Balance + NOFs

Question 1

Overview of common causes of loss of balance/unsteadiness

Answer 1

Impairment of :
Sensory component
Central component
Motor component

Question 2

Sensory components of falls

Answer 2

proprioreception (joint replacement)
vision (cataracts/refractive error)
Vestibular/hearing input (waxy ears, hearing aids)

Question 3

What is the cause of impairment of central processing?

Answer 3

3 Ds
Drugs (psychotropics)
dementia
depression

Question 4

Motor components of falls

Answer 4

Leg muscles affected:  
OA knee
age 
immobility
stroke 
PD

Question 5

What psychological consequence does falling have

Answer 5

fear of falls

Falls -> fear of falling –> decreased muscle activity -> muscle deconditioning- >unsteady gait -> falls

Question 6

How to test balace/gait

Answer 6

Timed Get Up and Go test:

• pt rises from a chair (firm, dining room style, with arms)
• walks 3 metres, turns and returns to the chair.
• normal < 13.5 secs

Question 7

How to assess postural hypotension

Answer 7

1. Measuring BP when the patient is supine (lying for >5mins)
2. Repeat BP when the patient stands up
3. And again, repeat BP after 3 minutes of standing.

Question 8

Dx of postural hypotension

Answer 8

Systolic BP fall> 20mmHg is considered diagnostic

Question 9

NOF prevention in elderly women

Answer 9

If >75 yo -> bisphosphonates (alendronate) + vit D + Ca

If 50-74 and fractured -> DXA scan

Question 10

Alternative to bisphosphonates for NOF prevention

Answer 10

denosumab injection every 6 mo

Question 11

Investigation of choice after a normal hip x ray but persisting sx

Answer 11

MRI

if not available within 24hrs, then CT

Question 12

RFs for NOF

Answer 12

genetic
Low vit D/Ca
Smoking
Alcohol
Lack of exercise
Low levels of gonadal sex steroids (esp women post menupause)