Risk of Falling in Patients with a Recent Fracture

Overview

Journal BMC Musculoskelet Disord

Publisher Biomed Central

Specialties Orthopedics
Physiology

Date 2007 Jun 30

PMID 17598891

Citations 22

Authors

Svenhjalmar van Helden

Caroline E Wyers

Pieter C Dagnelie

Martien C van Dongen

Gittie Willems

Peter R G Brink

Piet P Geusens

Affiliations

Soon will be listed here.

Abstract

Background: Patients with a history of a fracture have an increased risk for future fractures, even in short term. The aim of this study was to assess the number of patients with falls and to identify fall risk factors that predict the risk of falling in the first three months after a clinical fracture.

Methods: Prospective observational study with 3 months of follow-up in a large European academic and regional hospital. In 277 consenting women and men aged > or = 50 years and with no dementia and not receiving treatment for osteoporosis who presented to hospital with a clinical fracture, fall risk factors were assessed according to the guidelines on fall prevention in the Netherlands. Follow-up information on falls and fractures was collected by monthly telephone interview. Incidence of falls and odds ratio's (OR, with 95% confidence intervals) were calculated.

Results: 512 consecutive patients with a fracture were regarded for analysis, 87 were not eligible for inclusion and 137 patients were excluded. No follow-up data were available for 11 patients. Therefore full analysis was possible in 277 patients.A new fall incident was reported by 42 patients (15%), of whom five had a fracture. Of the 42 fallers, 32 had one new fall and 10 had two or more. Multivariate analysis in the total group with sex, age, ADL difficulties, urine incontinence and polypharmacy showed that sex and ADL were significant fall risk factors. Women had an OR of 3.02 (95% CI 1.13-8.06) and patients with ADL-difficulties had an OR of 2.50 (95% CI 1.27-4.93). Multivariate analysis in the female group with age, ADL difficulties, polypharmacy and presence of orthostatic hypotension indicated that polypharmacy was the predominant risk factor (OR 2.51; 95% CI: 1.19 - 5.28). The incidence of falls was 35% in women with low ADL score and polypharmacy compared to 15% in women without these risk factors (OR 3.56: CI 1.47 - 8.67).

Conclusion: 15% of patients reported a new fall and 5 patients suffered a new fracture within 3 months. Female sex and low ADL score were the major risk factors and, in addition, polypharmacy in women.

Citing Articles

Secondary fracture prevention in primary care: a narrative review.

Wang M, Seibel M Osteoporos Int. 2024; 35(8):1359-1376.

PMID: 38652313 PMC: 11281980. DOI: 10.1007/s00198-024-07036-1.

Characteristics of fallers who later sustain a hip fracture: a NOREPOS study.

Sogaard A, Aga R, Holvik K, Meyer H Osteoporos Int. 2022; 33(11):2315-2326.

PMID: 35927464 PMC: 9568442. DOI: 10.1007/s00198-022-06490-z.

Association between incident falls and subsequent fractures in patients attending the fracture liaison service after an index fracture: a 3-year prospective observational cohort study.

Vranken L, Wyers C, van der Velde R, Janzing H, Kaarsemakers S, Driessen J BMJ Open. 2022; 12(7):e058983.

PMID: 35896286 PMC: 9335024. DOI: 10.1136/bmjopen-2021-058983.

The Prevalence and Associated Risk Factors of Fear of Fall in the Elderly: A Hospital-Based, Cross-Sectional Study.

Dhar M, Kaeley N, Mahala P, Saxena V, Pathania M Cureus. 2022; 14(3):e23479.

PMID: 35475069 PMC: 9035266. DOI: 10.7759/cureus.23479.

The impact of urinary incontinence on falls: A systematic review and meta-analysis.

Moon S, Chung H, Kim Y, Kim S, Kwon O, Lee Y PLoS One. 2021; 16(5):e0251711.

PMID: 34010311 PMC: 8133449. DOI: 10.1371/journal.pone.0251711.

References

Schwartz A, Villa M, Prill M, Kelsey J, Galinus J, Delay R . Falls in older Mexican-American women. J Am Geriatr Soc. 1999; 47(11):1371-8. View

Podsiadlo D, Richardson S . The timed "Up & Go": a test of basic functional mobility for frail elderly persons. J Am Geriatr Soc. 1991; 39(2):142-8. DOI: 10.1111/j.1532-5415.1991.tb01616.x. View

Carey B, Potter J . Cardiovascular causes of falls. Age Ageing. 2002; 30 Suppl 4:19-24. DOI: 10.1093/ageing/30.suppl_4.19. View

Solomon D, Finkelstein J, Polinski J, Arnold M, Licari A, Cabral D . A randomized controlled trial of mailed osteoporosis education to older adults. Osteoporos Int. 2006; 17(5):760-7. DOI: 10.1007/s00198-005-0049-y. View

Albrand G, Munoz F, Sornay-Rendu E, Duboeuf F, Delmas P . Independent predictors of all osteoporosis-related fractures in healthy postmenopausal women: the OFELY study. Bone. 2003; 32(1):78-85. DOI: 10.1016/s8756-3282(02)00919-5. View

Pils K, Neumann F, Meisner W, Schano W, Vavrovsky G, van der Cammen T . Predictors of falls in elderly people during rehabilitation after hip fracture--who is at risk of a second one?. Z Gerontol Geriatr. 2003; 36(1):16-22. DOI: 10.1007/s00391-003-0142-9. View

Close J, Hooper R, Glucksman E, Jackson S, Swift C . Predictors of falls in a high risk population: results from the prevention of falls in the elderly trial (PROFET). Emerg Med J. 2003; 20(5):421-5. PMC: 1726177. DOI: 10.1136/emj.20.5.421. View

Stalenhoef P, Diederiks J, Knottnerus J, de Witte L, Crebolder H . The construction of a patient record-based risk model for recurrent falls among elderly people living in the community. Fam Pract. 2000; 17(6):490-6. DOI: 10.1093/fampra/17.6.490. View

Bischoff H, Stahelin H, Monsch A, Iversen M, Weyh A, von Dechend M . Identifying a cut-off point for normal mobility: a comparison of the timed 'up and go' test in community-dwelling and institutionalised elderly women. Age Ageing. 2003; 32(3):315-20. DOI: 10.1093/ageing/32.3.315. View

10.

. Prevention and management of osteoporosis. World Health Organ Tech Rep Ser. 2004; 921:1-164, back cover. View

11.

Masud T, Morris R . Epidemiology of falls. Age Ageing. 2002; 30 Suppl 4:3-7. DOI: 10.1093/ageing/30.suppl_4.3. View

12.

Francis R . Falls and fractures. Age Ageing. 2002; 30 Suppl 4:25-8. DOI: 10.1093/ageing/30.suppl_4.25. View

13.

WEI T, Hu C, Wang S, Hwang K . Fall characteristics, functional mobility and bone mineral density as risk factors of hip fracture in the community-dwelling ambulatory elderly. Osteoporos Int. 2002; 12(12):1050-5. DOI: 10.1007/pl00004184. View

14.

Scott V, Votova K, Scanlan A, Close J . Multifactorial and functional mobility assessment tools for fall risk among older adults in community, home-support, long-term and acute care settings. Age Ageing. 2007; 36(2):130-9. DOI: 10.1093/ageing/afl165. View

15.

. Guideline for the prevention of falls in older persons. American Geriatrics Society, British Geriatrics Society, and American Academy of Orthopaedic Surgeons Panel on Falls Prevention. J Am Geriatr Soc. 2001; 49(5):664-72. View

16.

van Helden S, Cals J, Kessels F, Brink P, Dinant G, Geusens P . Risk of new clinical fractures within 2 years following a fracture. Osteoporos Int. 2005; 17(3):348-54. DOI: 10.1007/s00198-005-2026-x. View

17.

Tinetti M, Speechley M, Ginter S . Risk factors for falls among elderly persons living in the community. N Engl J Med. 1988; 319(26):1701-7. DOI: 10.1056/NEJM198812293192604. View

18.

Geusens P, Milisen K, Dejaeger E, Boonen S . Falls and fractures in postmenopausal women: a review. J Br Menopause Soc. 2003; 9(3):101-6. DOI: 10.1258/136218003100322314. View

19.

Kempen G, Miedema I, Ormel J, Molenaar W . The assessment of disability with the Groningen Activity Restriction Scale. Conceptual framework and psychometric properties. Soc Sci Med. 1996; 43(11):1601-10. DOI: 10.1016/s0277-9536(96)00057-3. View

20.

Nevitt M, Cummings S, Kidd S, Black D . Risk factors for recurrent nonsyncopal falls. A prospective study. JAMA. 1989; 261(18):2663-8. View