a b s t r a c tBackground: Early in the development of geriatric medicine, falls were identified as a "geriatric giant", a nonspecific indicator of functional decompensation. This led to the notion of "falls prevention services", and the concept that identification of those patients at high risk of falls is essential to approach this group of elderly people. Objective: This work was carried out aiming to develop a model that predicts falls risk for both in-as well as outpatients using clinical variables that are easily assessed in clinical practice. Study Design: A case-control study to determine the risk factors and the prediction rule of falls risk among older people. Methods: Three hundred and seventy-three outpatients and 186 inpatients, with a minimum age of 65 years, were assessed for falls risk factors. The clinical characteristics with independent predictive value for the development of falls were selected using logistic regression analysis. The diagnostic performance of the prediction rule was evaluated using the area under the curve. Cross-validation controlled for over fitting of the data (internal validation) was also carried out. Results: The prediction rule consisted of five clinical variables: history of falls in the last 12 months, slowing of the walking speed/change in gait, history of loss of balance in the last 12 months, and impaired sight and weak hand grip. The prediction score ranged from 0 to 6.5, and corresponded to the percent chance of sustaining a fall. For several cutoff values, the positive and negative predictive values were determined. The area under the curve values for the prediction rule was 0.89. Conclusion: In elderly people, the risk of sustaining a fall can be predicted, thereby allowing individualized decisions regarding the patient's management. Falls risk assessment score is a new self-reported tool that can be used in standard clinical practice by all health care professionals both in the outpatient and the acute hospital inpatient settings. Assessing for the falls risk would help to minimize the negative impact of falling on the patient's physical, psychological, and social functional abilities.

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Osteoporosis is a major public health concern. Recent evidence from clinical and epidemiological trials on osteoporosis has stressed the urgency for early and accurate diagnosis of vertebral fractures. Despite the fact that vertebral fractures are very common and associated with decreased quality of life, they are frequently missed in daily clinical practice. The authors developed a protocol to be applied through a specialized nurse-led osteoporosis vertebral fracture service that allows for accurate diagnosis, identifies patients at risk and shortens the time of assessment and management. A total of 114 patients have been reviewed over 12 months. Completing the referral form and the clinic proforma helped the nurse cover all causes of vertebral fractures and shortened the lag time for assessment and management. Osteoporosis therapy was commenced once diagnosis was confirmed.

<b><i>Objective:</i></b> The aim of this study was to reach a consensus on an updated version of the recommendations for the diagnosis and Treat-to-Target management of osteoporosis that is effective and safe for individuals with chronic kidney disease (CKD) G4-G5D/kidney transplant. <b><i>Methods:</i></b> Delphi process was implemented (3 rounds) to establish a consensus on 10 clinical domains: (1) study targets, (2) risk factors, (3) diagnosis, (4) case stratification, (5) treatment targets, (6) investigations, (7) medical management, (8) monitoring, (9) management of special groups, (10) fracture liaison service. After each round, statements were retired, modified, or added in view of the experts’ suggestions, and the percent agreement was calculated. Statements receiving rates of 7–9 by more than 75% of experts’ votes were considered as achieving consensus. <b><i>Results:</i></b> The surveys were sent to an expert panel (<i>n</i> = 26), of whom 23 participated in the three rounds (2 were international experts and 21 were national). Most of the participants were rheumatologists (87%), followed by nephrologists (8.7%), and geriatric physicians (4.3%). Eighteen recommendations, categorized into 10 domains, were obtained. Agreement with the recommendations (rank 7–9) ranged from 80 to 100%. Consensus was reached on the wording of all 10 clinical domains identified by the scientific committee. An algorithm for the management of osteoporosis in CKD has been suggested. <b><i>Conclusion:</i></b> A panel of international and national experts established a consensus regarding the management of osteoporosis in CKD patients. The developed recommendations provide a comprehensive approach to assessing and managing osteoporosis for all healthcare professionals involved in its management.

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