Objective To examine the effectiveness and safety of non-pharmacological interventions to reduce bone loss among post-stroke adult patients. Data sources Cochrane Central Register of Controlled Trials (CENTRAL), Cochrane Database for Systematic Reviews, MEDLINE, CINAHL, ScienceDirect, Scopus, PubMed and PeDRO databases were searched from inception up to 31st August 2021. Methods A systematic review of randomized controlled trials, experimental studies without randomization and prospective cohort studies with concurrent control of non-pharmacological interventions for adult stroke patients compared with placebo or other stroke care. The review outcomes were bone loss, fall and fracture. The Cochrane Risk of Bias Tools were used to assess methodological quality, and Grading of Recommendations, Assessment, Development and Evaluations Framework to assess outcome quality. Synthesis Without Meta-Analysis (SWiM) was used for result synthesis. Results Seven studies (n = 453) were included. The methodological and outcome qualities varied from low to moderate. There were statistically significant changes between the intervention and parallel/placebo group in bone mineral density, bone mineral content, cortical thickness and bone turnover markers with specific physical and vibration therapies (p<0.05). Falls were higher in the intervention group, but no fracture was reported. Conclusion There was low to moderate evidence that physical and vibration therapies significantly reduced bone loss in post-stroke patients at the expense of a higher falls rate. The sample size was small, and the interventions were highly heterogeneous with different duration, intensities and frequencies. Despite osteoporosis occurring with ageing and accelerated by stroke, there were no studies on vitamin D or protein supplementation to curb the ongoing loss. Effective, high-quality non-pharmacological intervention to improve post-stroke bone health is required.
Background There have always been concerns about the increased risk of falls in the older person taking antihypertensive medications. This retrospective study is aimed to determine whether different classes and number of antihypertensive medication used were associated with increased risk of falls in the older person. Methods Data was obtained from the geriatric clinic database in HKL from 2015-2018. The data for fallers were extracted from the Falls Clinic while data for the control group of non-fallers were extracted from the General Geriatric clinic. Socio-demographic details, types of falls, types of medications, and risk factors of falls were analysed. Results 117 of the cases who were fallers and 39 cases of non-fallers were analysed. Univariate logistic regression revealed that age, Parkinson’s disease and hypertension to have significant association with falls. The fallers were then analysed to assess falls risk with the use of antihypertensive medications. Those on one anti-hypertensive medication had an increased risk of recurrent falls (AOR = 3.16; 95% CI: 1.47–6.82) compared to those without antihypertensive medications (AOR = 0.37; CI: 0.13-1.03) and those with two or more antihypertensive medications (AOR = 0.56; CI: 0.27-1.16). Multivariate logistic regression also revealed that the use of all antihypertensive classes were not associated with recurrent falls and injuries from falls. However, patients who were on diuretics had significant odds of admission for falls (AOR 3.05; 95% CI 1.14-8.21) compared to ACE inhibitors or angiotensin receptor blockers (AOR 0.88; CI 0.38-2.10), beta blockers (AOR 0.88; CI 0.35-2.24), calcium channel blockers (AOR 0.96; CI 0.42-2.23) or alpha blockers (AOR 0.41; CI 0.09-1.99). Conclusion Older person with advanced age and Parkinson’s disease should be screened for risk of falling. In addition, all older people on antihypertensive medications especially diuretics should also be monitored for increased risk of falls.
Introduction Osteoporosis is a chronic asymptomatic condition. The US National Bone Health Alliance recommends that osteoporosis may be diagnosed by bone mineral density (BMD) testing, the occurrence of low-trauma fractures or through the use of fracture risk algorithms. However, osteoporosis has low screening rates despite having clear treatment benefits. Methodology This study aimed to describe the characteristics of patients in the falls clinic with and without osteoporosis and the ways by which diagnosis of osteoporosis was made. A retrospective, descriptive study was carried out on all patients who attended the falls clinic from January 2015 till March 2019, with data collected from its falls database. Results A total of 117 patients were included in this study. All patients had a history of fall, either single or recurrent. 43 patients had osteoporosis, of which 72.1% were female (p value <0.05). In this study, age and ethnicity were not found to be risk factors for osteoporosis. Polypharmacy, having three or more comorbidities along with alcohol and smoking habits were also not significantly associated with osteoporosis. This study also showed no differences in terms of history of recurrent falls and level of mobility between the two groups of patients. Of the 43 patients with osteoporosis, six patients (14.0%) were diagnosed by BMD testing prior to their attendance at the falls clinic. 24 patients (55.8%) had a presumptive diagnosis of osteoporosis made based on prior fragility fracture, of which majority were vertebral fractures (45.8%); and the remaining 13 patients (32.0%) were diagnosed to have osteoporosis by BMD testing after their visit to the falls clinic. Conclusion Most patients who attended the falls clinic have had a prior fragility fracture, which could have been prevented by treatment. Screening for osteoporosis should therefore be carried out more robustly in the community to prevent injurious falls.
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