(9/11/99)-

With the knowledge that up to 75% of the variation in bone mass is genetically determined, the family based service provided by general practitioners needs to target high-risk daughters of women affected by osteoporosis with advice on modifiable risk factors and possible consideration of Hormone Replacement Therapy (HRT). However, there is still great debate about the efficacy, tolerability and safety of HRT. The safety question refers to evidence that in some women long term HRT increases the incidence of breast cancer a small degree. In the near future aging women can look to newer selective estrogen receptor modulator (SERM), a class of drugs called triphenylethylenes, which promise a new era of disease prevention. These drugs are presently under large-scale clinical trials. Check with your treating physician as to their status and potential use in your situation.

Osteoarthritis increases in prevalence with age. The knee is the site of more functional impairment than any other site on the body. Severe osteoarthritis is the main indication for total knee replacement in the elderly. Total knee replacement improves pain and joint function.

Calcium and vitamin D deficiency leads to secondary hyperparathyroidism, which contributes to bone density loss in elderly patients. Supplementation with Calcium and vitamin D is known to reduce risk of hip fractures in elderly women.

Postural stability declines with aging enhancing the risk of falls. Research literature indicates that physical exercise can improve postural stability and that hormone replacement therapy can also help (see above for some caution in using HRT). Reasons for falling can include impaired cognition, medication, reduced mobility, depression and pathological conditions such as stroke and Parkinson’s disease. Always inform your primary care physician of any untoward events, especially falls.

Antidepressant medications have been implicated in falls of elderly residents in nursing homes. The New England Journal of Medicine (1998; 339(13): 875-880) reported that new users of antidepressants in nursing homes fell more often than non-users. This increased fall rate persisted during drug therapy. When they compared the two types of medications commonly used, tricyclic antidepressants and selective serotonin reuptake inhibitors, there was little difference in the fall rate. Antidepressants are an important treatment modality for depression in the elderly, but safety must also be part of the treatment protocol.

Influenza can be a risk factor for a very serious pnemococcal infection in the elderly. There is strong evidence that vaccination can confer good protection against influenza and this reduces the chances of getting the serious infection. Yet up to 50% of those at risk for influenza do not receive the vaccine. As the winter season approaches, think about getting your flu shots and other inoculations that will help you handle the cold months.

Patients with stroke involving the hand are sometimes advised to squeeze a small ball as an aid to improving hand function. This procedure can lead to increased spasticity and even clawing of the hand. It is up to treating professionals to educate patients about this possible adverse effect.

Sept. 11, 1999
Harold Rubin MA, ABD, CRC, Guest Lecturer, Co-editor
http://www.therubins.com

to e-mail: hrubin12@nyc.rr or rubin@brainlink.com

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