White Matter Lesions and the Risk of Incident Hip Fracture in Older Persons<subtitle>Results From the Progetto Veneto Anziani Study</subtitle>

Abstract

Background: White matter lesions (WMLs) are associated with hypertension, an increased risk of falling, and impaired physical and cognitive performance that may affect the mechanical effect of falls. Methods: We hypothesized that WMLs are a risk factor for hip fracture (HF). We studied a sample of 820 community-dwelling Italian persons 65 years and older from the cohort of the Progetto Veneto Anziani Study who underwent brain magnetic resonance imaging at baseline. Subjects were classified as having no lesions, focal lesions, or diffuse WMLs. Results: Compared with those with no lesions, participants with diffuse WMLs were older, reported more falls, and had worse physical and cognitive performance, all factors implicated in the causal pathway to HF. During 9 years of follow-up, 51 HFs occurred. Hip fracture risk associated with diffuse WMLs markedly differed between participants younger than 80 years vs those 80 years and older. After adjustment among participants younger than 80 years, diffuse WMLs compared with no lesions were associated with a 2.7-fold (95% confidence interval, 1.1-7.1) increase in the risk of HF. Focal lesions were not statistically significantly associated with an increased risk of HF in the same age group (hazard ratio, 2.0; 95% confidence interval, 0.6-7.6). No associations between diffuse WMLs, focal lesions, and HF were evident among participants 80 years and older, possibly because of the limited sample size. Conclusions: White matter lesions represent an independent risk factor for HF in persons younger than 80 years. Older persons with diffuse WMLs should be considered candidates for multifactorial interventions aimed at reducing the risk of falling and fractures.

Cerebral White Matter Lesions, Gait, and the Risk of Incident Falls

“…However, those with increasing WMLV were more likely to have multiple falls, supporting a doseresponse relationship, and providing a potential explanation for the recent finding of an elevated fracture risk in those with severe WMLs. 29 Our findings parallel those from populationbased studies of WMLs and cognition in which the effects on cognition were seen predominantly in those with highest lesion loads. 22,28 The persistence of the association after exclusion of people with previous falls supports a temporal relationship between WML and incident falls.…”

Neuropathological Correlates of Falling in the CC75C Population-Based Sample of the Older Old

“…Hip fractures were independently associated with diffuse WML in subjects less than 80 years, but this association was not detected in subjects older than 80 [23]. In contrast, our study does find an association between white matter pallor and falls in donors aged over 80.…”

“…Total volume of white matter abnormalities seen on MRI has been associated with gait disturbance [5,[12][13][14][15][16][17][18], balance impairments [5, 13-15, 19, 20], increased tendency to fall [17,18,21,22] and hip fracture [23]. While some studies have demonstrated an association between decreased mobility and lesions located in deep white matter [24], others have found this more strongly associated with periventricular lesions [25,26], and a recent study suggested that both locations were independently associated with gait impairments and falls [27].…”

White Matter Lesions Are Associated With Hospital Admissions Because of Hip-Fractures and Trauma After Ischemic Stroke

“…16 According to the Leukoaraiosis and Disability in the Elderly study, patients with severe WMLs have impaired balance and typically have a history of twice as many falls when compared with mild WMLs. 7 In the study population of the present study, the rates of hip-fractures were even 4.0-fold in patients with moderate-to-severe WMLs when compared with patients with none-to-mild WMLs, whereas rates of trauma leading to hospital admission rates were 1.7-fold.…”

“…16 According to Cumulative risk of first hip-fracture after ischemic stroke in 383 patients of the Helsinki Stroke Aging Memory study cohort followed up for 12 years. Stratified for patients with none-to-mild and for moderate-to-severe white matter lesions (WMLs) on MRI.…”