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Current Osteoporosis Reports
Published in: Current Osteoporosis Reports 3/2011

01-09-2011

The Role of Falls in Fracture Prediction

Author: Heike A. Bischoff-Ferrari

Published in: Current Osteoporosis Reports | Issue 3/2011

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Abstract

Close to 75% of hip and non-hip fractures occur among seniors age 65 years and older. Notably, the primary risk factor for a hip fracture is a fall, and over 90% of all fractures occur after a fall. Thus, critical for the understanding and prevention of fractures at later age is their close relationship with muscle weakness and falling. In fact, antiresorptive treatment alone may not reduce fractures among individuals 80 years and older in the presence of nonskeletal risk factors for fractures despite an improvement in bone metabolism. This article will review the epidemiology of falls, and their importance in regard to fracture risk. Finally, fall prevention strategies and how these translate into fracture reduction are evaluated based on data from randomized controlled trials.
Literature
1.
Tinetti ME. Risk factors for falls among elderly persons living in the community. N Engl J Med. 1988;319:1701–7.PubMedCrossRef
2.
Campbell AJ, Reinken J, Allan BC, Martinez GS. Falls in old age: a study of frequency and related clinical factors. Age Ageing. 1981;10(4):264–70.PubMedCrossRef
3.
Fatalities and injuries from falls among older adults—United States, 1993–2003 and 2001–2005. MMWR Morb Mortal Wkly Rep. 2006;55(45):1221–4.
4.
Tinetti ME, Williams CS. The effect of falls and fall injuries on functioning in community-dwelling older persons. J Gerontol A Biol Sci Med Sci. 1998;53(2):M112–9.PubMedCrossRef
5.
Tinetti ME, Williams CS. Falls, injuries due to falls, and the risk of admission to a nursing home. N Engl J Med. 1997;337(18):1279–84.PubMedCrossRef
6.
Cummings SR, Nevitt MC, Browner WS, Stone K, Fox KM, Ensrud KE, et al. Risk factors for hip fracture in white women. Study of osteoporotic fractures research group. N Engl J Med. 1995;332(12):767–73.PubMedCrossRef
7.
Pluijm SM, Smit JH, Tromp EA, Stel VS, Deeg DJ, Bouter LM, et al. A risk profile for identifying community-dwelling elderly with a high risk of recurrent falling: results of a 3-year prospective study. Osteoporos Int. 2006;17(3):417–25. Epub 2006 Jan 17.PubMedCrossRef
8.
9.
Eberstadt N., H. G. Europe’s coming demographic challenge: unlocking the value of health. American Enterprise Institute for Public Policy Research. 2007.
10.
Europe Co. Recent demographic developments in Europe 2005 (2006) European population Committee of the Council of Europe: Strasbourg.
11.
12.
Lee RD. Global population aging and its economic consequences. Washington, DC: AEI Press, 2007. 2007.
13.
Melton 3rd LJ, Crowson CS, O’Fallon WM. Fracture incidence in Olmsted County, Minnesota: comparison of urban with rural rates and changes in urban rates over time. Osteoporos Int. 1999;9(1):29–37.PubMedCrossRef
14.
Gullberg B, Johnell O, Kanis JA. World-wide projections for hip fracture. Osteoporos Int. 1997;7(5):407–13.PubMedCrossRef
15.
Buchner DM, Hornbrook MC, Kutner NG, Tinetti ME, Ory MG, Mulrow CD, et al. Development of the common data base for the FICSIT trials. J Am Geriatr Soc. 1993;41(3):297–308.PubMed
16.
Cummings SR, Nevitt MC, Kidd S. Forgetting falls. The limited accuracy of recall of falls in the elderly. J Am Geriatr Soc. 1988;36(7):613–6.PubMed
17.
Kanis JA, Borgstrom F, De Laet C, Johansson H, Johnell O, Jonsson B, et al. Assessment of fracture risk. Osteoporos Int. 2005;16(6):581–9. Epub 2004 Dec 23.PubMedCrossRef
18.
Sandhu SK, Nguyen ND, Center JR, Pocock NA, Eisman JA, Nguyen TV. Prognosis of fracture: evaluation of predictive accuracy of the FRAX algorithm and Garvan nomogram. Osteoporos Int.21(5):863–71.
19.
van den Bergh JP, van Geel TA, Lems WF, Geusens PP. Assessment of individual fracture risk: FRAX and beyond. Curr Osteoporos Rep. 2010;8(3):131–7.PubMedCrossRef
20.
Cummings SR, Nevitt MC. Non-skeletal determinants of fractures: the potential importance of the mechanics of falls. Study of osteoporotic fractures research group. Osteoporos Int. 1994;4 Suppl 1:67–70.PubMedCrossRef
21.
Nguyen ND, Frost SA, Center JR, Eisman JA, Nguyen TV. Development of a nomogram for individualizing hip fracture risk in men and women. Osteoporos Int. 2007;17:17.
22.
Nevitt MC, Cummings SR. Type of fall and risk of hip and wrist fractures: the study of osteoporotic fractures. The study of osteoporotic fractures research group. J Am Geriatr Soc. 1993;41(11):1226–34.PubMed
23.
Vellas BJ, Wayne SJ, Romero LJ, Baumgartner RN, Garry PJ. Fear of falling and restriction of mobility in elderly fallers. Age Ageing. 1997;26(3):189–93.PubMedCrossRef
24.
Arfken CL, Lach HW, Birge SJ, Miller JP. The prevalence and correlates of fear of falling in elderly persons living in the community. Am J Public Health. 1994;84(4):565–70.PubMedCrossRef
25.
McClung MR, Geusens P, Miller PD, Zippel H, Bensen WG, Roux C, et al. Effect of risedronate on the risk of hip fracture in elderly women. Hip intervention program study group. N Engl J Med. 2001;344(5):333–40.PubMedCrossRef
26.
Graafmans WC, Ooms ME, Hofstee HM, Bezemer PD, Bouter LM, Lips P. Falls in the elderly: a prospective study of risk factors and risk profiles. Am J Epidemiol. 1996;143(11):1129–36.PubMed
27.
Arden NK, Nevitt MC, Lane NE, Gore LR, Hochberg MC, Scott JC, et al. Osteoarthritis and risk of falls, rates of bone loss, and osteoporotic fractures. Study of osteoporotic fractures research group. Arthritis Rheum. 1999;42(7):1378–85.PubMedCrossRef
28.
Arden NK, Crozier S, Smith H, Anderson F, Edwards C, Raphael H, et al. Knee pain, knee osteoarthritis, and the risk of fracture. Arthritis Rheum. 2006;55(4):610–5.PubMedCrossRef
29.
Dufour AB, Roberts B, Broe KE, Kiel DP, Bouxsein ML, Hannan MT. The factor-of-risk biomechanical approach predicts hip fracture in men and women: the Framingham Study. Osteoporos Int. 2011.
30.
Tinetti ME, Inouye SK, Gill TM, Doucette JT. Shared risk factors for falls, incontinence, and functional dependence. Unifying the approach to geriatric syndromes. Jama. 1995;273(17):1348–53.PubMedCrossRef
31.
Mowe M, Haug E, Bohmer T. Low serum calcidiol concentration in older adults with reduced muscular function. J Am Geriatr Soc. 1999;47(2):220–6.PubMed
32.
Close J, Ellis M, Hooper R, Glucksman E, Jackson S, Swift C. Prevention of falls in the elderly trial (PROFET): a randomized controlled trial. Lancet. 1999;353:93–7.PubMedCrossRef
33.
Province MA, Hadley EC, Hornbrook MC, Lipsitz LA, Miller JP, Mulrow CD, et al. The effects of exercise on falls in elderly patients. A preplanned meta-analysis of the FICSIT Trials. Frailty and Injuries: Cooperative Studies of Intervention Techniques. Jama. 1995;273(17):1341–7.PubMedCrossRef
34.
Wolf SL, Barnhart HX, Kutner NG, McNeely E, Coogler C, Xu T. Reducing frailty and falls in older persons: an investigation of Tai Chi and computerized balance training. Atlanta FICSIT Group. Frailty and Injuries: Cooperative Studies of Intervention Techniques. J Am Geriatr Soc. 1996;44(5):489–97.PubMed
35.
Oliver D, Connelly JB, Victor CR, Shaw FE, Whitehead A, Genc Y, et al. Strategies to prevent falls and fractures in hospitals and care homes and effect of cognitive impairment: systematic review and meta-analyses. Bmj. 2007;334(7584):82. Epub 2006 Dec 8.PubMedCrossRef
36.
Campbell AJ, Robertson MC, Gardner MM, Norton RN, Tilyard MW, Buchner DM. Randomised controlled trial of a general practice programme of home based exercise to prevent falls in elderly women. Bmj. 1997;315(7115):1065–9.PubMed
37.
• Bischoff-Ferrari HA, Dawson-Hughes B, Platz A, Orav EJ, Stahelin HB, Willett WC, et al. Effect of high-dosage cholecalciferol and extended physiotherapy on complications after hip fracture: a randomized controlled trial. Arch Intern Med. 2010;170(9):813–20. The trial tests a simple home exercise program in acute hip fracture patients instructed during acute care compared to standard physiotherapy. The trial also tested 2000 IU vitamin D compared to 800 IU vitamin D per day in a 2x2 factorial design. The higher vitamin D dose resulted in a 39% reduction in hospital re-admission, which was driven by a 60% reduction in fall-related injury. The higher dose of vitamin D did not reduce falls superior to 800 IU vitamin D. PubMedCrossRef
38.
Voukelatos A, Cumming RG, Lord SR, Rissel C. A randomized, controlled trial of tai chi for the prevention of falls: the Central Sydney tai chi trial. J Am Geriatr Soc. 2007;55(8):1185–91.PubMedCrossRef
39.
Li F, Harmer P, Fisher KJ, McAuley E, Chaumeton N, Eckstrom E, et al. Tai Chi and fall reductions in older adults: a randomized controlled trial. J Gerontol A Biol Sci Med Sci. 2005;60(2):187–94.PubMedCrossRef
40.
Wolf SL, Sattin RW, Kutner M, O’Grady M, Greenspan AI, Gregor RJ. Intense tai chi exercise training and fall occurrences in older, transitionally frail adults: a randomized, controlled trial. J Am Geriatr Soc. 2003;51(12):1693–701.PubMedCrossRef
41.
Lee MS, Pittler MH, Shin BC, Ernst E. Tai chi for osteoporosis: a systematic review. Osteoporos Int. 2007;23:23.
42.
Lundin-Olsson L, Nyberg L, Gustafson Y. Stops walking when talking as a predictor of falls in elderly people. Lancet. 1997;349(9052):617.PubMedCrossRef
43.
de Hoon EW, Allum JH, Carpenter MG, Salis C, Bloem BR, Conzelmann M, et al. Quantitative assessment of the stops walking while talking test in the elderly. Arch Phys Med Rehabil. 2003;84(6):838–42.PubMedCrossRef
44.
• Trombetti A, Hars M, Herrmann FR, Kressig RW, Ferrari S, Rizzoli R. Effect of music-based multitask training on gait, balance, and fall risk in elderly people: a randomized controlled trial. Arch Intern Med. 2011;171(6):525–33. Trombetti et al. test a new concept of dual tasking as a music-based coordination. Training in seniors at risk of falling and show a significant benefit on fall reduction in a controlled study design. PubMedCrossRef
45.
Harwood RH, Foss AJ, Osborn F, Gregson RM, Zaman A, Masud T. Falls and health status in elderly women following first eye cataract surgery: a randomised controlled trial. Br J Ophthalmol. 2005;89(1):53–9.PubMedCrossRef
46.
Bischoff-Ferrari HA, Dawson-Hughes B, Staehelin HB, Orav JE, Stuck AE, Theiler R, et al. Fall prevention with supplemental and active forms of vitamin D: a meta-analysis of randomised controlled trials. BMJ. 2009;339(1):339:b3692.CrossRef
47.
Bischoff-Ferrari HA, Willett WC, Wong JB, Stuck AE, Staehelin HB, Orav EJ, et al. Prevention of nonvertebral fractures with oral vitamin D and dose dependency: a meta-analysis of randomized controlled trials. Arch Intern Med. 2009;169(6):551–61.PubMedCrossRef
48.
49.
Bischoff-Ferrari HA, Borchers M, Gudat F, Durmuller U, Stahelin HB, Dick W. Vitamin D receptor expression in human muscle tissue decreases with age. J Bone Miner Res. 2004;19(2):265–9.PubMedCrossRef
50.
• Ceglia L, da Silva Morais M, Park LK, Morris E, Harris SS, Bischoff-Ferrari HA, et al. Multi-step immunofluorescent analysis of vitamin D receptor loci and myosin heavy chain isoforms in human skeletal muscle. J Mol Histol. 2010;41(2–3):137–42. Ceglia et al. confirm earlier findings of the presence of the vitamin D receptor in muscle tissue. PubMedCrossRef
51.
52.
Sorensen OH, Lund B, Saltin B, Andersen RB, Hjorth L, Melsen F, et al. Myopathy in bone loss of ageing: improvement by treatment with 1 alpha-hydroxycholecalciferol and calcium. Clin Sci (Colch). 1979;56(2):157–61.
53.
von Haehling S, Morley JE, Anker SD. An overview of sarcopenia: facts and numbers on prevalence and clinical impact. J Cachex Sarcopenia Muscle.1(2):129–33.
54.
55.
•• Michael YL, Whitlock EP, Lin JS, Fu R, O’Connor EA, Gold R. Primary care-relevant interventions to prevent falling in older adults: a systematic evidence review for the US. Preventive services task force. Ann Intern Med. 2011;153(12):815–25. The preventive task forced reviewed all evidence from clinical trials and concluded that vitamin D is an effective strategy in fall prevention.
56.
57.
•• Dawson-Hughes B, Mithal A, Bonjour JP, Boonen S, Burckhardt P, Fuleihan GE, et al. IOF position statement: vitamin D recommendations for older adults. Osteoporos Int. 2010;21(7):1151–4. The IOF released a position statement of vitamin D in May 2010 and recomments vitamin D supplementation at a dose of 800–1000 IU per day in all adults age 60 years and older to reduce their risk of falls and fracture. The 25(OH)D threshold for optimal fall and fracture prevention, as defined by the IOF, is 75 nmol/l (30 ng/ml). PubMedCrossRef
58.
Graafmans WC, Ooms ME, Hofstee HM, Bezemer PD, Bouter LM, Lips P. Falls in the elderly: a prospective study of risk factors and risk profiles. Am J Epidemiol. 1996;143(11):1129–36.PubMed
59.
Grant AM, Avenell A, Campbell MK, McDonald AM, MacLennan GS, McPherson GC, et al. Oral vitamin D3 and calcium for secondary prevention of low-trauma fractures in elderly people (Randomised Evaluation of Calcium Or vitamin D, RECORD): a randomised placebo-controlled trial. Lancet. 2005;365(9471):1621–8.PubMedCrossRef
60.
Trivedi DP, Doll R, Khaw KT. Effect of four monthly oral vitamin D3 (cholecalciferol) supplementation on fractures and mortality in men and women living in the community: randomised double blind controlled trial. BMJ. 2003;326(7387):469.PubMedCrossRef
61.
Latham NK, Anderson CS, Lee A, Bennett DA, Moseley A, Cameron ID. A randomized, controlled trial of quadriceps resistance exercise and vitamin D in frail older people: the Frailty Interventions Trial in Elderly Subjects (FITNESS). J Am Geriatr Soc. 2003;51(3):291–9.PubMedCrossRef
62.
Cummings SR, Nevitt MC, Kidd S. Forgetting falls. J Am Geriatr Soc. 1988;36(7):613–6.PubMed
63.
64.
Bischoff-Ferrari HA, Dietrich T, Orav EJ, Dawson-Hughes B. Positive association between 25-hydroxy vitamin d levels and bone mineral density: a population-based study of younger and older adults. Am J Med. 2004;116(9):634–9.PubMedCrossRef
65.
Bischoff-Ferrari HA, Dietrich T, Orav EJ, Hu FB, Zhang Y, Karlson EW, et al. Higher 25-hydroxyvitamin D concentrations are associated with better lower-extremity function in both active and inactive persons aged > =60 y. Am J Clin Nutr. 2004;80(3):752–8.PubMed
66.
Wicherts IS, van Schoor NM, Boeke AJ, Visser M, Deeg DJ, Smit J, et al. Vitamin D status predicts physical performance and its decline in older persons. J Clin Endocrinol Metab. 2007;6:6.
67.
Bischoff HA, Stahelin HB, Dick W, Akos R, Knecht M, Salis C, et al. Effects of vitamin D and calcium supplementation on falls: a randomized controlled trial. J Bone Miner Res. 2003;18(2):343–51.PubMedCrossRef
68.
Pfeifer M, Begerow B, Minne HW, Abrams C, Nachtigall D, Hansen C. Effects of a short-term vitamin D and calcium supplementation on body sway and secondary hyperparathyroidism in elderly women. J Bone Miner Res. 2000;15(6):1113–8.PubMedCrossRef
69.
Broe KE, Chen TC, Weinberg J, Bischoff-Ferrari HA, Holick MF, Kiel DP. A higher dose of vitamin d reduces the risk of falls in nursing home residents: a randomized, multiple-dose study. J Am Geriatr Soc. 2007;55(2):234–9.PubMedCrossRef
70.
Bischoff-Ferrari HA, Orav EJ, Dawson-Hughes B. Effect of cholecalciferol plus calcium on falling in ambulatory older men and women: a 3-year randomized controlled trial. Arch Intern Med. 2006;166(4):424–30.PubMedCrossRef
71.
Dawson-Hughes B, Harris SS, Krall EA, Dallal GE. Effect of calcium and vitamin D supplementation on bone density in men and women 65 years of age or older. N Engl J Med. 1997;337(10):670–6.PubMedCrossRef
72.
Bischoff-Ferrari HA, Willett WC, Wong JB, Giovannucci E, Dietrich T, Dawson-Hughes B. Fracture prevention with vitamin D supplementation: a meta-analysis of randomized controlled trials. Jama. 2005;293(18):2257–64.PubMedCrossRef
73.
Visser M, Deeg DJ, Puts MT, Seidell JC, Lips P. Low serum concentrations of 25-hydroxyvitamin D in older persons and the risk of nursing home admission. Am J Clin Nutr. 2006;84(3):616–22. quiz 71–2.PubMed
Metadata
Title
The Role of Falls in Fracture Prediction
Author
Heike A. Bischoff-Ferrari
Publication date
01-09-2011
Publisher
Current Science Inc.
Published in
Current Osteoporosis Reports / Issue 3/2011
Print ISSN: 1544-1873
Electronic ISSN: 1544-2241
DOI
https://doi.org/10.1007/s11914-011-0059-y

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