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Primary biliary cirrhosis is associated with falls and significant fall related injury

Lookup NU author(s): Dr James Frith, Dr Simon Kerr, Dr Lisa Robinson, Katharine Wilton, Jessie Pairman, Professor David Jones, Professor Julia Newton

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Abstract

Background: Osteoporosis and autonomic dysfunction are prevalent in the autoimmune liver disease primary biliary cirrhosis (PBC). Postural hypotension is one consequence of autonomic dysfunction and is a recognized risk factor for falls, which, alongside osteoporosis could lead to significant injury and fractures. Aim: To determine the prevalence and sequelae of falls in PBC and to identify modifiable risk factors. Design: Cross-sectional, geographical, population census of PBC and two control groups: primary sclerosing cholangitis and a community dwelling population. Multidisciplinary falls assessment of a representative group of PBC. Methods: Symptom assessment tools, completed by the three cohorts, determined the prevalence of falls, injuries and associated symptoms. Multidisciplinary assessments, adhering to NICE guidelines, identified modifiable fall associations. Results: Significantly more of the PBC population had fallen (72% P < 0.001) than both control groups. Fifty-five percent had fallen in the last year (P < 0.001), and 22% more than once in the last year (P < 0.01). Seventy percent of PBC fallers were injured, 27% fractured a bone and 19% were admitted to hospital, all significantly more common than controls. Postural dizziness was significantly worse in fallers (P < 0.001), as were balance (P < 0.001) and lower limb strength (P = 0.002). Lower limb strength was independently associated with number of falls in previous year (β = 0.184, P < 0.001). Conclusion: Falls and resultant injury are prevalent in PBC and more common than previously recognized. Addressing postural dizziness, poor balance and lower limb weakness using a multidisciplinary approach has the potential to reduce falls, morbidity and mortality and as a result improve quality of life. © The Author 2010. Published by Oxford University Press on behalf of the Association of Physicians.


Publication metadata

Author(s): Frith J, Kerr S, Robinson L, Elliott C, Ghazala C, Wilton K, Pairman J, Jones D, Newton J

Publication type: Article

Publication status: Published

Journal: QJM

Year: 2010

Volume: 103

Issue: 3

Pages: 153-161

Print publication date: 08/01/2010

ISSN (print): 1460-2725

ISSN (electronic): 1460-2393

Publisher: Oxford University Press

URL: http://dx.doi.org/10.1093/qjmed/hcp188

DOI: 10.1093/qjmed/hcp188

PubMed id: 20061369


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