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How to reduce falls: essential reading

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Last week we reported that pre-menopausal South Asian women could be more at risk of developing osteoporosis than white women in later life. This story caught my eye as I had just been to a meeting for people newly diagnosed with osteoporosis and so have bones that are brittle and fracture easily.

I was surprised to hear that one in two women and one in five men over the age of 50 experience fractures, mostly as a result of low bone density.

More worrying are the statistics around hip fractures which commonly occur in older people and are frequently associated with osteoporosis. It is estimated that there are 65,000 cases each year in England with the current medical and social care costs thought to be around £2 billion annually. I was shocked to learn that a third of these patients will die of comorbidities within twelve months of a fractured neck of femur and 50% will lose their ability to walk independently.

Yet many people do not know about osteoporosis and its effects on bone health until they break a bone.

Years ago osteoporosis was accepted as part of ageing but there has been considerable advances in the management of the condition. We now know that there is a genetic component to the condition but there are also modifiable risk factors associated with diet, exercise, smoking and use of medications such as steroid therapy.

Clearly there is a need for more preventive care, detection of those at risk and careful management of those with a confirmed diagnosis to improve bone health.

A key part of nursing care for people with osteoporosis is falls prevention and identification of pre-existing medical problems that make them vulnerable to falls. In this week’s archive issue we explore orthostatic hypotension which is an abnormal decrease in systolic blood pressure and can lead to dizziness, light headedness and falls. The authors of this article note that assessment of lying and standing blood pressure should be part of any structured assessment.

Having one osteoporosis-related fracture doubles the risk of having another. Our second article illustrates how nurse-led fracture liaison services can identify patients who are at risk of further fractures and ensure conditions such as osteoporosis are identified and treated.

Our third article describes the use of a care bundle to reduce falls in hospitals and illustrates the importance of falls champions.

It is important that nurses assess falls risk but are also aware of underlying conditions that may increase fracture risk. There is an opportunity during any contact with patients to raise awareness of osteoporosis, discuss risk and ensure early identification leading to monitoring and treatment.

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