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Immobile patients sustain fractures from disuse.

LAS VEGAS -- Frail, elderly persons in long-term care have a real but underrecognized risk of minimal-trauma fractures, said Dr. Violeta Galabova at the annual meeting of the American Geriatrics Society.

The problem hasn't been extensively studied, but osteoporosis associated with disuse is thought to be the primary mechanism behind the fractures, which often occur as the patient is being moved. "It's very important to teach nursing staff proper transfer techniques," said Dr. Galabova, a fellow in geriatric medicine at the University of Pennsylvania, Philadelphia.

People who are confined to bed or a wheelchair for 6 months or more are especially vulnerable, particularly if they've had a previous fracture. Other risk factors include use of predisposing medications such as steroids, and poor nutritional status, as reflected in a body mass index less than 20 kg/[m.sup.2] or a serum albumin level below 3 g/dL. Such patients should be watched carefully and might benefit from supplementation with calcium and vitamin D and treatment with bisphosphonates, Dr. Galabova told this newspaper.

She described three patients whose cases illustrate how these fractures may become apparent. The first was a 101-year-old woman who had been wheelchair bound for several years. During a routine examination, her doctor noted swelling of her left leg and diagnosed a spontaneous fracture of the left tibial-fibular segment, which occurred without any identifiable precipitating event. Over the next few years, she developed two more lower-extremity fractures.

The second was a 93-year-old bed-bound woman who had a history of a hip fracture and seizures. While in a nursing home, she sustained a fracture of the right femur and the left humerus, both during routine transfers from a wheelchair to bed.

In the third case, a 79-year-old man with Parkinson's disease and a right total hip arthroplasty was able to get around with a walker until he fell and sustained a sub-arachnoid hemorrhage that left him confined to bed. Six months after his fall, he complained of pain in his right thigh while being adjusted in bed, and was diagnosed with a spiral periprosthetic fracture of the right femur.

BY NORRA MACREADY

Los Angeles Bureau
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Title Annotation:Rheumatology
Author:MacReady, Norra
Publication:Internal Medicine News
Geographic Code:1USA
Date:Sep 15, 2004
Words:355
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