Objective:  To determine the impact of awareness‐raising strategies of calcium and vitamin D supplements in the active management of bone health of older people living in nursing care facilities in Australia. Design:  We compared data drawn from two prospective cohort studies that have evaluated falls and fractures in older people living in hostels (intermediate care facilities): the FREE study (conducted from 1996–2002, n = 1107) and the ongoing FREEDOM study (commenced in 2006, n = 1284 screened individuals). Both studies recruited older people living in a large number of nursing care facilities in northern Sydney (Australia). Results:  We found a small but significant increase in both calcium and vitamin D supplementation in the FREEDOM study participants compared to those in the FREE study. Calcium alone increased from 6.2% to 10.5% (P = 0.0002), vitamin D alone from 5.8% to 7.9% (P = 0.04) and the combined use of calcium and vitamin D increased from 1.6% to 11.9% (P < 0.0001). Conclusion:  There appears to be increasing awareness of the need for calcium and vitamin D supplementation in older people in nursing care facilities. However, given the high prevalence of osteoporosis and vitamin D deficiency among this population, the levels of supplementation achieved must still be considered suboptimal for treatment and prevention of osteoporosis and falls.

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Rapidly destructive osteoarthritis or rapidly destructive arthrosis (RDA) of the hip is an uncommon disorder of unknown etiology where there is a rapid destruction of both the acetabulum and the femoral head. The condition typically affects elderly females with normal or osteoarthritic hip joints, and presents with new-onset severe hip pain and dysfunction. It is thought to be caused by extremely rapid osteoarthritic changes leading to an impact of the femoral head into the acetabulum, with subsequent osteonecrosis and insufficiency fracture of the femoral head. Differential diagnosis should include those conditions known to potentially lead to rapid hip destruction, such as septic arthritis, metabolic bone diseases, autoimmune inflammatory arthritis, malignancy and classical osteonecrosis. Sequential X-rays in patients with fast worsening of hip symptoms and a high degree of clinical suspicion seem mandatory to avoid extensive joint destruction and facilitate better arthroplasty outcomes in these patients. In the present report we present a clinical case of bilateral RDA, and we offer a useful review for clinicians on the differential diagnosis of this condition and the main physiopathological mechanisms behind its occurrence.