OUESTION 3

What nonpharmacologic recommendations are important for her treatment

plan?

The nonpharmacologic recommendations that are important to KDs treatment plan

are:
 Exercise - The National Osteoporosis Foundation (NOF) recommends regular
weight bearing, for example walking and stair climbing and muscle-strengthening
(eg. weight training)exercises for 30 minute sessions a day in order to improve
agility, strength, posture and balance. Since KD has a problem with balance and
recently suffered a wrist fracture, this non pharmacological recommendation
would be best suited for her in order to reduce her risk of falls and further
fractures.
 Tobacco use and Alcohol Intake - the NOF recommends smoking cessation
since tobacco use is harmful to the skeleton, due to its components of nicotine
and cadmium which have toxic effects on bone cells. Smoking indirectly harms
the bone by lowering body weight and harms it directly by lowering the amount
of calcium absorbed by the intestine and changing the way the body processes
Vitamin D. The NOF Clinicians’ Guide recommends that the alcohol intake
should not exceed three or more drinks per day due to the risk of falling and
increased danger to bone health. As seen from KD’s previous tobacco use and
alcohol intake history , she has completely ceased smoking and reduced her
alcohol intake to one drink a week. Therefore she should continue lowering her
alcohol intake until she has also stopped drinking completely in order to reduce
her risk of falling and preventing further damage to her bone health.
 Reducing fall risk - According to the NOF, the table below shows the following
risk factors for falling;
TABLE 1.0 SHOWING THE RISK FACTORS FOR FALLS ("The new
"Clinician's Guide to Prevention and Treatment of Osteoporosis" has been released by
the National Osteoporosis Foundation.", 2008)
MEDICAL FACTORS ENVIRONMENTAL FACTORS
Orthostatic hypertension Loose throw rugs
Kyphosis Low level lighting

Depression and anxiety Slippery outdoor conditions

Medications that cause over-sedation Obstacles in the walking path

 Narcotics
 Psychotropic
Dehydration No assistive devices in the bathroom

Vitamin D insufficiency
Impaired mobility
Urgent urinary incontinence

KD should implement certain fall- prevention measures in order to reduce the risk of
falling which include:
- assessing neurologic issues such as Parkinson’s disease which can affect balance
- assessing prescription medications for side effects that can affect balance and
stability such as anti-seizure drugs, antidepressants, sedatives and tranquilizers. In
particular, blood pressure lowering medications may cause faintness if they lower
your blood pressure too much.
- checking vision and hearing and correcting any problems, and having a home safety
checklist.

REFERENCES
- Medscape Log In. (2018). Medscape.org. Retrieved 17 February 2018, from
https://www.medscape.org/viewarticle/728450
- The new "Clinician's Guide to Prevention and Treatment of Osteoporosis" has been
released by the National Osteoporosis Foundation. (2008). Pharmacoeconomics &
Outcomes News, &NA;(548), 3. http://dx.doi.org/10.2165/00151234-200805480-
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