Predictors for Falls and Fractures in the Longitudinal Aging Study Amsterdam

Abstract

The objective of this study was to identify easily measurable predictors for falls, recurrent falls, and fractures using a population-based prospective cohort study of 1469 elderly, born before 1931, in three regions of the Netherlands. The baseline at-home interview was in 1992. In 1995, falls experienced in the preceding year and fractures over the preceding 38-month period were registered. In a period of 1 year, 32% of the participants fell at least once, and 15% fell two or more times. The rate of recurrent falls was similar in men and women up until the age of 75 years. The total number of fractures was 85, including 23 wrist fractures, 12 hip fractures, and 9 humerus fractures. The incidence density per 1000 person-years for any fracture was 25.1 (95% confidence interval [CI], 18.9 -31.4) for women and 8.2 (95% CI, 4.5-12.0) for men, respectively. Multiple logistic regression identified urinary incontinence, impaired mobility, use of analgetics, and use of antiepileptic drugs as the predictors most strongly associated with recurrent falls. Female gender, living alone, past fractures, inactivity, body height, and use of analgetics proved to be the predictors most strongly associated with fractures. The probabilities of recurrent falls were 4.7% (95% CI, 2.9 -7.5%) to 59.2% (95% CI, 24.1-86.9%) with zero to four predictors, respectively. The probability of fractures ranged from 0.0% (95% CI, 0.0 -0.4%) without any of the identified predictors to 12.9% (95% CI, 4.4 -32.2%) with all six predictors present. Our study shows that the risk of recurrent falls and of fractures can be predicted using up to, respectively, four and six easily measurable predictors. This study emphasizes the importance of impaired mobility and inactivity as predictors for falls and fractures. (J Bone Miner

Risk factors for recurrent falls among Brazilian women and men: the Brazilian Osteoporosis Study (BRAZOS)

“…Our study assessed both genders of the general population aged 40 and older. The prevalence was similar to that found in the Study of Osteoporotic Fractures (SOF) 14 , LASA 15 and a study carried out in southern Australia, in which 28 to 32% of individuals reported at least one fall in the previous year 16 . In Latin America, the prevalence of falls also exhibits considerable variation (from 21.6% in Barbados to 34% in Chile).…”

Functional limitations and poor physical performance as independent risk factors for self-reported fractures in older persons

“…In previous studies in the LASA cohort and in other studies, poor balance was a risk factor for falls [7,26], which cause more than 90% of hip fractures [27]. In addition to balance, functional status and other measures of physical performance were also risk factors for falls [7,28]. Moreover, functional status and physical performance can be improved by training [29], and these risk factors may therefore be valuable for intervention strategies.…”

“…The predictive value of the tandem stand might be better if the tandem stand is assessed for more than 10 s [25]. In previous studies in the LASA cohort and in other studies, poor balance was a risk factor for falls [7,26], which cause more than 90% of hip fractures [27]. In addition to balance, functional status and other measures of physical performance were also risk factors for falls [7,28].…”

“…Studying treatable risk factors in a prospective cohort study might help to determine which risk factors should be included in an intervention strategy. Only a few prospective cohort studies have examined the association between treatable risk factors, such as physical functioning, and the risk of hip fractures [5,6,7] or other osteoporotic fractures [8,9,10].…”

Canadian Consensus Conference on Osteoporosis, 2006 Update

“…Some studies have considered fractures that occur as a result of any fall from a height of less than a meter, such as after having missed 1 to 3 steps in a staircase, as fragility fractures. [50][51][52][53][54][55] Measurement of height loss is a good clinical indicator of vertebral fracture. 56 Klotzbuecher et al 57 performed a meta-analysis of the risk of future fracture, given the history of prior fracture, and concluded that women with prior fracture had a 2-to 10-fold risk of another fracture, compared with those without fracture.…”