a b s t r a c tBackground: Early in the development of geriatric medicine, falls were identified as a "geriatric giant", a nonspecific indicator of functional decompensation. This led to the notion of "falls prevention services", and the concept that identification of those patients at high risk of falls is essential to approach this group of elderly people. Objective: This work was carried out aiming to develop a model that predicts falls risk for both in-as well as outpatients using clinical variables that are easily assessed in clinical practice. Study Design: A case-control study to determine the risk factors and the prediction rule of falls risk among older people. Methods: Three hundred and seventy-three outpatients and 186 inpatients, with a minimum age of 65 years, were assessed for falls risk factors. The clinical characteristics with independent predictive value for the development of falls were selected using logistic regression analysis. The diagnostic performance of the prediction rule was evaluated using the area under the curve. Cross-validation controlled for over fitting of the data (internal validation) was also carried out. Results: The prediction rule consisted of five clinical variables: history of falls in the last 12 months, slowing of the walking speed/change in gait, history of loss of balance in the last 12 months, and impaired sight and weak hand grip. The prediction score ranged from 0 to 6.5, and corresponded to the percent chance of sustaining a fall. For several cutoff values, the positive and negative predictive values were determined. The area under the curve values for the prediction rule was 0.89. Conclusion: In elderly people, the risk of sustaining a fall can be predicted, thereby allowing individualized decisions regarding the patient's management. Falls risk assessment score is a new self-reported tool that can be used in standard clinical practice by all health care professionals both in the outpatient and the acute hospital inpatient settings. Assessing for the falls risk would help to minimize the negative impact of falling on the patient's physical, psychological, and social functional abilities.
Osteoporosis is a major public health concern. Recent evidence from clinical and epidemiological trials on osteoporosis has stressed the urgency for early and accurate diagnosis of vertebral fractures. Despite the fact that vertebral fractures are very common and associated with decreased quality of life, they are frequently missed in daily clinical practice. The authors developed a protocol to be applied through a specialized nurse-led osteoporosis vertebral fracture service that allows for accurate diagnosis, identifies patients at risk and shortens the time of assessment and management. A total of 114 patients have been reviewed over 12 months. Completing the referral form and the clinic proforma helped the nurse cover all causes of vertebral fractures and shortened the lag time for assessment and management. Osteoporosis therapy was commenced once diagnosis was confirmed.
<b><i>Objective:</i></b> The aim of this study was to reach a consensus on an updated version of the recommendations for the diagnosis and Treat-to-Target management of osteoporosis that is effective and safe for individuals with chronic kidney disease (CKD) G4-G5D/kidney transplant. <b><i>Methods:</i></b> Delphi process was implemented (3 rounds) to establish a consensus on 10 clinical domains: (1) study targets, (2) risk factors, (3) diagnosis, (4) case stratification, (5) treatment targets, (6) investigations, (7) medical management, (8) monitoring, (9) management of special groups, (10) fracture liaison service. After each round, statements were retired, modified, or added in view of the experts’ suggestions, and the percent agreement was calculated. Statements receiving rates of 7–9 by more than 75% of experts’ votes were considered as achieving consensus. <b><i>Results:</i></b> The surveys were sent to an expert panel (<i>n</i> = 26), of whom 23 participated in the three rounds (2 were international experts and 21 were national). Most of the participants were rheumatologists (87%), followed by nephrologists (8.7%), and geriatric physicians (4.3%). Eighteen recommendations, categorized into 10 domains, were obtained. Agreement with the recommendations (rank 7–9) ranged from 80 to 100%. Consensus was reached on the wording of all 10 clinical domains identified by the scientific committee. An algorithm for the management of osteoporosis in CKD has been suggested. <b><i>Conclusion:</i></b> A panel of international and national experts established a consensus regarding the management of osteoporosis in CKD patients. The developed recommendations provide a comprehensive approach to assessing and managing osteoporosis for all healthcare professionals involved in its management.
Osteoporosis is a chronic disease where the nurse specialist can make a significant impact. The osteoporosis nurse specialist has an important role, not only in the prevention and management of osteoporosis but also in the promotion of skeletal health across the public health and social care arenas and in the continuing development of services across primary and secondary care. The scale of the problem in women and the potential role of hormone replacement therapy in the prevention and treatment of osteoporosis has played down the problem of osteoporosis and osteoporotic fractures in men, thus facilitating a negligent attitude. This article summarizes the outcome of a dedicated male osteoporosis clinic, which was started by the lead clinicians in metabolic bone disease and falls and subsequently was run by the osteoporosis nurse specialist. A clinic proforma which can be used as a standard in clinical practice is presented. In addition, an algorithm for the management of men with osteoporosis is discussed.
Background
This is a Clinical Practice Guideline update released by the Egyptian Academy of Bone Health and Metabolic Bone Diseases. It does not replace the clinical practice guidelines published for the treatment of osteoporosis in 2021, but it entails specific recommendations and selective criteria for romosozumab as another pharmacological agent for treatment of postmenopausal osteoporosis. It has been issued, in part, due to the imminent approval of romosozumab in Egypt.
Main text
The guideline recommends the use of romosozumab, for up to 1 year, for the reduction of vertebral, hip, and non-vertebral fractures in postmenopausal women with severe osteoporosis at very high risk of fracture/imminent fracture risk: defined as T-score less than − 2.5 and a prior hip or vertebral fracture in the past 24 months or a very high fracture risk, as identified by FRAX (FRAX major osteoporosis fracture > 30%, FRAX hip fracture > 4.5%). The recommended dosage of romosozumab is 210 mg monthly by subcutaneous injection for 12 months. For osteoporotic postmenopausal women who have completed a 12-month course of romosozumab, treatment with an anti-resorptive osteoporosis therapy is recommended to maintain bone mineral density gains and reduce fracture risk. The treatment is not recommended for women at high risk of cardiovascular disease and stroke, which includes those with prior myocardial infarction or stroke.
In conclusion, strategies to osteoporosis management have been highly diversified, with bone health specialists have become able to set up treatment plan tailored to the individual patient’s requirement. Patients with severe osteoporosis at very high fracture risk need stronger therapeutic regimens to start with. Romosozumab endorses bone formation and suppresses bone resorption, leading to a greater anabolic window and a superior positive impact on bone mineral density.
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