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Osteoporosis International

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Open Access 01-03-2016 | Original Article

Risk factors for hip fracture in very old people: a population-based study

Authors: R. Wiklund, A. Toots, M. Conradsson, B. Olofsson, H. Holmberg, E. Rosendahl, Y. Gustafson, H. Littbrand

Published in: Osteoporosis International | Issue 3/2016

Abstract

Summary

Knowledge of risk factors for hip fracture among very old people is limited. Walking indoors with help from ≤1 person, Parkinson’s disease, currently smoking, delirium in the previous month, underweight, and age were associated with increased risk of hip fracture and could be important for preventive strategy development.

Introduction

The purpose of this study is to investigate risk factors for hip fracture among a representative sample of very old people.

Methods

In total, 953 participants from the Umeå 85+/Gerontological Regional Database population-based cohort study were interviewed and assessed during home visits. Associations of baseline characteristics with hip fracture during the maximum 5-year follow-up period were analyzed using Cox proportional hazards regression.

Results

Participants had a mean age of 89.3 ± 4.7 years; 65.8 % were women, 36.8 % lived in residential care facilities, 33.6 % had dementia, and 20.4 % had histories of hip fracture. During a mean follow-up period of 2.7 years, 96 (10.1 %) individuals sustained hip fracture. Walking indoors with help from no more than one person (hazard ratio [HR] = 8.57; 95 % confidence interval [CI], 1.90–38.71), Parkinson’s disease (HR = 5.12; 95 % CI, 1.82–14.44), currently smoking (HR = 4.38; 95 % CI 2.06–9.33), delirium in the previous month (HR = 2.01; 95 % CI, 1.15–3.49), underweight (body mass index <22; HR = 1.74, 95 % CI, 1.09–2.77), and age (HR = 1.09; 95 % CI, 1.04–1.14) were associated independently with an increased risk of hip fracture. Hip prosthesis at baseline decreased the risk of hip fracture (HR = 0.37; 95 % CI, 0.15–0.91), but only for those with bilateral hip prostheses.

Conclusions

Seven factors were associated independently with incident hip fracture during follow-up in this sample of very old people. These factors could have important clinical implications in identifying persons at high risk of hip fracture, as well as in the development of effective preventive strategies.

Wade SW, Strader C, Fitzpatrick LA, Anthony MS (2012) Sex- and age-specific incidence of non-traumatic fractures in selected industrialized countries. Arch Osteoporos 7(1–2):219–227CrossRefPubMed

Johnell O, Kanis JA (2006) An estimate of the worldwide prevalence and disability associated with osteoporotic fractures. Osteoporos Int 17(12):1726–1733CrossRefPubMed

Gullberg B, Johnell O, Kanis JA (1997) World-wide projections for hip fracture. Osteoporos Int 7(5):407–413CrossRefPubMed

United Nations (2013) World Population Ageing 2013. ST/ESA/SER.a/348 edn. Department of Economic and Social Affairs, Population Division, New York

Haleem S, Lutchman L, Mayahi R, Grice JE, Parker MJ (2008) Mortality following hip fracture: trends and geographical variations over the last 40 years. Injury 39(10):1157–1163CrossRefPubMed

Marks R (2010) Hip fracture epidemiological trends, outcomes, and risk factors, 1970–2009. Int J Gen Med 3:1–17PubMedPubMedCentral

Diamantopoulos AP, Hoff M, Hochberg M, Haugeberg G (2013) Predictors of short- and long-term mortality in males and females with hip fracture—a prospective observational cohort study. PLoS One 8(10):e78169CrossRefPubMedPubMedCentral

Anpalahan M, Morrison SG, Gibson SJ (2014) Hip fracture risk factors and the discriminability of hip fracture risk vary by age: a case-control study. Geriatr Gerontol Int 14(2):413–419CrossRefPubMed

Ensrud KE, Ewing SK, Taylor BC, Fink HA, Stone KL, Cauley JA, Tracy JK, Hochberg MC, Rodondi N, Cawthon PM, Study of Osteoporotic Fractures Research G (2007) Frailty and risk of falls, fracture, and mortality in older women: the study of osteoporotic fractures. J Gerontol A Biol Sci Med Sci 62(7):744–751CrossRef

10.

Hillier TA, Lui LY, Kado DM, LeBlanc ES, Vesco KK, Bauer DC, Cauley JA, Ensrud KE, Black DM, Hochberg MC, Cummings SR (2012) Height loss in older women: risk of hip fracture and mortality independent of vertebral fractures. J Bone Miner Res 27(1):153–159CrossRefPubMedPubMedCentral

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):145–149CrossRefPubMed

12.

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):188–192CrossRefPubMed

13.

Dargent-Molina P, Douchin MN, Cormier C, Meunier PJ, Breart G, Group ES (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):593–599CrossRef

14.

Nevitt MC, Johnell O, Black DM, Ensrud K, Genant HK, Cummings SR (1994) Bone mineral density predicts non-spine fractures in very elderly women. Study of Osteoporotic Fractures Research Group. Osteoporos Int 4(6):325–331CrossRefPubMed

15.

Schott AM, Cormier C, Hans D, Favier F, Hausherr E, Dargent-Molina P, Delmas PD, Ribot C, Sebert JL, Breart G, Meunier PJ (1998) How hip and whole-body bone mineral density predict hip fracture in elderly women: the EPIDOS Prospective Study. Osteoporos Int 8(3):247–254CrossRefPubMed

16.

Grønskag AB, Forsmo S, Romundstad P, Langhammer A, Schei B (2010) Incidence and seasonal variation in hip fracture incidence among elderly women in Norway. The HUNT Study. Bone 46(5):1294–1298CrossRefPubMed

17.

Tromp AM, Ooms ME, Popp-Snijders C, Roos JC, Lips P (2000) Predictors of fractures in elderly women. Osteoporos Int 11(2):134–140CrossRefPubMed

18.

Thorell K, Ranstad K, Midlov P, Borgquist L, Halling A (2014) Is use of fall risk-increasing drugs in an elderly population associated with an increased risk of hip fracture, after adjustment for multimorbidity level: a cohort study. BMC Geriatr 14:131CrossRefPubMedPubMedCentral

19.

Chen JS, Simpson JM, March LM, Cameron ID, Cumming RG, Lord SR, Seibel MJ, Sambrook PN (2008) Risk factors for fracture following a fall among older people in residential care facilities in Australia. J Am Geriatr Soc 56(11):2020–2026CrossRefPubMed

20.

Chen JS, Sambrook PN, Simpson JM, Cameron ID, Cumming RG, Seibel MJ, Lord SR, March LM (2009) Risk factors for hip fracture among institutionalised older people. Age Ageing 38(4):429–434CrossRefPubMed

21.

Folstein MF, Folstein SE, McHugh PR (1975) "Mini-mental state". A practical method for grading the cognitive state of patients for the clinician. J Psychiatr Res 12(3):189–198CrossRefPubMed

22.

Collin C, Wade DT, Davies S, Horne V (1988) The Barthel ADL Index: a reliability study. Int Disabil Stud 10(2):61–63CrossRefPubMed

23.

Katz S, Ford AB, Moskowitz RW, Jackson BA, Jaffe MW (1963) Studies of illness in the aged. The Index of ADL: a standardized measure of biological and psychosocial function. JAMA 185:914–919CrossRefPubMed

24.

Guigoz Y, Vellas B, Garry PJ (1996) Assessing the nutritional status of the elderly: the Mini Nutritional Assessment as part of the geriatric evaluation. Nutr Rev 54(1 Pt 2):S59–65PubMed

25.

The Diagnostic and Statistical Manual of Mental Disorders, Forth Edition: DSM-IV-Text Revision (2000). American Psychiatric Association, Washington, DC

26.

Sheikh JI (1986) Geriatric Depression Scale (GDS): recent evidence and development of a shorter version. Clin Gerontol 5(00):165–173

27.

Björkelund KB, Larsson S, Gustafson L, Andersson E (2006) The Organic Brain Syndrome (OBS) scale: a systematic review. Int J Geriatr Psychiatr 21(3):210–222CrossRef

28.

The National Board of Health and Welfare (2011) Nutrition for good health and social care (In Swedish). ISBN 978-91-86885-39-7, 2011-9-2 edn.,

29.

Omsland TK, Holvik K, Meyer HE, Center JR, Emaus N, Tell GS, Schei B, Tverdal A, Gjesdal CG, Grimnes G, Forsmo S, Eisman JA, Sogaard AJ (2012) Hip fractures in Norway 1999–2008: time trends in total incidence and second hip fracture rates: a NOREPOS study. Eur J Epidemiol 27(10):807–814CrossRefPubMed

30.

Kanis JA, Oden A, McCloskey EV, Johansson H, Wahl DA, Cooper C, Epidemiology IOFWGo, Quality of L (2012) A systematic review of hip fracture incidence and probability of fracture worldwide. Osteoporos Int 23 (9):2239–2256

31.

von Heideken WP, Gustavsson JM, Lundin-Olsson L, Kallin K, Nygren B, Lundman B, Norberg A, Gustafson Y (2006) Health status in the oldest old. Age and sex differences in the Umea 85+ Study. Aging Clin Exp Res 18(2):116–126CrossRef

32.

Prior JC, Langsetmo L, Lentle BC, Berger C, Goltzman D, Kovacs CS, Kaiser SM, Adachi JD, Papaioannou A, Anastassiades T, Towheed T, Josse RG, Brown JP, Leslie WD, Kreiger N, Ca MOSRG (2015) Ten-year incident osteoporosis-related fractures in the population-based Canadian Multicentre Osteoporosis Study—comparing site and age-specific risks in women and men. Bone 71:237–243CrossRefPubMed

33.

Nilson F, Moniruzzaman S, Gustavsson J, Andersson R (2013) Trends in hip fracture incidence rates among the elderly in Sweden 1987–2009. J Public Health (Oxf) 35(1):125–131CrossRef

34.

Requena G, Abbing-Karahagopian V, Huerta C, De Bruin ML, Alvarez Y, Miret M, Hesse U, Gardarsdottir H, Souverein PC, Slattery J, Schneider C, Rottenkolber M, Schmiedl S, Gil M, De Groot MC, Bate A, Ruigomez A, Garcia Rodriguez LA, Johansson S, de Vries F, Montero D, Schlienger R, Reynolds R, Klungel OH, de Abajo FJ (2014) Incidence rates and trends of hip/femur fractures in five European countries: comparison using e-healthcare records databases. Calcif Tissue Int 94(6):580–589CrossRefPubMed

35.

von Heideken WP, Gustafson Y, Kallin K, Jensen J, Lundin-Olsson L (2009) Falls in very old people: the population-based Umea 85+ study in Sweden. Arch Gerontol Geriatr 49(3):390–396CrossRef

36.

Parkkari J, Kannus P, Palvanen M, Natri A, Vainio J, Aho H, Vuori I, Jarvinen M (1999) Majority of hip fractures occur as a result of a fall and impact on the greater trochanter of the femur: a prospective controlled hip fracture study with 206 consecutive patients. Calcif Tissue Int 65(3):183–187CrossRefPubMed

37.

Tanner DA, Kloseck M, Crilly RG, Chesworth B, Gilliland J (2010) Hip fracture types in men and women change differently with age. BMC Geriatr 10:12CrossRefPubMedPubMedCentral

38.

Yates LB, Karasik D, Beck TJ, Cupples LA, Kiel DP (2007) Hip structural geometry in old and old-old age: similarities and differences between men and women. Bone 41(4):722–732CrossRefPubMedPubMedCentral

39.

Pulkkinen P, Gluer CC, Jamsa T (2011) Investigation of differences between hip fracture types: a worthy strategy for improved risk assessment and fracture prevention. Bone 49(4):600–604CrossRefPubMed

40.

Stenvall M, Olofsson B, Lundström M, Svensson O, Nyberg L, Gustafson Y (2006) Inpatient falls and injuries in older patients treated for femoral neck fracture. Arch Gerontol Geriatr 43(3):389–399CrossRefPubMed

41.

Lundström M, Olofsson B, Stenvall M, Karlsson S, Nyberg L, Englund U, Borssén B, Svensson O, Gustafson Y (2007) Postoperative delirium in old patients with femoral neck fracture: a randomized intervention study. Aging Clin Exp Res 19(3):178–186CrossRefPubMed

42.

Kanis JA, Oden A, Johnell O, Johansson H, De Laet C, Brown J, Burckhardt P, Cooper C, Christiansen C, Cummings S, Eisman JA, Fujiwara S, Gluer C, Goltzman D, Hans D, Krieg MA, La Croix A, McCloskey E, Mellstrom D, Melton LJ 3rd, Pols H, Reeve J, Sanders K, Schott AM, Silman A, Torgerson D, van Staa T, Watts NB, Yoshimura N (2007) The use of clinical risk factors enhances the performance of BMD in the prediction of hip and osteoporotic fractures in men and women. Osteoporos Int 18(8):1033–1046CrossRefPubMed

43.

Johnell O, Kanis JA, Oden A, Johansson H, De Laet C, Delmas P, Eisman JA, Fujiwara S, Kroger H, Mellstrom D, Meunier PJ, Melton LJ 3rd, O'Neill T, Pols H, Reeve J, Silman A, Tenenhouse A (2005) Predictive value of BMD for hip and other fractures. J Bone Miner Res 20(7):1185–1194CrossRefPubMed

44.

Kanis JA, Johnell O, De Laet C, Johansson H, Oden A, Delmas P, Eisman J, Fujiwara S, Garnero P, Kroger H, McCloskey EV, Mellstrom D, Melton LJ, Pols H, Reeve J, Silman A, Tenenhouse A (2004) A meta-analysis of previous fracture and subsequent fracture risk. Bone 35(2):375–382CrossRefPubMed

45.

El-Khoury F, Cassou B, Charles MA, Dargent-Molina P (2013) The effect of fall prevention exercise programmes on fall induced injuries in community dwelling older adults: systematic review and meta-analysis of randomised controlled trials. BMJ 347:f6234PubMedPubMedCentral

46.

Kanis JA, Johnell O, Oden A, Johansson H, McCloskey E (2008) FRAX and the assessment of fracture probability in men and women from the UK. Osteoporos Int 19(4):385–397CrossRefPubMedPubMedCentral

47.

Kanis J, Oden A, Johnell O (2001) Acute and long-term increase in fracture risk after hospitalization for stroke. Stroke 32(3):702–706CrossRefPubMed

48.

Clinton J, Franta A, Polissar NL, Neradilek B, Mounce D, Fink HA, Schousboe JT, Matsen FA 3rd (2009) Proximal humeral fracture as a risk factor for subsequent hip fractures. J Bone Joint Surg Am 91(3):503–511CrossRefPubMedPubMedCentral

49.

Baker NL, Cook MN, Arrighi HM, Bullock R (2011) Hip fracture risk and subsequent mortality among Alzheimer's disease patients in the United Kingdom, 1988–2007. Age Ageing 40(1):49–54CrossRefPubMed

50.

Tolppanen AM, Lavikainen P, Soininen H, Hartikainen S (2013) Incident hip fractures among community dwelling persons with Alzheimer's disease in a Finnish nationwide register-based cohort. PLoS One 8(3):e59124CrossRefPubMedPubMedCentral

51.

Gill SS, Anderson GM, Fischer HD, Bell CM, Li P, Normand SL, Rochon PA (2009) Syncope and its consequences in patients with dementia receiving cholinesterase inhibitors: a population-based cohort study. Arch Intern Med 169(9):867–873CrossRefPubMed

52.

Olazaran J, Valle D, Serra JA, Cano P, Muniz R (2013) Psychotropic medications and falls in nursing homes: a cross-sectional study. J Am Med Dir Assoc 14(3):213–217CrossRefPubMed

Title: Risk factors for hip fracture in very old people: a population-based study
Authors: R. Wiklund
A. Toots
M. Conradsson
B. Olofsson
H. Holmberg
E. Rosendahl
Y. Gustafson
H. Littbrand
Publication date: 01-03-2016
Publisher: Springer London
Published in: Osteoporosis International / Issue 3/2016
Print ISSN: 0937-941X
Electronic ISSN: 1433-2965
DOI: https://doi.org/10.1007/s00198-015-3390-9

Keynote webinar | Spotlight on sleep in brain health

Springer Medicine

Risk factors for hip fracture in very old people: a population-based study

Abstract

Summary

Introduction

Methods

Results

Conclusions

Keynote webinar | Spotlight on sleep in brain health

Springer Medicine

Abstract

Summary

Introduction

Methods

Results

Conclusions

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