BACKGROUND: Approximately 30 per cent of people over 65 years of age and living in the community fall each year; the number is higher in institutions Although less than one fall in 10 results in a fracture, a fifth of fall incidents require medical attention OBJECTIVES: To assess the effects of interventions designed to reduce the incidence of falls in elderly people (living in the community, or in institutional or hospital care) SEARCH STRATEGY: We searched the Cochrane Bone, Joint and Muscle Trauma Group Specialised Register (January 2003), Cochrane Central Register of Controlled Trials (The Cochrane Library, Issue 1, 2003), MEDLINE (1966 to February 2003), EMBASE (1988 to 2003 Week 19), CINAHL (1982 to April 2003), The National Research Register, Issue 2, 2003, Current Controlled Trials (wwwcontrolled-trialscom accessed 11 July 2003) and reference lists of articles No language restrictions were applied Further trials were identified by contact with researchers in the field SELECTION CRITERIA: Randomised trials of interventions designed to minimise the effect of, or exposure to, risk factors for falling in elderly people Main outcomes of interest were the number of fallers, or falls Trials reporting only intermediate outcomes were excluded DATA COLLECTION AND ANALYSIS: Two reviewers independently assessed trial quality and extracted data Data were pooled using the fixed effect model where appropriate MAIN RESULTS: Sixty two trials involving 21,668 people were includedInterventions likely to be beneficial:Multidisciplinary, multifactorial, health/environmental risk factor screening/intervention programmes in the community both for an unselected population of older people (4 trials, 1651 participants, pooled RR 073, 95%CI 063 to 085), and for older people with a history of falling or selected because of known risk factors (5 trials, 1176 participants, pooled RR 086, 95%CI 076 to 098), and in residential care facilities (1 trial, 439 participants, cluster-adjusted incidence rate ratio 060, 95%CI 050 to 073) A programme of muscle strengthening and balance retraining, individually prescribed at home by a trained health professional (3 trials, 566 participants, pooled relative risk (RR) 080, 95% confidence interval (95%CI) 066 to 098) Home hazard assessment and modification that is professionally prescribed for older people with a history of falling (3 trials, 374 participants, RR 066, 95% CI 054 to 081) Withdrawal of psychotropic medication (1 trial, 93 participants, relative hazard 034, 95%CI 016 to 074) Cardiac pacing for fallers with cardioinhibitory carotid sinus hypersensitivity (1 trial, 175 participants, WMD -520, 95%CI -940 to -100) A 15 week Tai Chi group exercise intervention (1 trial, 200 participants, risk ratio 051, 95%CI 036 to 073) Interventions of unknown effectiveness:Group-delivered exercise interventions (9 trials, 1387 participants) Individual lower limb strength training (1 trial, 222 participants) Nutritional supplementation (1 trial, 46 participants) Vitamin D supplementation, with or without calcium (3 trials, 461 participants) Home hazard modification in association with advice on optimising medication (1 trial, 658 participants), or in association with an education package on exercise and reducing fall risk (1 trial, 3182 participants) Pharmacological therapy (raubasine-dihydroergocristine, 1 trial, 95 participants) Interventions using a cognitive/behavioural approach alone (2 trials, 145 participants) Home hazard modification for older people without a history of falling (1 trial, 530 participants) Hormone replacement therapy (1 trial, 116 participants) Correction of visual deficiency (1 trial, 276 participants)Interventions unlikely to be beneficial:Brisk walking in women with an upper limb fracture in the previous two years (1 trial, 165 participants) AUTHORS' CONCLUSIONS: Interventions to prevent falls that are likely to be effective are now available; less is known about their effectiveness in preventing fall-related injuries Costs per fall prevented have been established for four of the interventions and careful economic modelling in the context of the local healthcare system is important Some potential interventions are of unknown effectiveness and further research is indicated Language: en

Interventions for preventing falls in elderly people

The epidemiology of falls and syncope.

https://www.thelancet.com/pdfs/journals/lancet/PIIS0140-6736(98)06119-4.pdf

Prevention of falls in the elderly trial (PROFET) : a randomised controlled trial

Objective: To review the epidemiology and causes of falls and fall-related injuries in nursing homes and to provide clinicians with a structured framework to evaluate and treat nursing home residen...

Falls in the Nursing Home

Epidemiology of hip fractures

Effect of external hip protectors on hip fractures

It has long been debated for many tissues in our bodies whether they are permanent or constantly refreshed as we go through life. Nuclear bomb testing in the 1950s and 1960s released a large amount of the carbon-14 isotope into the atmosphere, giving researchers the ability to determine the age and turnover of human tissues, ranging from the heart to the brain to, now, the cartilage. Heinemeier and colleagues used this so-called “14C bomb pulse” method to date cartilage from 23 individuals ranging from 18 to 76 years of age. They examined cartilage from knee joints, taking samples from both highly and moderately loaded areas, in both healthy individuals and those with osteoarthritis. The authors discovered that the collagen matrix of human cartilage is essentially permanent, with no major replacement even with disease. This finding has important implications for the tissue engineering and regenerative medicine fields, where the structural permanence of collagen will need to be contemplated when designing new cartilage repair strategies.

Radiocarbon dating reveals minimal collagen turnover in both healthy and osteoarthritic human cartilage

Purpose
To evaluate the feasibility of 18F-FDG PET/CT for initial assessment in high-grade bone sarcomas (BS) and soft tissue sarcomas (STS).

The diagnostic and prognostic value of ¹⁸F-FDG PET/CT in the initial assessment of high-grade bone and soft tissue sarcoma. A retrospective study of 89 patients.

The aim of the study was to quantitate changes in bone mineral density (BMD) in the distal femur following uncemented porous-coated total knee arthroplasty. Eight patients with total knee arthroplasties (PCA Primary, Howmedica, Rutherford, NJ) (female:male ratio, 6:2; mean age, 70 years; range, 51-77 years) were scanned by dual-photon absorptiometry within 3 months after surgery and at 2 years. An average decrease of 36% (P = .01) was found in BMD behind the anterior flange of the femoral prosthesis. Proximal to the fixation pegs, BMD increased by 22% (P = .12), but behind the posterior flange of the femoral component, BMD remained unchanged (P = .53). Stress shielding anteriorly in the distal femur occurred in all patients examined 2 years after surgery, and the increase in BMD proximal to the fixation pegs was probably a result of increased and altered mechanical loading.

Changes in Bone Mineral Density of the Distal Femur Following Uncemented Total Knee Arthroplasty

We measured bone remodeling of the proximal tibia prospectively for 3 years after uncemented total knee arthroplasty (TKA) in 25 knees with primary arthrosis. in the trabecular bone below the tibial component, bone mineral density (BMD) was measured in 6 different regions of interest (ROI), using dual photon absorptiometry (DPA). in the tibial condyles, where the change in knee alignment indicated that the load was reduced postoperatively, a fast bone loss of 7-20% was seen during the first 6 months after surgery. A small, but significant increase in BMD of 2-7% was seen in the tibial condyles, where the load was increased. on average, the density for all ROI below the tibial component showed a significant and progressive decrease in BMD, reaching 22% at 3 years follow-up.

https://www.tandfonline.com/doi/pdf/10.3109/17453679509002305

Michael Mørk Petersen

Papers

Effect of external hip protectors on hip fractures

Radiocarbon dating reveals minimal collagen turnover in both healthy and osteoarthritic human cartilage

The diagnostic and prognostic value of ¹⁸F-FDG PET/CT in the initial assessment of high-grade bone and soft tissue sarcoma. A retrospective study of 89 patients.

Changes in Bone Mineral Density of the Distal Femur Following Uncemented Total Knee Arthroplasty

Changes in bone mineral density of the proximal tibia after uncemented total knee arthroplasty: A 3-year follow-up of 25 knees