1. An
overview of
Osteoporosis,
Bone Health
Falls Awareness & Falls Prevention
Daragh Rodger
Advanced Nurse Practitioner
Care of the Older Adult Community

2. Report of the
National Steering Group
on the
Prevention of Falls in
Older People and
the Prevention and
Management of
Osteoporosis
throughout LifeFalls strategy
2008

4. Treatment

5. Osteoporosis comes from ‘osteo’ meaning bone and the
greek word por (passage) ie simply it means porous
bone.
Osteoporosis results in loss of bone strength, thus making
bone more fragile and easily susceptible to fracture.
Osteoporosis is classed as a bone density 2.5 or more
standard deviations below normal peak bone mass
(WHO, 2002)
• Normal Bone Density 0 - -1
• Osteopenia -1 - -2.5
• Osteoporosis > -2.5
DEXA SCAN RESULTS

6. DXA scan
Bone health assessment
Bone health Education
•Diet
•Exercise
•Lifestyle choice
St Mary’s Healthy Ageing Clinic

7. A T-score compares the patient’s
results with the mean peak bone mass
(thickness of bones) of a large number
of normal females and males between
the ages of 20-40.
A Z-score compares the patient’s
score with their own age group; this
should only be used in the diagnosis
of the spine in children and
adolescents

10. Bone Density Results – Healthy Ageing Clinic
0
100
200
300
400
500
600
700
2010
Osteoporosis
561
Osteopenia
465
Normal
621

11. Osteoporosis Treatment
Prevention and Treatment
options
Calcium and Vitamin D are
essential for the treatment and
prevention of osteoporosis. If it is
not acquired in the diet it is
necessary to take a supplement.
This applies to everyone
regardless of DEXA scan result.
Exercise is also an essential
component in the treatment and
prevention of osteoporosis.

12. Treatment Options
Anti resorptives – Bisphosphonates decreases bone
resorption
eg. Alendronate – Fosamax 70mg - once a week
Alendronate combined with Vitamn D – Fosavance 5600
– Fosamax 70mg with 5600iu Vitamin D once a week
Ibandronate – Bonviva 150mg – once a month
Ibandronate – Bonviva by IV 3mg – every 3 months
Risedronate – Actonel 35mg – once a week
Risedronate – Actonel 35mg combi( with calcium) one
actonel a week and one calcium 500mg for six days of
week
Zoledronic Acid – Aclasta – once a year IV infusion
Osteoporosis Treatment

13. Strontium Ranelate – Protelos – dual action bone agent –
prevents bone loss and it increases bone formation – one 2g
sachet daily
Parathyroid Hormone – Teriparatide – Forsteo
Stimulates bone formation and is given by subcutaneous
injection for a period of 18 Months. It mimics the action of
natural human hormone. It is the most potent anabolic agent.
It is reserved for use of severe osteoporosis and is usually only
prescribed by a specialist physcian.
Denosumab – Prolia – monoclonal antibody
Prevents bone loss and osteoporosis – 60mg subcutaneous
injection 6 monthly
Osteoporosis Treatment

14. Compliance
• Improved patient education
• Good communication
• Taking into account patient's preferences
• Involving them in treatment decisions may
improve adherence.
• Offering support service – by phone
• Follow up scan to show improvement
Osteoporosis Treatment

15. Health Promotion
• Health promotion was identified as a key factor for bone
health and fracture prevention
• Development of Primary Care multidisciplinary teams
was of key importance to improve the prevention and
management of osteoporosis
• Primary Care is the appropriate setting to meet 90-95%
of all health and personal social service needs.
Strategy to prevent falls and fractures in Ireland’s ageing
population June 2008

16. Bone
Health
What can we do
Be aware – Community, Residential, Acute care.
Identifying those at risk – Fractures new & old, falls.
Carry out risk assessment for osteoporosis
Refer for further interventions – DEXA, physio, OT.
Provide education on diet, exercise and treatment options
Provide support – compliance with medications
Remember
Bone health is a lifelong process.

17. Bone health through the ages
1-12yrs 13-22yrs Adult Over 80
years
Peak Bone Mass
Age related bone mass Age related bone loss

18. Bone Health in the Park

19. 19

20. www.bonehealth.co20

21. 21

22. Falls awareness

23. Impact on Older Adult
• Where we work - Care of the Older Adult – all
settings
• Impact of these figures on our client group
– Loss of independence
– Suffering
– Severe disability
– Depression
– Need for home support
23

24. • Ageing population
• In 2030 a number of the present day work force will
be over 50 years of age
• In 2030 many of us may/will fall and will be a statistic
• Through education we can help reduce these figures
Real Life Facts
24

25. Impact on Society
• Loss to family and community
• Cost - Overstretched economy
• Provision of services home care, respite care,
extended care
• Proactive approach required rather than reactive
• Education is key
25

26. FOREVER AUTUMN
Implementation of a falls awareness
programme for all staff – clinical and
non clinical, illustrating the potential for
falls amongst the older adults in our
care.
Elements included:
• Revision of St Mary’s Falls Prevention
and Management Policy
• New Falls Risk Assessment Tool
• New Falls Risk Symbols
• New Falls Reduction Measures

27. Key Message
All staff have a
role to play in
reducing the risk
of falls – clinical
and non clinical –
know your role!

28. Review of Falls Data from January - June 2013
New Data Measurement
Interventions to prevent potential falls
Evidence to staff of benefits of Forever
Autumn Programme in action
*Compared to falls data pre Forever Autumn in 2011
Phoenix Park Community
Nursing Unit
33% Reduction*
St Mary’s Hospital 15% Reduction*

29. Development of an online resource to offer support,
guidance and continued education in falls prevention and
management across the care spectrum for older adults:-
•Acute Hospital Care
•Community Care
•Intellectual Disabilities Care
•Palliative Care
•Residential Care
Proactive collaborative approach to falls prevention by
providing a platform for continuing engagement
www.foreverautumn.co

30. www.foreverautumn.co

31. To promote bone health, falls reduction, falls prevention
and effective falls management
To provide a platform to share the repository of
information to the wider community to enhance
quality care through presentations, articles of
interest, develop special interest groups etc.
www.foreverautumn.co

32. St Mary’s Community Falls
Service
The Falls Service at St Mary’s Hospital is a
consultant Geriatrician led multidisciplinary
service offering the following:
– Clinical assessment by Nursing and Medical staff
– Investigations
– Physiotherapy assessment
– Occupational therapy assessment
– Social worker services
– Education & support

33. Poster Campaign
2013
Prompt patients to ask
about screening for
osteoporosis and will be
placed in key patient
waiting
Areas:-
• A&E department
• Fracture Clinic
• Outpatient clinic
• GP surgery
• Health centre
33

35. Bone
Health
Further Information
National Osteoporosis Society
International Osteoporosis Foundation
Strategy to prevent falls and fractures in Ireland’s ageing
population June 2008 HSE, DOHC, NCAOP, Irish
Osteoporosis Society