Fall direction, bone mineral density, and function: Risk factors for hip fracture in frail nursing home elderly

被引:248
作者
Greenspan, SL
Myers, ER
Kiel, DP
Parker, RA
Hayes, WC
Resnick, NM
机构
[1] Beth Israel Deaconess Med Ctr, Dept Orthoped Surg, Div Bone & Mineral Metab, Boston, MA 02215 USA
[2] Beth Israel Deaconess Med Ctr, Dept Orthoped Surg, Div Gerontol, Boston, MA 02215 USA
[3] Beth Israel Deaconess Med Ctr, Dept Orthoped Surg, Orthoped Biomech Lab, Boston, MA 02215 USA
[4] Beth Israel Deaconess Med Ctr, Dept Med, Biometr Ctr, Boston, MA 02215 USA
[5] Harvard Univ, Sch Med, Charles A Dana Res Inst, Boston, MA 02114 USA
[6] Hebrew Rehabil Ctr Aged, Roslindale, MA USA
[7] Brigham & Womens Hosp, Div Gerontol, Boston, MA 02114 USA
关键词
D O I
10.1016/S0002-9343(98)00115-6
中图分类号
R5 [内科学];
学科分类号
1002 ; 100201 ;
摘要
PURPOSE: To determine the importance of fall characteristics, body habitus, function, and hip bone mineral density as independent risk factors for hip fracture in frail nursing home residents. SUBJECTS AND METHODS: In this prospective, case-control study of a single, long-term care facility, we enrolled 132 ambulatory residents (95 women and 37 men) aged 65 and older, including 32 cases (fallers with hip fracture) and 100 controls (fallers with no hip fracture). Principal risk factors included fall characteristics, body habitus, measures of functional assessment, and hip bone mineral density by dual-energy X-ray absorptiometry. RESULTS: In multivariate analysis, including only those with knowledge of the fall direction (n = 100), those who fell and suffered a hip fracture were more likely to have fallen sideways (odds ratio 5.7, 95% confidence interval [CI] 1.7 to 18, P = 0.004) and have a low hip bone mineral density (odds ratio 1.9, 95% CI 0.97 to 3.7, P = 0.06) than those who fell and did not fracture. When all participants were included (n = 132) and subjects who did not know fall direction were coded as not having fallen to the side, a fall to the side (odds ratio 3.9, 95% CI 1.3 to 11, P = 0.01), low hip bone density (odds ratio 1.8, 95% CI 1.03 to 3, P = 0.04), and impaired mobility (odds ratios 6.4, 95% CI 1.9 to 21, P = 0.002) were independently associated with hip fracture. Sixty-seven percent of subjects (87% with and 62% without hip fracture) had a total hip bone mineral density greater than 2.5 SD below adult peak bone mass and were therefore classified as having osteoporosis using World Health Organization criteria. CONCLUSIONS:,Among frail elderly nursing home fallers, the preponderance of whom are osteoporotic, a fall to the side, a low hip bone density, and impairment in mobility are all important and independent risk factors for hip fracture. These data suggest that, among the frailest elderly, measures to reduce the severity of a sideways fall and improve mobility touch on new domains of risk, independent of bone mineral density, that need to be targeted for hip fracture prevention in this high-risk group. (C) 1998 by Excerpta Medica, Inc.
引用
收藏
页码:539 / 545
页数:7
相关论文
共 44 条
  • [1] DECREASE IN VERTEBRAL BONE-DENSITY AFTER HIP-ARTHROPLASTY - A QUANTITATIVE COMPUTED-TOMOGRAPHY STUDY IN 18 ARTHROSIS CASES
    ADOLPHSON, P
    VONSIVERS, K
    DALEN, N
    JONSSON, U
    DAHLBORN, M
    [J]. ACTA ORTHOPAEDICA SCANDINAVICA, 1994, 65 (01): : 12 - 14
  • [2] [Anonymous], OLDEST OLD
  • [3] [Anonymous], 1991, Resident assessment instrument training manual and resource guide
  • [4] Randomised trial of effect of alendronate on risk of fracture in women with existing vertebral fractures
    Black, DM
    Cummings, SR
    Karpf, DB
    Cauley, JA
    Thompson, DE
    Nevitt, MC
    Bauer, DC
    Genant, HK
    Haskell, WL
    Marcus, R
    Ott, SM
    Torner, JC
    Quandt, SA
    Reiss, TF
    Ensrud, KE
    [J]. LANCET, 1996, 348 (9041) : 1535 - 1541
  • [5] AN EPIDEMIOLOGIC-STUDY OF FALL-RELATED FRACTURES AMONG INSTITUTIONALIZED OLDER-PEOPLE
    CALI, CM
    KIEL, DP
    [J]. JOURNAL OF THE AMERICAN GERIATRICS SOCIETY, 1995, 43 (12) : 1336 - 1340
  • [6] VITAMIN-D(3) AND CALCIUM TO PREVENT HIP-FRACTURES IN ELDERLY WOMEN
    CHAPUY, MC
    ARLOT, ME
    DUBOEUF, F
    BRUN, J
    CROUZET, B
    ARNAUD, S
    DELMAS, PD
    MEUNIER, PJ
    [J]. NEW ENGLAND JOURNAL OF MEDICINE, 1992, 327 (23) : 1637 - 1642
  • [7] ESTIMATING STATURE FROM KNEE HEIGHT FOR PERSONS 60 TO 90 YEARS OF AGE
    CHUMLEA, WC
    ROCHE, AF
    STEINBAUGH, ML
    [J]. JOURNAL OF THE AMERICAN GERIATRICS SOCIETY, 1985, 33 (02) : 116 - 120
  • [8] IMPAIRED VISION AND HIP FRACTURE - THE FRAMINGHAM-STUDY
    FELSON, DT
    ANDERSON, JJ
    HANNAN, MT
    MILTON, RC
    WILSON, PWF
    KIEL, DP
    [J]. JOURNAL OF THE AMERICAN GERIATRICS SOCIETY, 1989, 37 (06) : 495 - 500
  • [9] QUALITY ASSURANCE FOR BONE DENSITOMETRY RESEARCH STUDIES - CONCEPT AND IMPACT
    GLUER, CC
    FAULKNER, KG
    ESTILO, MJ
    ENGELKE, K
    ROSIN, J
    GENANT, HK
    [J]. OSTEOPOROSIS INTERNATIONAL, 1993, 3 (05) : 227 - 235
  • [10] COMPARATIVE-ASSESSMENT OF DUAL-PHOTON ABSORPTIOMETRY AND DUAL-ENERGY RADIOGRAPHY
    GLUER, CC
    STEIGER, P
    SELVIDGE, R
    ELLIESENKLIEFOTH, K
    HAYASHI, C
    GENANT, HK
    [J]. RADIOLOGY, 1990, 174 (01) : 223 - 228