitalized with a hip fracture, as registered in the National Patient Register, between 2006 and 2010. A total of 2300 were diagnosed with PCa before the hip fracture and 66% of them were treated with ADT. The main outcome was death as registered in the National Cause of Death Register. The risk of death was estimated using multivariate Cox Proportional Hazards regression analyses and standardized mortality ratios (SMRs) taking into account PCa risk category, history of fractures, civil status, Charlson Comorbidity Index, and treatment with bisphosphonates. Results: In the analysis for risk of death >90 days after a hip fracture, there was an increased risk of death among PCa men on ADT, especially those aged <84 years (e.g., HR at 3-6 months after hip fracture: 2.47 (95%CI: 1.85-3.30) compared to men free of PCa with a hip fracture). The SMRs showed that PCa men on ADT who got a hip fracture were seven times more likely to die than expected in the reference population of all men with PCa, whereas PCa men who were not on ADT and had a hip fracture were 13 times more likely to die than expected in this reference population. However, the absolute risk difference between men with and without a hip fracture was 30 per 1,000 person-years when evaluating the effect of a hip fracturing among men on ADT, whereas a hip fracture would cause an additional 20 per 1,000 person-years to die among PCa men without ADT as well as among men free of PCa. Conclusions: Our SMRs and absolute risk calculations show that hip fractures are more dangerous in PCa men treated with ADT than in PCa men without ADT or in men free of PCa.

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Osteoporosis is a Predictive Factor for Nephrolithiasis in an Adult Free-Living Caucasian Population From Southern Italy: A Longitudinal Retrospective Study Based on a General Practice Database

Calcified Tissue International ◽

10.1007/s00223-020-00737-9 ◽

2020 ◽

Vol 107 (5) ◽

pp. 446-452 ◽

Cited By ~ 1

Author(s):

Domenico Rendina ◽

Lanfranco D’Elia ◽

Marco Evangelista ◽

Gianpaolo De Filippo ◽

Alfonso Giaquinto ◽

...

Keyword(s):

Bone Mineral Density ◽

Bone Mineral ◽

Predictive Factor ◽

Southern Italy ◽

Adult Population ◽

High Morbidity ◽

Mineral Density ◽

Free Living ◽

Increased Risk ◽

High Incidence

Abstract Osteoporosis and nephrolithiasis are common multifactorial disorders with high incidence and prevalence in the adult population worldwide. Both are associated with high morbidity and mortality if not correctly diagnosed and accurately treated. Nephrolithiasis is considered a risk factor for reduced bone mineral density. Aim of this retrospective longitudinal study was to evaluate if osteoporosis is a predictive factor for the nephrolithiasis occurrence. Free-living subjects referring to “COMEGEN” general practitioners cooperative operating in Naples, Southern Italy. Twelve thousand seven hundred ninety-four Caucasian subjects (12,165 female) who performed bone mineral density by dual-energy X-ray absorptiometry and have a negative personal history for nephrolithiasis. Subjects aged less than 40 years or with signs or symptoms suggestive of secondary osteoporosis were excluded from the study. In a mean lapse of time of 19.5 months, 516 subjects had an incident episode of nephrolithiasis. Subjects with osteoporosis had an increased risk of nephrolithiasis than subjects without osteoporosis (Hazard Ratio = 1.33, 95% Confidence Interval 1.01–1.74, p = 0.04). Free-living adult subjects over the age of 40 with idiopathic osteoporosis have an increased risk of incident nephrolithiasis, suggesting the advisability of appropriate investigation and treatment of the metabolic alterations predisposing to nephrolithiasis in patients with osteoporosis. The study protocol was approved by the ASL Napoli 1 Ethical Committee, protocol number 0018508/2018

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Risk of hip fracture in patients with a history of schizophrenia

The British Journal of Psychiatry ◽

10.1192/bjp.bp.106.023671 ◽

2007 ◽

Vol 190 (2) ◽

pp. 129-134 ◽

Cited By ~ 111

Author(s):

Louise Howard ◽

Graham Kirkwood ◽

Morven Leese

Keyword(s):

Hip Fracture ◽

Antipsychotic Medication ◽

Univariate Analysis ◽

General Practice Research Database ◽

Practice Research ◽

Research Database ◽

Mineral Density ◽

Increased Risk ◽

History Of ◽

Clinically Significant

BackgroundThere is evidence of an association between decreased bone mineral density schizophrenia, and prolactin-raising antipsychotic medication. However, it is not known whether this is clinically significant.AimsTo investigate whether patients with a history of schizophrenia are at increased risk of hip fracture.MethodIn a case-control study, we compared cases of ‘hip fracture’ on the General Practice Research Database (n=16 341) with matched controls (n=29 889).ResultsHip fracture was associated with schizophrenia (OR=1.73; 95% CI 1.32-2.28), and prolactin-raising antipsychotics (OR=2.6; 95% CI 2.432.78), in the univariate analysis. In the multivariate analysis, prolactin-raising antipsychotics were independently associated with hip fracture but schizophrenia was not. A significant interaction between gender and antipsychotics was found in the association with hip fracture (P=0.042); OR=2.12 (95% C11.73-2.59)for men, OR=l.93 (95% C11.78-2.10) for women.ConclusionsThe association between prolactin-raising antipsychotic medication and hip fracture may have serious implications for public health. Mental health service patients may require preventive measures including dietary and lifestyle advice.

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Increased risk for hip fracture and low bone mineral density with high dietary intake of vitamin A

Osteoporosis International ◽

10.1007/bf02499892 ◽

1996 ◽

Vol 6 (S1) ◽

pp. 88-88

Author(s):

H. Melhus ◽

K. Michelsson ◽

A. Kindmark ◽

R. Bergström ◽

L. Holmberg ◽

...

Keyword(s):

Bone Mineral Density ◽

Hip Fracture ◽

Vitamin A ◽

Dietary Intake ◽

Bone Mineral ◽

Mineral Density ◽

Low Bone Mineral Density ◽

Increased Risk ◽

High Dietary Intake

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Microstructural and Strength Changes in Trabecular Bone in Elderly Patients with Type 2 Diabetes Mellitus

Diagnostics ◽

10.3390/diagnostics11030577 ◽

2021 ◽

Vol 11 (3) ◽

pp. 577

Author(s):

Mercè Giner ◽

Cristina Miranda ◽

María Angeles Vázquez-Gámez ◽

Patricia Altea-Manzano ◽

María-José Miranda ◽

...

Keyword(s):

Diabetes Mellitus ◽

Type 2 Diabetes ◽

Type 2 Diabetes Mellitus ◽

Hip Fracture ◽

Trabecular Bone ◽

Material Strength ◽

Mineral Density ◽

Trabecular Thickness ◽

Increased Risk

Type 2 diabetes mellitus (T2DM) is one of the most common chronic diseases worldwide and it is associated with an increased risk of osteoporosis and fragility fractures. Our aim is to analyze the effect of T2DM on bone quality. This is a case-control study. The studied population consisted of 140 patients: 54 subjects with hip fracture (OP) without T2DM, 36 patients with hip fracture and T2DM (OP-T2DM), 28 patients with osteoarthritis (OA) without T2DM, and 22 patients with OA and T2DM (OA-T2DM). Bone markers, bone mineral density, FRAX score, microstructural, and bone material strength from femoral heads were assessed. The group with hip fracture presented lower BMD values than OA (p < 0.05). The OP, OP-T2DM, and OA-T2DM groups showed a decrease in bone volume fraction (BV/TV), in trabecular number (Tb.N), and in trabecular thickness (Tb.Th), while an increase was presented in the structural model index (SMI) and trabecular bone pattern factor (Tb.Pf), The groups OP, OP-T2DM, and OA-T2DM also presented lower values than those in group OA regarding the biomechanical parameters in the form of Young’s modulus or elastic modulus, toughness, ultimate stress, ultimate load, extrinsic stiffness, and work to failure (p < 0.05). Our results show the negative effect of type 2 diabetes mellitus on trabecular bone structure and mechanical properties.

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Major depressive disorder is a risk factor for low bone mass, central obesity, and other medical conditions

Dialogues in Clinical Neuroscience ◽

10.31887/dcns.2011.13.1/gcizza ◽

2011 ◽

Vol 13 (1) ◽

pp. 73-87 ◽

Cited By ~ 8

Keyword(s):

Major Depressive Disorder ◽

Bone Loss ◽

Depressive Disorder ◽

Bone Mass ◽

Adult Population ◽

Premenopausal Women ◽

Osteoporotic Fractures ◽

Mineral Density ◽

Major Depressive ◽

Increased Risk

Major depressive disorder (MDD) is one of the most common psychiatric illnesses in the adult population. It is often associated with an increased risk of cardiovascular disease. Osteoporosis is also a major public health threat. Multiple studies have reported an association between depression and low bone mineral density, but a causal link between these two conditions is disputed. Here the most important findings of the POWER (Premenopausal, Osteoporosis Women, Alendronate, Depression) Study, a large prospective study of bone turnover in premenopausal women with major depression, are summarized. The endocrine and immune alterations secondary to depression that might affect bone mass, and the possible role of poor lifestyle in the etiology of osteoporosis in subjects with depression, are also reviewed, as is the potential effect of antidepressants on bone loss. It is proposed that depression induces bone loss and osteoporotic fractures, primarily via specific immune and endocrine mechanisms, with poor lifestyle habits as potential contributory factors.

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