Resources for the Comprehensive Geriatric Assessment based
Proactive and Personalised Primary Care of the Elderly
Bone Health Assessment
The most common bone problems found in older people are osteoporosis and vitamin D deficiency, which are typically clinically silent.
Other diseases may present, such as Paget’s disease of the bone, osteomalacia (clinically evident vitamin D deficiency), and hyperparathyroidism.
Bone pain or hypercalcaemia raises the suspicion of fractures, bony metastases or primary malignancy of the bone.
FRAX
Fracture Risk Assessment Tool
Fracture risk assessment based on applicable risk factors.
10 min.
Q-Fracture
Q-Fracture
Fracture risk assessment based on applicable risk factors, optimised for UK population.
10 min.
Because of increased bone loss after the menopause in women, and age-related bone loss in both women and men, the prevalence of osteoporosis increases markedly with age, from 2% at 50 years to more than 25% at 80 years in women.
Osteoporotic fracture or fragility fracture is the major clinical consequence of reduced bone density (Cummings S, 1985).
Hip fractures and those of the vertebrae with clinical manifestations are especially important since they carry an increase in mortality (Huntjens KM, 2010)
Assessment
The comprehensive assessment of an older person with regard to bone health should include:
History:
Previous fractures. Bony pain. Loss of height or change of posture. Weight loss. Diet, alcohol and smoking history. Current level of exercise and approximate exposure to sunlight. Current or previous use of glucocorticoids. Family history of fracture or osteoporosis. Age at menopause.
Examination:
Height, weight and posture. Evidence of arthritis. Muscle strength.
Fracture risk :
The WHO risk calculator available (FRAX®) calculates the ten-year probability of a major osteoporotic fracture.
FRAX results are reliable whether calculated with or without BMD result (Kanis JA, 2008).
For UK populations, the QFracture® score may be more appropriate for fracture risk assessment (Hippisley-Cox J, 2009).
The Bone Health Assessment is one of 5 sub-domains of the
Medical Assessment
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The Medical Assessment is one of 8 domains of the
Comprehensive Geriatric Assessment (CGA)
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