Simply Ask Them About Their Balance--Future Fracture Risk in a Nationwide Cohort Study of Twins

Abstract

The principal causal components of an osteoporotic fracture are a fall and weakened bone strength. While bone quality measures have been frequently studied, the ability of simple measures of impaired balance to predict fracture risk has received less attention. Computer-assisted telephone interviews were conducted between 1998 and 2000 among 24,598 Swedish twins aged 55 years or older. Impaired balance at the time of interview was reported by 2,890 (12%) of the twins. Twin pairs who were discordant with regard to impaired balance were selected for analysis and followed for fractures through 2005. In a pairwise analysis, the odds ratio for hip fracture was 3.13 (95% confidence interval (CI): 1.62, 6.05) among twins with impaired balance as compared with their co-twins with normal balance. When previously recognized clinical risk factors for osteoporotic fracture were considered in the model, the odds ratio for hip fracture with impaired balance was 3.88 (95% CI: 1.40, 10.72). Approximately 40% of all hip fractures were attributable to impaired balance. The odds ratios for any fracture and any osteoporotic fracture for twins with impaired balance were 2.00 (95% CI: 1.29, 3.11) and 2.39 (95% CI: 1.49, 3.82), respectively. These results imply that self-reported impaired balance is a novel and readily assessed risk factor for future fractures in the elderly.

Kinematic measures for assessing gait stability in elderly individuals: a systematic review

“…Of the 92 different outcome measures, 48 were measured with the aid of a movement laboratory, consisting of optical motion tracking camera systems, force plates, treadmills, etc. [8,34,35,64,65,73,[76][77][78]80,81,85] and were assigned to the high-cost category (table 2).…”

A comprehensive fracture prevention strategy in older adults: the European Union Geriatric Medicine Society (EUGMS) statement

“…There is no international consensus for assessing the fall risk profile of older people, even if it is well understood that people at higher risk of future falls are those aged 75 or older, those who have fallen during the previous 12 months or those who have fear of falling or significant gait, muscle strength, or balance problems [16,[22][23][24][25][26][27][28]. The fall risk profile is also dependent on the setting and some other factors, including cognitive impairment which may be associated with increased risk taking.…”

“…Other interventions have been ineffective or inconsistent for falls although the rate of recurrent falls may be reduced [35]. A multifactorial and interprofessional approach, determined by individual assessment of functional, medical, and social concerns, may be a more appropriate strategy to prevent falls in older people at high risk of falling [20,[22][23][24][25][26][27][28][29][30][31][32][33][34]36]. Moreover, this tailored approach [37] may provide opportunities to address previously unidentified health problems (e.g.…”

A comprehensive fracture prevention strategy in older adults: The European Union Geriatric Medicine Society (EUGMS) statement

“…There is no international consensus for assessing the fall risk profile of older people, even if it is well understood that people at higher risk of future falls are those aged 75 or older, those who have fallen during the previous 12 months or those who have fear of falling or significant gait, muscle strength, or balance problems (16,(22)(23)(24)(25)(26)(27)(28). The fall risk profile is also dependent on the setting and some other factors, including cognitive impairment which may be associated with increased risk-taking.…”

“…Other interventions have been ineffective or inconsistent for falls although the rate of recurrent falls may be reduced (35). A multifactorial and interprofessional approach, determined by individual assessment of functional, medical, and social concerns, may be a more appropriate strategy to prevent falls in older people at high risk of falling (20,(22)(23)(24)(25)(26)(27)(28)(29)(30)(31)(32)(33)(34)36). Moreover, this tailored approach (37) may provide opportunities to address previously unidenti ed health problems (e.g.…”