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Osteoporosis: treatment options
Published in Barry G. Wren, Progress in the Management of the Menopause, 2020
The aim of treatment of osteoporosis is to maintain, and ideally to restore, bone strength safely. Anti vertebral fracture efficacy has been reported using bisphosphonates1–4, estrogen5,6, calcitonin7, 1,25-dihydroxyvitamin D8,9, 1α-hydroxyvitamin D10, calcium supplements11,12 and fluoride in some, but not all, studies15–16 Anti-hip fracture efficacy was reported using calcium plus vitamin D in elderly women in nursing homes17, but not in elderly women living independently18. Annual parenteral vitamin D has been reported to reduce hip fractures in elderly persons in the community19. Hip protectors prevent hip fractures in women and men in nursing homes20. Alendronate has been reported to reduce the incidence of hip fractures in women with osteoporosis4.
Matched Data
Published in Peter Cummings, Analysis of Incidence Rates, 2019
Matching is not used in many randomized controlled trials or cohort studies because it requires extra expense and effort. However, matching in some situations can be both convenient and effective as a method for minimizing possible confounding. Some randomized trials make comparisons within the same person to eliminate confounding by genetic factors, age, sex, and behaviors. To test laser treatment of retinal disease, one eye of each subject can be randomized to treatment and the other to control status. Similarly, some dental treatments can be evaluated by randomizing some teeth to treatment and some to control status within the same person. Hip protectors are cushioning pads intended to prevent hip fractures. To estimate the efficacy of protectors, the hips of each study participant could be randomly assigned to use of the protector or not (Cummings, McKnight, and Greenland 2003, Cummings and Weiss 2003, Cummings 2007a). Randomizing the two hips of each individual, one to a hip protector and the other not, would control for bone density, propensity to fall, and other risk factors. A matched design and matched analysis would avoid imbalance due to dropouts or missing data, because those factors would always eliminate both hips in a pair.
Paper 6 Answers
Published in Hayley Dawson, Anna Trigell, EMQs for the nMRCGP® Applied Knowledge Test, 2018
The 85-year-old woman in Question 48 should ideally be on calcium and vitamin D (as should her co-residents). Hip protectors can reduce the risk of hip fracture in frail elderly women, but trials have been inconsistent and compliance can be a problem!
Older Adults’ Psychosocial Responses to a Fear of Falling: A Scoping Review to Inform Occupational Therapy Practice
Published in Occupational Therapy in Mental Health, 2020
Sin Yan Flora Wu, Ted Brown, Mong-lin Yu
Second, Brownsell and Hawley (2004) emphasized the importance of evaluating the cognitive capacity of the target client group. Those with adequate cognitive function may benefit from CBT while people with dementia may require a carer-assisted exercise program as a means to increase fitness (a modifiable falls risk factor) (Taylor et al., 2017). It is also worthwhile exploring the meaning of falls to the people involved and the personal factors associated with fear of falling because it may influence their level of interest and engagement with the interventions recommended (Stewart & McKinstry, 2012). For example, those who fear the potential for fall-related injuries may benefit from the prescription of a fall detector. In addition, older adults who have fear about fall-related injuries may benefit from being provided with hip protectors (Brownsell & Hawley, 2004; Cameron et al., 2000).
Effectiveness of non-pharmaceutical interventions to prevent falls and fall-related fractures in older people living in residential aged care facilities – a systematic review and network meta-analysis protocol
Published in Physical Therapy Reviews, 2019
Michiel Twiss, Roger Hilfiker, Timo Hinrichs, Eling D. de Bruin, Slavko Rogan
We plan to compare the effectiveness of most common non-pharmaceutical interventions to prevent falls and fall-related fractures in residents of aged care facilities (RACFs). We will define three groups of most common non-pharmaceutical interventions based on the Prevention of Falls Network Europe (ProFaNE) classification system [35]. Group one ‘Exercise’ (Ex) will be grouped into several categories: gait, balance, co-ordination and functional training; strength/resistance (including power training); flexibility; 3D (tai chi, qi gong, dance, yoga); general physical activity; endurance; exergaming (exercise games, virtual reality); other kind of exercises. Group two will be ‘Hip Protectors’ (HP). Group three ‘Other interventions’ (O) will include: physical environment changes (hazard reductions), interventions to increase knowledge (education of staff and/or older adults).
Number needed to treat based on real-world evidence for non-vitamin K antagonist oral anticoagulants versus vitamin K antagonist oral anticoagulants in stroke prevention in patients with non-valvular atrial fibrillation
Published in Journal of Medical Economics, 2019
Jean-Baptiste Briere, Kevin Bowrin, Aurélie Millier, Mondher Toumi, Piotr Wojciechowski, Vanessa Taieb
Calculating the NNT using the difference in the incidence rates, expressed as the number of events per unit of time, is also appropriate for time-to-event outcomes. However, NNTs calculated with this method represent the number of person-moments needed to be treated to prevent the occurrence of one event compared to the control group16,17,21,28. Therefore, it cannot be interpreted in terms of patients needed to be treated. Some authors argue that this method can lead to false results. For example, Suissa et al.17 commented on a trial evaluating the risk of hip fracture among elderly patients using a hip protector compared to control, with varying follow-up times. Using incidence rates, the authors calculated a NNT at 1 year of 41 persons30. However, when using the Kaplan–Meier approach, the NNT was 35 patients17. The incidence difference method makes several important assumptions, including constant risk over time17, the existence of exponentially distributed survival times21, small baseline risks, and strong treatment effects21. Furthermore, it can only be used if the relative benefit of one drug over another does not increase over time17.