Prophylaxis of falls and treatment of fractures

This review has highlighted important preventive measures for falls and fractures in elderly osteopenic patients, and has discussed the therapeutic possibilities after an osteoporotic fracture has occurred. Assuming that a large proportion of osteoporotic fractures are a consequence of traumatic falls, and are not spontaneous, due to osseous weakness, preventive measures in elderly people are best directed to counteract muscular weakness, improve agility and correct visual impairment. It is also important to guard against unnecessary obstacles in the home and the reflex habits of doctors to prescribe hypnotics and tranquillizers, as well as their occasional tendency to overtreat hypertension. Practical examples of rational measures to protect against these causes of fractures have been given. In the second part of the review, the treatment of fractures has been delineated. The goals are adequate pain relief, early immobilization of the patient, avoidance of overtreatment and fast restoration of the quality of life. Three stages of pain relief by drugs are outlined. The first consists of a simple non-narcotic analgesic, such as paracetamol. In a second stage, either the combination of paracetamol with a muscle relaxant or the administration of a narcotic analgesic of medium potency is proposed. As a third stage, several therapeutic approaches to the administration of potent narcotic analgesics have been discussed. Non-drug measures, such as the use of heat, ultra-soft mattresses, walking frames, crutches and sticks, as well as active forms of physiotherapy, have been discussed both in terms of pain relief and early mobilization.