lmplemenLaLlon-

ldenLlfy and documenL how each sLep of Lhe CC (cllnlcal pracLlce guldellne) wlll be carrled ouL and
develop an lmplemenLaLlon LlmeLable
-ldenLlfy lndlvldual responslble for each sLep of Lhe CC
-ldenLlfy supporL sysLems LhaL lmpacL Lhe dlrecL care
-LducaLe and Lraln approprlaLe lndlvlduals ln speclflc CC lmplemenLaLlon and Lhen lmplemenL Lhe CC


lnsLlLuLe measures Lo lmprove funcLlon and Lry Lo prevenL serlous compllcaLlons

Measures Lo prevenL falls or reduce Lhe frequency of falllng and Lhe severlLy of ln[urles from falllng may
lnclude
-CompensaLlng for neurologlc and musculoskeleLal deflclLs where posslble (eg by encouraglng
exerclses LhaL lmprove posLure lncreaslng muscle sLrengLh especlally ln Lhe proxlmal leg muscles
LreaLlng sympLoms of neuropaLhy and arLhrlLls and prevenLlng conLracLures)
-lmplemenLlng approprlaLe rehablllLaLlve or resLoraLlve servlces such as musclesLrengLhenlng and
welghLbearlng exerclse as LoleraLed by Lhe paLlenL and asslsLed ambulaLlon
-CorrecLlng LreaLable causes of orLhosLaLlc hypoLenslon and dlzzlness (eg by lmprovlng fluld lnLake
dlsconLlnulng unnecessary resLrlcLlon of dleLary salL and reduclng doses of anLlhyperLenslve
medlcaLlons dlureLlcs and oLher medlcaLlons LhaL can cause dlzzlness or llghLheadedness)
-ulsconLlnulng or reduclng doses of medlcaLlons LhaL affecL balance or level of consclousness
-Lnsurlng LhaL floor coverlngs are noL loose or sllppery
-Lnsurlng LhaL llghLlng ls adequaLe especlally aL nlghL
-lmplemenLlng a LolleLlng schedule Lo avold unasslsLed Lrlps Lo Lhe baLhroom (especlally aL nlghL) whlch
ofLen resulL ln falls
-lnsLalllng chalr and bed alarms or placlng call buLLons wlLhln Lhe paLlenLs reach
-lnsLalllng handralls ln baLhrooms and hallways
-CpLlmlzlng sensory capaclLy (eg by encouraglng Lhe use of glasses and hearlng alds addresslng
perlpheral neuropaLhy and removlng lmpacLed cerumen from ears)
-8educlng cluLLer ln rooms and hallways Lo allow cognlLlvely lmpalred lndlvlduals Lo ambulaLe safely
-uslng a long shoe horn or a longreach clamp Lo reduce sLrenuous flexlon of Lhe splne
-uslng beds LhaL are low Lo Lhe floor and floor pads LhaL provlde cushlonlng when a paLlenL falls ouL of
bed
-uslng hlp proLecLors conslsLenLly ln paLlenLs aL hlgh rlsk of falllng
-AdmlnlsLerlng vlLamln u and calclum supplemenLaLlon


erlodlcally assess monlLor and documenL Lhe paLlenLs progress

lf feaslble obLaln ob[ecLlve measuremenLs of Lhe paLlenLs sympLoms and overall course aL leasL every 6
monLhs Such lndlcaLors lnclude
-lndlcaLors of sLrengLh and moblllLy
-Measures of funcLlon and dependency ln acLlvlLles of dally llvlng
-Cb[ecLlve paln scales
oLenLlal Parms

-Calclum supplemenLs may cause consLlpaLlon
-CalclLonln may cause nasal lrrlLaLlon
-AlendronaLe lbandronaLe and rlsedronaLe may cause dyspepsla esophageal lrrlLaLlon
musculoskeleLal paln and oLher sympLoms
-8aloxlfene may cause hoL flashes and lncreased rlsk of deaLh caused by sLroke
-8ack braces and kyphoorLhoses wlLh welghLs may cause sores from Lrauma Lo frall skln

hLLp//wwwguldellnegov/conLenLaspx?ld13392searchosLeoporosls


Table 1. Risk Factors for Osteoporosis
OFemale gender
OAge
OFamily history of osteoporosis or fracture
OSmall body frame and low body weight
OCaucasian, Asian, or Hispanic/Latino (although African Americans may also be at risk)
OHistory of fracture
OLow levels of sex hormones
O Low estrogen levels in women, including menopause
O Low levels of testosterone and estrogen in men
ODiet
O Low calcium intake
O Low vitamin D intake
O Excessive intake of protein, sodium, and caffeine
OInactive lifestyle
OSmoking
OExcess alcohol use
OCertain medications (Table 2 below)
OCertain diseases and conditions (Table 3 below)









Table 2. Medications Associated with Adverse Effects on Bone Metabolism
OAromatase inhibitors
OAnticonvulsants (phenytoin, phenobarbital, carbamazepine)
OChemotherapeutic drugs (methotrexate, cyclosporine A)
OExcess thyroid hormone replacement (thyroid stimulating hormone [TSH] below the normal range)
OExcess vitamin A
OGlucocorticoids
OGonadotropin-releasing hormone agonists and antagonists
OHeparin
OLithium



Table 3. Secondary Causes of Osteoporosis
OChronic liver failure
OChronic kidney disease
OChronic obstructive lung disease
OCushing's syndrome
ODisuse, immobilization, or paralysis
OHyperthyroidism or excess thyroid hormone replacement
OHypogonadism (in both men and women)
OMalabsorption syndrome, cirrhosis, inflammatory bowel disease
OMultiple myeloma, leukemia, lymphoma
OPrimary hyperparathyroidism
ORheumatoid arthritis
OType 1 and type 2 diabetes
OVitamin D deficiency