Objectives: Falls are associated with several negative outcomes. Early identification of those who are at risk of falling is of importance in geriatrics, and comprehensive geriatric assessment (CGA) seems to be promising in this regard. Therefore, the present study investigated whether the multidimensional prognostic index (MPI), based on a standard CGA, is associated with falls in the Osteoarthritis Initiative (OAI). Design: Longitudinal, 8 years of follow-up. Setting and participants: Community-dwelling older people (>= 65 years of age) with knee osteoarthritis or at high risk for this condition. Methods: A standardized CGA including information on functional, nutritional, mood, comorbidities, medications, quality of life, and cohabitation status was used to calculate a modified version of the MPI, categorized as MPI-1 (low), MPI-2 (moderate), and MPI-3 (high risk). Falls were self-reported and recurrent fallers were defined as >= 2 in the previous year. Logistic regression was carried out and results are reported as odds ratio (ORs) with their 95% confidence intervals (Cis). Results: The final sample consisted of 885 older adults (mean age 71.3 years, female = 54.6%). Recurrent fallers showed a significant higher MPI than their counterparts (0.46 +/- 0.17 vs 0.38 +/- 0.16; P < .001). Compared with those in MPI-1 category, participants in MPI-2 (OR 2.13; 95% CI 1.53-2.94; P < .001) and in MPI-3 (OR 5.98; 95% CI 3.29-10.86; P < .001) reported a significant higher risk of recurrent falls over the 8-years of follow-up. Similar results were evident when using an increase in 0.1 points in the MPI or risk of falls after 1 year. Conclusions and implications: Higher MPI values at baseline were associated with an increased risk of recurrent falls, suggesting the importance of CGA in predicting falls in older people. (C) 2019 AMDA - The Society for Post-Acute and Long-Term Care Medicine.

This document is a Joint Position Statement by Gruppo Italiano di OrtoGeriatria (GIOG) supported by Società Italiana di Gerontologia e Geriatria (SIGG), and Associazione Italiana Psicogeriatria (AIP) on management of hip fracture older patients. Orthogeriatric care is at present the best model of care to improve results in older patients after hip fracture. The implementation of orthogeriatric model of care, based on the collaboration between orthopaedic surgeons and geriatricians, must take into account the local availability of resources and facilities and should be integrated into the local context. At the same time the programme must be based on the best available evidences and planned following accepted quality standards that ensure the efficacy of the intervention. The position paper focused on eight quality standards for the management of hip fracture older patients in orthogeriatric model of care. The GIOG promotes the development of a clinic database with the aim of obtaining a qualitative improvement in the management of hip fracture.

To determine (i) clinicoradiological presentation and outcome of rapidly destructive knee osteoarthritis (RDKOA) after global medical treatment including knee lavage plus corticosteroid injection, (ii) predisposing factors of subsequent requirement to knee surgery.Retrolective monocenter study with tibiofemoral RDKOA, defined as a loss of at least 50% of joint space width within 1 year, with a post lavage follow-up of at least 1 year.One hundred and eleven patients were enrolled, age 64.1 years, BMI: 28.9, 70.3% female. VAS pain was 56.1 mm, Lequesne index: 11.9, WOMAC function score: 51.9. Chronic mechanical effusion (216 white cells/mm3) was aspirated in 102 patients (91.9%), lasting more than 6 months in 71.4%. Medial tibiofemoral compartment was concerned in 79.3%. Joint space loss reached 52.2% in extension and 71.0% in semi-flexed position within a mean 7.3-month period. Radiological chondrocalcinosis was present in 13.5% and osteonecrosis in 12.6%. Lavage (one liter, two 14-gauge cannulae) plus corticosteroid was completed by hyaluronic acid injections in 71.2% of patients. Eighty-nine patients were reviewed with a mean follow-up period of 55.0 months. Thirty-seven (41.6%) required surgery. Mean delay between lavage and surgery was 16.1 months. Pain was acceptable in 100.0% of operated patients and 87.8% of non-operated patients. Multivariate regression analysis determined that functional impairment, assessed by the maximal walking time, and radiological severity in extension were baseline predisposing factors of subsequent requirement to surgery.The outcome of RDKOA seems less severe than expected after global medical treatment.

The aim of the study was to estimate the absolute risk of fracture in a sample of postmenopausal women with the Italian version of FRAX®, using femoral neck bone mineral density (BMD) and 3 internationally validated clinical risk factors (CRFs) (history of fragility fracture, family history of hip fracture, current smoking). We retrospectively studied 9586 women (mean age 64.1 yr) examined in three osteoporosis centers from Northern Italy over two years (2001–2002). The risk of major osteoporotic (clinical spine, hip, forearm and humerus) and hip fractures was estimated using the online version of the FRAX algorithm adapted for Italy. The median 10-year risk was 7.5% for osteoporotic fracture and 1.7% for hip fracture. 25% of subjects had a 10-year risk ≥12.1 % for osteoporotic fracture and ≥4.1% for hip fracture. The median 10-year risk of fracture increased with the number of prevalent CRFs. For major osteoporotic fractures risk rose from 6.3% to 10.9%, 21.4% and 40.9% with 1, 2 and 3 prevalent CRFs, respectively. For hip fractures the corresponding figures were: 1.3%, 2.7%, 7.0% and 21.9%, respectively. However, it must be emphasized that in 2 out of 3 women, none of the CRFs examined was present and the assessment of risk was limited to age and BMD. Our data provide the first description of the effect of the combination of BMD, age and CRFs on fracture risk stratification in a large sample of Italian postmenopausal women using FRAX®. The results are a useful starting point to define criteria for the application of FRAX® in clinical practice in Italy.

Introduction.We explored the prevalence of vitamin D deficiency and secondary hyperparathyroidism(sHPTH) ina case–control studyof100HIV-infectedpatients (HIV) and100 matched controls.Methods. HIVwere included if theywere naive to antiretroviral therapy (ART) or receiving first line ART. Healthy controls were matched for age (age range 25–65 years) and gender. Subjects, recruited between February–April 2009, underwent a standardized assessment to evaluate demographic and anthropometric characteristics, bone mineral density (BMD), serum calcium, phosphate, 25-hydroxy-vitamin D (25OHD), PTH, markers of bone turnover, clinical history and ART regimens (HIV only). The proportion of patientswith 25OHD 65 pg/ml was calculated. Secondary analyses were undertaken to evaluate variables associated with vitamin D deficiency in HIV. Results. The two groups were comparable with regard to baseline characteristics, except for alcohol intake, level of physical activity and prevalence of fractures. A significantly greater proportion (p =20), reclassification analyses showed that the GFRC reclassified more patients who sustaineda fracture to higher risk categories (85.4%), but alsomorepatientswhodidnot sustain a fracture (68.7%). Therefore, net reclassification was not significant (p>0.05, Table 1). Even after correction of the 10-year risk of FRAX (1/(major fractures/all fractures)=1/(36/ 48)=1.33) the results remained the same, and also when BMD was not included (data not shown). Discussion: GFRC, compared with FRAX, resulted in significantly higher fracture risks for women who did and did not sustain a fracture after baseline. GFRC reclassified significantly more women who did sustain a fracture to higher risk categories. However, the net reclassification was not significant. This article is part of a Special Issue entitled ECTS 2011. Disclosure of interest: None declared. doi:10.1016/j.bone.2011.03.054 OC03/AHP03 Adherence to recommendations for fall prevention significantly affects the risk of falling after hip fracture in older women M. Di Monaco , C. Castiglioni ⁎, F. Vallero , E. De Toma , L. De Lauso , R. Tappero c a Osteoporosis Research Center, Presidio Sanitario San Camillo, Torino, Italy

Hip fracture (HF) is a common event in the geriatric population and is often associated with significant morbidity, mortality and costs for the Healthcare Systems. The growing awareness of HF consequences and the expected rise in the total number of HF worldwide have led to the development and implementation of models of care alternative to the traditional ones for the acute and post-acute management of HF older adults. These services were set to minimize in-hospital complications, streamline hospital care and provide early discharge with the main objectives of improving functional and clinical outcomes, and reducing healthcare costs associated with hip and other fractures. Basically, the main feature that distinguishes these models is the different healthcare professional that retains the responsibility of the care during the acute and postacute phases. This review has been conceived to provide a brief description of the models implemented in the last twenty years, to describe their potential benefits on short- and long-term outcomes, to define the strengths and limitations of these models and the areas of uncertain, and to make some consideration about the future. Actually, on the basis of available studies, it is not possible to define the best model of care for HF older adults. However, the more complex and sophisticated services, characterized by a multidisciplinary approach demonstrated, in randomized-controlled and before-after observational studies, to produce better outcomes compared to the traditional or simplest models. Further research is warranted to confirm long-term functional and clinical benefits of these models and to evaluate their cost-effectiveness.