The Director - Spring 2010 - (Page 19)
Ask Dr. Si
ME D IC ATI O N ISS UE S
Dear Dr. Si. I was recently employed as a registered nurse supervisor in a nursing facility and the facility’s practice is to place every resident on calcium supplementation after they experience a fall. I don’t understand how this approach will prevent further falls or prevent fractures in nursing facility residents whether they are either osteopenic or osteoporotic. SD. Cincinnati Ohio
By William Simonson, PharmD, FASCP, CGP
V i t a m in D a n d C a l c i um f o r P r e v e n t i o n o f F r ac t u r e s an d F a l l s
In this quarterly column Dr. Simonson answers your questions on medications. If you have a question that you would like to have answered, please send it via e-mail to “AskDrSi@aol.com”. Answers to the most pertinent questions will be published in this column.
effort that is too little and too late to have benefit. Too late because insufficient calcium intake will have a long-lasting negative effect on bone integrity which will not be reversed after short-term calcium supplementation. Too little because, in addition to calcium supplementation, vitamin D supplementation should also be considered. In addition, the use of
min D supplementation actually decreases the incidence of falls by increasing muscle strength, which in turn improves balance and reduces falls. Researchers have found that for this benefit to be realized individuals need a daily intake of at least 800 international units (IU) of vitamin D and importantly they have found that benefit in terms of reduced falls can be seen in a matter of months after beginning the supplementation. Five years ago daily vitamin D intake of 600 IU was considered sufficient but opinions are changing and evidence exists that significantly higher doses are needed. In fact, I just read one article that endorses a daily dosage of 1000 IU to 2000 IU, and at an educational symposium presented recently at the annual meeting of the American Medical Directors Association, even higher daily doses of 4000 IU were recommended. What I would suggest is that your facility re-evaluate its policy on falls and fracture prevention, including their current policy to initiate calcium supplementation after a fall. Two AMDA Clinical Practice Guidelines, “Falls and Fall Risk” and “Osteoporosis and Fracture Prevention,” could serve as important resources by which to develop a comprehensive policy that includes all the members of the interdisciplinary team and uses calcium and vitamin D supplementation as well as prescription osteoporosis medications. Through the proper interventions, falls and fractures can be often prevented and residents can be spared the negative outcomes that accompany these serious and common events.
Dear SD, Your question deals with two important issues—fall prevention and fracture prevention—two different but completely interrelated issues that are even more significant in residents with osteoporosis or osteopenia. An important goal in nursing facilities, especially for residents with bone weakness, is to prevent the first fracture. If that can be accomplished the terrible complications and negative outcomes of a fracture can be avoided. Numerous studies have shown that nursing facility residents typically receive insufficient calcium for a number of reasons including resident food preferences and lactose intolerance, which limits the consumption of milk and other high-calcium dairy products. In addition, adequate calcium supplementation is infrequently and inconsistently prescribed for nursing facility residents. Insufficient calcium intake will predispose residents to increased fracture risk, but bone integrity depends on sufficient calcium intake over time, not after short-term calcium supplementation. In my opinion, your facility’s policy to start calcium supplementation after a resident experiences a fall is a futile
e know that vitamin D plays an important role in strengthening bones by facilitating the incorporation of calcium into bone, but more recently it has been found that sufficient Vitamin D supplementation actually decreases the incidence of falls by increasing muscle strength, which in turn improves balance and reduces falls.
bone-strengthening medications such as the bisphosphonates (eg, Fosamax® (alendronate), Actonel® (risedronate), and Boniva® (ibandronate) or other medications available for osteoporosis prevention and treatment should play an important role in a facility’s initiative to prevent falls and fractures. We know that vitamin D plays an important role in strengthening bones by facilitating the incorporation of calcium into bone, but more recently it has been found that sufficient Vita-
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Table of Contents for the Digital Edition of The Director - Spring 2010
The Director - Spring 2010
From the Executive Director
State Chapter Chatter
Healthcare Reform Management: The Don's Role
Newton's 9 Selecting Stellar Talent
Women, Stabotage & Bullying...Oh My!
How to Stay Energized in a Changing World
Ask Dr. Si
Pneumococcal Pneumonia in the LTC Setting
In the News
NADONA/LTC National Conference 2010
Continuing Education Artcile: Basic Wound Management in Long Term Care and the Use of Medications in the Treatments of Wounds
The Director - Spring 2010