Osteoporosis

frailty phenotypic criteria

weight loss

fatigue

low physical activity

slowness

weakness

weight loss

• >10 lbs unintentional

• scale or self report

fatigue

• exhaustion with regular activity

• series of questions, 0-6 scale w/ higher score indicating fatigue

low physical activity

• sedentary behavior (<383 kcal/week men) (<270 kcal/week women)

• capture sedentary activity pattern with series of questions

slowness

• usual pace over 15 feet

• less than 0.8 m/s

• 0.65 m/s or less (W <159 cm or M <173 cm)

• 0.76 m/s or less (W <159 cm or M <173 cm)

weakness

• grip strength, STS

• <30 kg for men and <20 kg for women

• less than 8 in 30 secs

fit (not frail)

• Physically active, no restrictions. Few chronic conditions, if any.

• Gait speed > 1.0-1.2 m/s 30s CRT 15 reps or more

• Independent floor transfer

mild frailty (prefrail)

• Adaptations to mobility, life space mobility restrictions start.

• Impaired recovery from illness/injury.

• Gait speed 0.8-1.2 m/s

• 30s CRT 8-15 reps

• Modified floor transfer

moderate frailty

• Loss of independence evident, needs assistance. Life space restrictions.

• Gait speed 0.5-0.8 m/s

• 30s CRT <8 reps

• Assistance for floor transfer

severe frailty (end stage)

• Dependent ADLs/mobility, inactive, dying. Life expectancy 6-12 months.

• Gait speed < 0.5 m/s

• 30s CRT unable

• Floor transfer Unable

comprehensive geriatric assessment (CGA)

most comprehensive method to assess frailty

frailty index

70 items, score of >0.5, 100% dead in 20 months

•Considers number of deficits accumulated over time (cumulative deficit model)

•Disability

•Diseases

•Physical and cognitive deficits

•Psychosocial risk factors

Geriatric syndromes (i.e., falls, delirium, UTI, etc.)

TUG

>10 secs

gait speed

<0.8 m/s

frailty index for elders (FIFE)

self report

•Questionnaire

  Score of 0 Yes answers= no frailty 

  Score of 1-3 Yes answers= frailty risk

  Score of 4 or greater yes answers = frailty

phenotype of frailty

may use STS instead of handgrip strength

life space

<60 points indicates 4.4x higher risk of SNF during subsequent 6 yrs

what shows greatest sensitivity for predicting occurrence of disability, mortality, instituionalization?

VES 13

frailty criteria

gait speed, grip strength, repeated chair stands

cognitive frailty

•Steeper cognitive decline than without physical frailty

•APOE4 allele not associated with cognitive frailty

•Strongly associated with grip strength and gait speed

•Multiple risk factors: CV events, nutritional deficits, hormonal imbalance, inflammation, increased Aß in brain, lifestyle, and depression

psychological frailty

•Depression common (20-53%)

•Low resilience + depressive symptoms can predict frailty

•High resilience and well-being reduced likelihood of frailty

social frailty

•Limited social support = increased risk of frailty

•Loneliness and social isolation associated with slow gait speed and less resilience

nutrition

•Mini Nutritional Assessment (MNA): screen for wt loss

•Focus on underlying cause

•EEA supplementation

•Vitamin D supplementation

hormone tx

•SARMS and testosterone may treat sarcopenia

•Results still inconclusive

pharmaceuticals

•Med review essential

•Deprescribing:

•statins

•glucocorticoids

•anticholinergics

•benzodiazepines

•Vitamin D: 800-1000 IUs/day

primary prevention

set of actions taken before a disease or health problem occurs to reduce its incidence in a population

secondary prevention

focuses on early detection of a problem to reduce harm and support early intervention and treatment 

tertiary prevention

•aims to improve the quality of life for people who already have a disease by reducing its effects

frailty CPG guidelines

•1. Suspect frailty in individuals > 75 yr old in any type of setting

•2. Evaluate for frailty using SPPB along with assessing body wt, reducing PA, and fatigue level

•3. Confirm frailty in those with at least 3 of the 5 phenotypes

•4. Provide complete assessment of patient across ICF model

•5. Promote  PA and proper diet to increase body weight

•6. Provide monitoring and regular assessments

•7. ID frail older adults in hospital settings, est appropriate DP

•8. Pt info should be available throughout healthcare database

primary osteoporosis

postmenopausal, idiopathic

secondary osteoporosis

following disease condition

osteoporosis risk factors

•post-menopausal (estrogen deficiency)

•other hormonal factors (hyperparathyroidism, Cushing syndrome)

•sedentary lifestyle

•Vitamin D deficiency

•Cigarette smoking

•Asian, Caucasian

•Excessive caffeine consumption

T scores

•WHO diagnostic classification in postmenopausal women, men over 50

•Cannot be applied to healthy and young population

Z score

•reporting BMD in healthy pre-menopausal women, men under 50, children

•-2.0 or less is below healthy range

•above -2.0 is expected range

osteoporosis treatment

• vitamin D + calcium

• fluoride supplements

• bisphosphonates

• calcitonin

• injected human parathyroid hormone

• regular WB activity

• raloxifene

• surgery to reduce kyphosis, realign vertebrae

what to avoid- osteoporosis

• trunk flexion & excess rotation

• high impact exercise

• joint mobs/manual percussion