Q. Several years ago my 82-year-old mother fell and broke her hip. She is now living with us and I wonder if there is anything we can do to prevent a recurrence of this problem.
A. A recent article in the New England Journal of Medicine reported that the risk factors for a hip fracture included abnormalities in the function of the legs, neurological problems and weakness, visual impairment, Parkinson's disease, a prior stroke and the use of long-acting barbiturates. Other studies have noted an association between alcohol use and falls. Fractures were also more common among thinner women, suggesting some protection from the "padding" of body fat.
The experts advise physical therapy for those with limits in the use of their legs; avoidance of medications that alter awareness or judgment and vigorous treatment of any visual problems. They also suggest home modificationsthat lessen the height of a potential fall as well as the likelihood of falling onto a hard surface. These include lowering beds, installing wall-to-wall carpeting and providing grab bars and additional stair rails.
Q. After 16 years of diabetes, my kidneys now show damage, according to lab tests. What can be done to prevent further damage?
A. Blood pressure control is the most effective way to delay the progression of the early stages of kidney disease in diabetes. If your blood pressure is elevated and you are obese, losing weight is the most important thing you can do for both your blood pressure and diabetes. In addition, you should restrict your intake of salt and alcohol and try to exercise regularly.
Drug treatment is necessary if your blood pressure remains too high despite these measures. Many experts believe medicines called angiotensin-converting enzyme (ACE) inhibitors are the best choice to treat hypertension in diabetics.
Recent studies have concluded that a diet low in protein and phosphorus also slows the rate of kidney damage in individuals with diabetes. Some studies have shown that strict control of blood sugar retards or prevents kidney damage in animals, but there is no proof that better control of sugar levels will prevent the worsening of kidney disease in people.
Dr. Margolis is professor of medicine and biological chemistry at the Johns Hopkins School of Medicine and associate dean for faculty affairs at the school.
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