Top

Osteoporosis International

Published in:

01-06-2014 | Original Article

Fall-related risk factors and heel quantitative ultrasound in the assessment of hip fracture risk: a 10-year follow-up of a nationally representative adult population sample

Authors: M. Kauppi, S. Stenholm, O. Impivaara, J. Mäki, M. Heliövaara, A. Jula

Published in: Osteoporosis International | Issue 6/2014

Abstract

Summary

Maximal walking speed and quantitative ultrasound index (QUI) were significant and independent predictors of hip fracture among subjects aged ≥55 years. A model including readily available variables along with simple fall-related factors may be clinically useful in the assessment of hip fracture risk even without a QUI measurement.

Introduction

This study assessed fall-related risk factors along with heel bone quantitative ultrasound (QUS) measurements for the prediction of hip fracture during a mean follow-up of 9.8 years in a nationally representative population sample.

Methods

The study population consisted of 2,300 subjects (1,331 women and 969 men) aged 55 years or over, who had participated in a comprehensive health survey in 2000–2001. Information on the subjects’ health and fall-related risk factors was obtained with interviews, questionnaires and tests carried out by specially trained professionals. QUS measurements were made by means of the Hologic Sahara device. First emerging cases of hip fracture were identified from the National Hospital Discharge Register.

Results

During the follow-up, 96 subjects sustained a hip fracture. Slow maximal walking speed, low quantitative ultrasound index (QUI), high age, tallness, short waist circumference, Parkinson’s disease and the number of central nervous system active medication were significant and independent predictors of hip fracture. The model including all of these risk factors explained 68 % of the variation in hip fracture risk. Excluding QUI from this model reduced the percentage to 66 %.

Conclusions

Maximal walking speed and QUI were significant and independent predictors of hip fracture. A model including readily available variables such as age, gender, height and waist circumference along with simple fall-related factors may be of clinical use in the assessment of hip fracture risk even without a QUS measurement.

Available only for authorised users

Johnell O, Kanis JA, Oden A, Sernbo I, Redlund-Johnell I, Petterson C, De Laet C, Jonsson B (2004) Mortality after osteoporotic fractures. Osteoporos Int 15(1):38–42PubMedCrossRef

Compston J (2004) Action plan for the prevention of osteoporotic fractures in the European community. Osteoporos Int 15(4):259–262PubMedCrossRef

Hans D, Durosier C, Kanis JA, Johansson H, Schott-Pethelaz AM, Krieg MA (2008) Assessment of the 10-year probability of osteoporotic hip fracture combining clinical risk factors and heel bone ultrasound: the EPISEM prospective cohort of 12,958 elderly women. J Bone Miner Res 23(7):1045–1051. doi:10.1359/jbmr.080229 PubMedCrossRef

Kanis JA (2002) Diagnosis of osteoporosis and assessment of fracture risk. Lancet 359(9321):1929–1936PubMedCrossRef

Hans D, Schott AM, Duboeuf F, Durosier C, Meunier PJ (2004) Does follow-up duration influence the ultrasound and DXA prediction of hip fracture? The EPIDOS prospective study. Bone 35(2):357–363PubMedCrossRef

Krieg MA, Cornuz J, Ruffieux C, Van Melle G, Buche D, Dambacher MA, Hans D, Hartl F, Hauselmann HJ, Kraenzlin M, Lippuner K, Neff M, Pancaldi P, Rizzoli R, Tanzi F, Theiler R, Tyndall A, Wimpfheimer C, Burckhardt P (2006) Prediction of hip fracture risk by quantitative ultrasound in more than 7,000 Swiss women ≥70 years of age: comparison of three technologically different bone ultrasound devices in the SEMOF study. J Bone Miner Res 21(9):1457–1463PubMedCrossRef

Bauer DC, Ewing SK, Cauley JA, Ensrud KE, Cummings SR, Orwoll ES (2007) Quantitative ultrasound predicts hip and non-spine fracture in men: the MrOS study. Osteoporos Int 18(6):771–777

Moayyeri A, Adams JE, Adler RA, Krieg MA, Hans D, Compston J, Lewiecki EM (2012) Quantitative ultrasound of the heel and fracture risk assessment: an updated meta-analysis. Osteoporos Int 23(1):143–153. doi:10.1007/s00198-011-1817-5 PubMedCrossRef

Allolio B (1999) Risk factors for hip fracture not related to bone mass and their therapeutic implications. Osteoporos Int 9(Suppl 2):S9–S16PubMedCrossRef

10.

Cawthon PM, Fullman RL, Marshall L, Mackey DC, Fink HA, Cauley JA, Cummings SR, Orwoll ES, Ensrud KE (2008) Physical performance and risk of hip fractures in older men. J Bone Miner Res 23(7):1037–1044. doi:10.1359/jbmr.080227 PubMedCentralPubMedCrossRef

11.

Dargent-Molina P, Favier F, Grandjean H, Baudoin C, Schott AM, Hausherr E, Meunier PJ, Breart G (1996) Fall-related factors and risk of hip fracture: the EPIDOS prospective study. Lancet 348(9021):145–149PubMedCrossRef

12.

Chen YY, Cheng PY, Wu SL, Lai CH (2012) Parkinson’s disease and risk of hip fracture: an 8-year follow-up study in Taiwan. Parkinsonism Relat Disord 18(5):506–509. doi:10.1016/j.parkreldis.2012.01.014 PubMedCrossRef

13.

Hartikainen S, Lönnroos E, Louhivuori K (2007) Medication as a risk factor for falls: critical systematic review. J Gerontol A Biol Sci Med Sci 62(10):1172–1181PubMedCrossRef

14.

Cumming RG, Nevitt MC, Cummings SR (1997) Epidemiology of hip fractures. Epidemiol Rev 19(2):244–257PubMedCrossRef

15.

Cauley JA, Danielson ME, Boudreau R, Barbour KE, Horwitz MJ, Bauer DC, Ensrud KE, Manson JE, Wactawski-Wende J, Shikany JM, Jackson RD (2011) Serum 25-hydroxyvitamin D and clinical fracture risk in a multiethnic cohort of women: the Women’s Health Initiative (WHI). J Bone Miner Res 26(10):2378–2388. doi:10.1002/jbmr.449 PubMedCentralPubMedCrossRef

16.

Menant JC, Close JC, Delbaere K, Sturnieks DL, Trollor J, Sachdev PS, Brodaty H, Lord SR (2012) Relationships between serum vitamin D levels, neuromuscular and neuropsychological function and falls in older men and women. Osteoporos Int 23(3):981–989. doi:10.1007/s00198-011-1637-7 PubMedCrossRef

17.

Cauley JA, Parimi N, Ensrud KE, Bauer DC, Cawthon PM, Cummings SR, Hoffman AR, Shikany JM, Barrett-Connor E, Orwoll E (2010) Serum 25-hydroxyvitamin D and the risk of hip and nonspine fractures in older men. J Bone Miner Res 25(3):545–553. doi:10.1359/jbmr.090826 PubMedCentralPubMedCrossRef

18.

Dargent-Molina P, Schott AM, Hans D, Favier F, Grandjean H, Baudoin C, Meunier PJ, Breart G (1999) Separate and combined value of bone mass and gait speed measurements in screening for hip fracture risk: results from the EPIDOS study, Epidemiologie de l’Osteoporose. Osteoporos Int 9(2):188–192PubMedCrossRef

19.

Durosier C, Hans D, Krieg MA, Ruffieux C, Cornuz J, Meunier PJ, Schott AM (2007) Combining clinical factors and quantitative ultrasound improves the detection of women both at low and high risk for hip fracture. Osteoporos Int 18(12):1651–1659. doi:10.1007/s00198-007-0414-0 PubMedCrossRef

20.

Taylor BC, Schreiner PJ, Stone KL, Fink HA, Cummings SR, Nevitt MC, Bowman PJ, Ensrud KE (2004) Long-term prediction of incident hip fracture risk in elderly white women: study of osteoporotic fractures. J Am Geriatr Soc 52(9):1479–1486PubMedCrossRef

21.

Nguyen ND, Pongchaiyakul C, Center JR, Eisman JA, Nguyen TV (2005) Identification of high-risk individuals for hip fracture: a 14-year prospective study. J Bone Miner Res 20(11):1921–1928PubMedCrossRef

22.

McGrother CW, Donaldson MM, Clayton D, Abrams KR, Clarke M (2002) Evaluation of a hip fracture risk score for assessing elderly women: the Melton Osteoporotic Fracture (MOF) study. Osteoporos Int 13(1):89–96PubMedCrossRef

23.

Aromaa A, Koskinen S (eds) (2004) Health and functional capacity in Finland. Baseline results of the health 2000 health examination survey. National Public Health Institute, Publications of the National Public Health Institute B12 / 2004, Helsinki. Also available at: http://www.terveys2000.fi/julkaisut/baseline.pdf

24.

Heistaro S (ed) (2008) Methodology report: Health 2000 Survey. National Public Health Institute, Publications of the National Public Health Institute B26/2008, Helsinki. Also available at:http://www.terveys2000.fi/doc/methodologyrep.pdf

25.

Kauppi M, Impivaara O, Mäki J, Heliövaara M, Marniemi J, Montonen J, Jula A (2009) Vitamin D status and common risk factors for bone fragility as determinants of quantitative ultrasound variables in a nationally representative population sample. Bone 45(1):119–124. doi:10.1016/j.bone.2009.03.659 PubMedCrossRef

26.

Crome I, Li TK, Rao R, Wu LT (2012) Alcohol limits in older people. Addiction 107(9):1541–1543. doi:10.1111/j.1360-0443.2012.03854.x PubMedCrossRef

27.

Malmivaara A, Heliövaara M, Knekt P, Reunanen A, Aromaa A (1993) Risk factors for injurious falls leading to hospitalization or death in a cohort of 19,500 adults. Am J Epidemiol 138(6):384–394PubMed

28.

Royston P (2006) Explained variation for survival models. Stata J 6(1):83–96

29.

Pencina MJ, D’Agostino RB Sr, D’Agostino RB Jr, Vasan RS (2008) Evaluating the added predictive ability of a new marker: from area under the ROC curve to reclassification and beyond. Stat Med 27(2):157–172. doi:10.1002/sim.2929, discussion 207-112PubMedCrossRef

30.

Tosteson AN, Melton LJ, Melton LJ 3rd, Dawson-Hughes B, Baim S, Favus MJ, Khosla S, Lindsay RL (2008) Cost-effective osteoporosis treatment thresholds: the United States perspective. Osteoporos Int 19(43):437–447. doi:10.1007/s00198-007-0550-6 PubMedCentralPubMedCrossRef

31.

Tiedemann A, Sherrington C, Lord SR (2005) Physiological and psychological predictors of walking speed in older community-dwelling people. Gerontology 51(6):390–395. doi:10.1159/000088703 PubMedCrossRef

32.

Callisaya ML, Blizzard L, Schmidt MD, McGinley JL, Lord SR, Srikanth VK (2009) A population-based study of sensorimotor factors affecting gait in older people. Age Ageing 38(3):290–295. doi:10.1093/ageing/afp017 PubMedCrossRef

33.

Abellan van Kan G, Rolland Y, Andrieu S, Bauer J, Beauchet O, Bonnefoy M, Cesari M, Donini LM, Gillette Guyonnet S, Inzitari M, Nourhashemi F, Onder G, Ritz P, Salva A, Visser M, Vellas B (2009) Gait speed at usual pace as a predictor of adverse outcomes in community-dwelling older people an International Academy on Nutrition and Aging (IANA) Task Force. J Nutr Health Aging 13(10):881–889PubMedCrossRef

34.

Dargent-Molina P, Douchin MN, Cormier C, Meunier PJ, Breart G (2002) Use of clinical risk factors in elderly women with low bone mineral density to identify women at higher risk of hip fracture: the EPIDOS prospective study. Osteoporos Int 13(7):593–599PubMedCrossRef

35.

Ensrud KE, Blackwell T, Mangione CM, Bowman PJ, Bauer DC, Schwartz A, Hanlon JT, Nevitt MC, Whooley MA (2003) Central nervous system active medications and risk for fractures in older women. Arch Intern Med 163(8):949–957PubMedCrossRef

36.

Boyle N, Naganathan V, Cumming RG (2010) Medication and falls: risk and optimization. Clin Geriatr Med 26(4):583–605. doi:10.1016/j.cger.2010.06.007 PubMedCrossRef

37.

Kauppi M, Impivaara O, Mäki J, Heliövaara M, Jula A (2013) Quantitative ultrasound measurements and vitamin D status in the assessment of hip fracture risk in a nationally representative population sample. Osteoporos Int. doi:10.1007/s00198-013-2355-0 PubMed

38.

Faulkner KG, Cummings SR, Black D, Palermo L, Gluer CC, Genant HK (1993) Simple measurement of femoral geometry predicts hip fracture: the study of osteoporotic fractures. J Bone Miner Res 8(10):1211–1217. doi:10.1002/jbmr.5650081008 PubMedCrossRef

39.

Hannan MT, Broe KE, Cupples LA, Dufour AB, Rockwell M, Kiel DP (2012) Height loss predicts subsequent hip fracture in men and women of the Framingham Study. J Bone Miner Res 27(1):146–152. doi:10.1002/jbmr.557 PubMedCentralPubMedCrossRef

40.

Compston J (2013) Obesity and bone. Curr Osteoporos Rep 11(1):30–35. doi:10.1007/s11914-012-0127-y PubMedCrossRef

41.

Lai JK, Lucas RM, Clements MS, Roddam AW, Banks E (2010) Hip fracture risk in relation to vitamin D supplementation and serum 25-hydroxyvitamin D levels: a systematic review and meta-analysis of randomised controlled trials and observational studies. BMC Public Health 10:331. doi:10.1186/1471-2458-10-331 PubMedCentralPubMedCrossRef

42.

Määttä M, Terho E, Jokinen H, Pulkkinen P, Korpelainen J, Heikkinen J, Keinänen-Kiukaanniemi S, Jämsä T, Korpelainen R (2012) Lifestyle factors and site-specific risk of hip fracture in community dwelling older women—a 13-year prospective population-based cohort study. BMC Musculoskelet Disord 13:173. doi:10.1186/1471-2474-13-173

43.

Trimpou P, Landin-Wilhelmsen K, Oden A, Rosengren A, Wilhelmsen L (2010) Male risk factors for hip fracture-a 30-year follow-up study in 7,495 men. Osteoporos Int 21(3):409–416. doi:10.1007/s00198-009-0961-7 PubMedCrossRef

44.

Kanis JA, Johansson H, Johnell O, Oden A, De Laet C, Eisman JA, Pols H, Tenenhouse A (2005) Alcohol intake as a risk factor for fracture. Osteoporos Int 16(7):737–742PubMedCrossRef

45.

Hippisley-Cox J, Coupland C (2012) Derivation and validation of updated QFracture algorithm to predict risk of osteoporotic fracture in primary care in the United Kingdom: prospective open cohort study. BMJ 344:e3427PubMedCrossRef

46.

Collins GS, Mallett S, Altman DG (2011) Predicting risk of osteoporotic and hip fracture in the United Kingdom: prospective independent and external validation of QFractureScores. BMJ 342:d3651PubMedCentralPubMedCrossRef

47.

Gillespie LD, Robertson MC, Gillespie WJ, Sherrington C, Gates S, Clemson LM, Lamb SE (2012) Interventions for preventing falls in older people living in the community. Cochrane Database Syst Rev 9:CD007146. doi:10.1002/14651858.CD007146.pub3 PubMed

48.

Sund R (2012) Quality of the Finnish Hospital Discharge Register: a systematic review. Scand J Public Health 40(6):505–515

Title: Fall-related risk factors and heel quantitative ultrasound in the assessment of hip fracture risk: a 10-year follow-up of a nationally representative adult population sample
Authors: M. Kauppi
S. Stenholm
O. Impivaara
J. Mäki
M. Heliövaara
A. Jula
Publication date: 01-06-2014
Publisher: Springer London
Published in: Osteoporosis International / Issue 6/2014
Print ISSN: 0937-941X
Electronic ISSN: 1433-2965
DOI: https://doi.org/10.1007/s00198-014-2674-9

At a glance: The STEP trials

Springer Medicine

Fall-related risk factors and heel quantitative ultrasound in the assessment of hip fracture risk: a 10-year follow-up of a nationally representative adult population sample

Abstract

Summary

Introduction

Methods

Results

Conclusions

At a glance: The STEP trials

Springer Medicine

Abstract

Summary

Introduction

Methods

Results

Conclusions

Please log in to get access to this content

Other articles of this Issue 6/2014

Celiac disease and risk of fracture in adults—a review

TBS result is not affected by lumbar spine osteoarthritis

Comment on Cassell and Clapperton: A decreasing trend in fall-related hip fracture incidence in Victoria, Australia

Bone mineral density and bone turnover in non-cirrhotic patients with chronic hepatitis C and sustained virological response to antiviral therapy with peginterferon-alfa and ribavirin

The decreasing trend in hip fractures: response to Stevens & Rudd

How long should we treat?