Falls risk factors

Many of the risk factors for osteoporosis and osteoporotic fractures are predictors of low bone mineral density, such as age and ethnicity (Table 53-1). The most important risk factors for fracture are low bone mineral density, personal history of adult fracture, age, and family history of osteoporotic fracture. Other important risk factors for osteoporosis and osteoporotic fractures include menopausal status, smoking status, and low body weight. As bone mineral density decreases, the risk of fracture increases. However, the threshold at which individual patients develop a fracture varies, and other factors may play a role in fracture susceptibility. One such factor that can influence the development of fracture is falling. 

Risk factors for the development of HAP fall into four general categories ... 

Disturbances of sleep are typical of mood disorders, and belong to the core symptoms of major depression. More than 90% of depressed patients complain of impaired sleep quality [60], Typically, patients suffer from difficulties in falling asleep, frequent nocturnal awakenings, and early morning awakening. Not only is insomnia a typical symptom of depression but, studies suggest, conversely, insomnia may be an independent risk factor for depression. In bipolar disorders sleep loss may also be a risk factor for the development of mania. Hypersomnia is less typical for depression [61] and, in contrast to insomnia, may be related to certain subtypes of depression, such as seasonal affective disorder (SAD). 

A patient history should be obtained to identify history of adult fractures, comorbidities, surgeries, falls, and the presence of risk factors for osteoporosis. 

Bone mineral density changes Use of medroxyprogesterone may be considered among the risk factors for development of osteoporosis. The rate of bone loss is greatest in the early years of use and then subsequently approaches the normal rate of age-related fall. 

WHO estimates that over 30% of the global burden of disease can be attributed to environmental factors and that 40% of this burden falls on children under five years of age, who account for only 10% of the world s population (WHO, 2004a). At least three million children under five years of age die annually due to environment-related illnesses. Environmental risk factors act in concert and are exacerbated by adverse social and economic conditions, particularly poverty and malnutrition. 

Philips DIW, Barker DJP, Fall CHD, Seckl JR, Whorwood CB, Wood PJ (1998) Elevated plasma cortisol concentrations An expression for the relationship between low birth weight and adult cardiovascular risk factors. J Clin Endocrinol Metab, 83 757-760. 

A risk factor for fracture following a fall in older people is osteoporosis. Is there any best practice advice If so what is the source and provide a brief summary of that advice. 

Over 70% of the patients were older than 65 years, 50% were women, and 24% had a benzodiazepine prescription during the hospital stay. The findings suggested that the use of benzodiazepines with short and very short half-lives is an important and independent risk factor for falls. Their prescription for older hospitalized patients should be carefully evaluated. 

Only niacin offers benefits in regard to newly determined, independent risk factors for the development and progression of heart disease and the incidence of heart attacks and strokes. It lowers levels of a particularly nasty variant of LDL termed lipoprotein(a). The vitamin improves the balance of the hormonelike substances called prostaglandins, with the detrimental thromboxane falling and the protective prostacycline going up. Activity of blood platelets, cells involved in the clotting process, decrease, resulting in fewer clots that can lead to heart attacks. 

Myers AH, Baker SP, Van Natta ML, Abbey H, Robinson EG. Risk factors associated with falls and injuries among elderly institutionalized persons. Am J Epidemiol 1991 133(ll) 1179-90. 

Supervised treatment of P. vivax malaria with chloroquine (600 mg on day 1, 450 mg on days 2 and 3) and primaquine (15 mg/day for 14 days) has been studied in 50 patients in a non-endemic area of Brazil in a prospective open trial (3). G6PD status was not checked. The relapse-free cure rate at 6 months was 86%. There were no important adverse events. Risk factors for relapse included lower doses of primaquine. In patients over 60 kg in weight, the dose of primaquine can fall short of recommendations (0.25-0.3 mg/kg/day), and this can contribute to the risk of relapse. 

A low pretreatment platelet count, the dose of interferon alfa, and the haptoglobin phenotype are risk factors for ribavirin-induced anemia, and the fall in hemoglobin is independent of dose in the therapeutic range (16). In five patients with chronic hepatitis C on hemodialysis who received subcutaneous interferon alfa-2b and oral ribavirin for 40 weeks, the dose of ribavirin was titrated based on hemoglobin, with bone marrow support by erythropoietin (17). There was significant bone marrow toxicity in all five. A dose of 200 mg/day produced a steady-state AUC comparable to that obtained with 1000-1200 mg/ day in historical controls with normal renal fnnction. More severe anemia was possibly due to chronic renal insufficiency in addition to the prolonged effects of ribavirin. 

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