Management and rehabilitation

• In particular, surgical management of hip fracture needs to be adequately resourced to allow early fixation and rapid mobilisation. The involvement of multidisciplinary rehabilitation teams is essential to lessen morbidity and mortality, reduce length of stay and facilitate return to usual activities.

• After initial care of any fracture, inactivity and bed rest should be kept to a minimum and physiotherapy should be considered. Adequate analgesia is an essential part of the early rehabilitation stage. Graded exercise programs, including postural exercise and hydrotherapy, play a role in restoring mobility and function.

• The pain from vertebral crush fractures may be severe, but it is usually short term (six to eight weeks) and should resolve as the fracture heals. Although anabolic steroids and calcitonin are often used in acute pain relief, there is no evidence that they are more effective than simple and less expensive forms of analgesia. Those suffering multiple crush fractures, with loss of height and deformity ("dowager's hump"), may have chronic pain. Specific pain management programs may be useful, including medications, transcutaneous electrical nerve stimulation and relaxation. There is no evidence that braces or surgical corsets are useful in these patients except in the acute situation.

Falls prevention

Multifactorial falls prevention strategies have been shown to be effective in some studies. These include specific exercise programs, medication management (especially to reduce the use of sedatives and tranquillisers), assessment of vision and footwear, and home and environmental modifications.

Analysis of data from the Dubbo Osteoporosis Epidemiology Study found that quadriceps strength, postural sway and bone density were independent predictors of subsequent fracture. Most observational and epidemiological studies suggest that physical activity is associated with a reduced risk of falling, likely because of improved balance and coordination skills.

Hip protectors reduce the incidence of hip fracture, especially in nursing home residents. More research is needed on their effectiveness and particularly on their acceptability.

Falls prevention programs are likely to be most effective when aimed at "at risk" individuals in the community. However, they are not necessarily inexpensive and more research is required to identify the components (e.g., balance training) which are most effective and cost-effective.

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