LAS VEGAS — Elderly patients in long-term care have a real but underrecognized risk of minimal-trauma fractures, Violeta Galabova, M.D., warned at the annual meeting of the American Geriatrics Society.
Osteoporosis associated with disuse, although not extensively studied, 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 wheelchair for 6 months or more are especially vulnerable, particularly if they've already sustained 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
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 3 years ago, 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, the patient developed two more lower-extremity fractures.
The second patient was a 93-year-old bed-bound woman who had a history of a hip fracture and seizures. Since admission to 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 a history of Parkinson's disease and a right total hip arthroplasty was able to get around with a walker until he fell and sustained a subarachnoid 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 by a member of the nursing home staff, and was diagnosed with a spiral periprosthetic fracture of the right femur.
It may be premature to recommend routine preventive measures for all nursing home patients, but people with risk factors for disuse fractures deserve close watching, Dr. Galabova said.