Community-dwelling Older Men with Dementia Are at High Risk of Hip Fracture, but Not Any Other Fracture: The Concord Health and Aging in Men Project

Aim: The aim of the present longitudinal study of community-dwelling older men was to examine the association between cognitive status at baseline, and falls, fractures and bone loss over time.

Methods: In the Concord Health and Aging in Men Project, 1705 community-dwelling men aged 70-97 years had detailed baseline clinical assessment of cognitive status (dementia, mild cognitive impairment [MCI] and normal cognition), as well as depression, physical activity, neuromuscular function, health status, sociodemographics, comorbidities, medication use and serum 25 hydroxyvitamin D, 1,25 dihydroxyvitamin D and parathyroid hormone levels. During a mean follow-up period of 6 years, participants were contacted 4-monthly to ascertain incident falls and fractures, the latter being confirmed by radiographic reports. Bone mineral density was measured by dual X-ray absorptiometry at multiple time-points.

Results: At baseline, 120 men were assessed to have MCI and 93 men to have dementia. Over time, there were 162 first incident fractures, including 43 hip and 32 vertebral fractures. In univariate models, baseline dementia, but not MCI, predicted an increased incidence of hip fracture (HR 6.95, 95% CI 3.47-13.96), but not vertebral (HR 2.26, 95% CI 0.79-6.46) or non-hip non-vertebral fracture (HR 0.73, 95% CI 0.27-1.99). The strong risk of hip fractures associated with dementia remained after accounting for potential confounders (HR 4.44, 95% CI 1.97-9.98). In multivariate analyses, dementia (incidence rate ratio 2.26, 95% CI 1.70-2.99), but not MCI, was associated with an increased risk of falls compared with normal cognition. There was no association between baseline dementia and change in bone mineral density.

Conclusions: Older men with dementia, but not MCI, have a greater tendency to fall and sustain hip fractures, but not any other types of fractures. Geriatr Gerontol Int 2018; 18: 1479-1484.