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The relationship among history of falls, osteoporosis, and fractures in postmenopausal women,☆☆,,★★,,♢♢

https://doi.org/10.1053/apmr.2002.33111Get rights and content

Abstract

Geusens P, Autier P, Boonen S, Vanhoof J, Declerck K, Raus J. The relationship among history of falls, osteoporosis, and fractures in postmenopausal women. Arch Phys Med Rehabil 2002;83:903-6. Objective: To study the relative contribution of osteoporosis and falls to the occurrence of symptomatic fractures in postmenopausal women. Design: Retrospective survey of current osteoporosis in relation to falls and fractures in the preceding year. Setting: Patients of general practitioners of the area around a Belgian university. Participants: A total of 2649 consecutive postmenopausal women (mean age, 61y; range, 45–91y). Interventions: Not applicable. Main Outcome Measures: Current bone density measurements (single-photon absorptiometry in the forearm) were analyzed in relation to self-reported incidence of falls and fractures in the preceding year. Results: Osteoporosis was found in 15% of the patients, 19% reported 1 or more falls during the preceding year, and 1.8% had a fracture during the preceding year. The age-adjusted risk for a fracture in the past 12 months for a 1 standard deviation decrease in bone density was 1.9 (95% confidence interval [CI], 1.4–2.5; P<.01). Adjusted risk for age, bone density, and body mass index (BMI) for a fracture in the past 12 months in patients who reported a fall was 6.0 (95% CI, 3.1–11.5; P<.001). Compared with women without osteoporosis and without a fall, women with osteoporosis without a fall had an age- and BMI-adjusted fracture risk of 2.8 (95% CI, 0.6–12.8; P<.10), and women with osteoporosis and a fall had an adjusted-fracture risk of 24.8 (95% CI, 6.9–88.6; P<.0001). Conclusions: Falls are a major contributing factor to the occurrence of symptomatic fractures in postmenopausal women, independent of and additive to the risk attributable to age and osteoporosis. © 2002 by the American Congress of Rehabilitation Medicine and the American Academy of Physical Medicine and Rehabilitation

Section snippets

Methods

General practitioners of the area around the Limburg University Centre (Diepenbeek, Belgium) were invited to participate. The 74 collaborating general practitioners attended workshops on the aim and methods of the study. They were invited to measure bone density in women who consulted a participating physician when a densitometer was available in their practice (usually 1+wk) and who were able to give a detailed fall history. General practitioners were individually trained to measure bone

Results

The mean age of the 2649 evaluated postmenopausal women was 61 years (range, 45–91y), with a mean weight of 68kg (range, 38–156kg) and mean height of 161cm (range, 115–181cm). In these women, a total of 158 fractures were reported during the previous 2 years and 45 fractures during the previous year (mean age, 64y; range, 45–86y). The numbers and sites of fractures are in table 1.

Table 1: Location, percentage, and number of fractures in 2649 women during the last 2 years

Fracture TypeFractures %

Discussion

The results of the present study indicate that recent falls are a major risk factor for fractures in postmenopausal women, independent of and additive to, age and bone density. Recent prospective studies3, 4 have found falls to be an independent predictor of hip fracture, with a moderately elevated relative risk of 2.0. We found the OR for a recent fracture associated with a history of recent falls to be 6.0. Osteoporosis without falls more than doubled the fracture risk but this was not

Conclusion

Falls are a major contributing factor to the occurrence of symptomatic fractures in postmenopausal women, independent of and additive to the risk attributable to age and osteoporosis.

References (24)

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    Supported by MSD, Belgium, and Hologic, Belgium.

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    No commercial party having a direct financial interest in the results of the research supporting this article has or will confer a benefit upon the author(s) or upon any organization with which the author(s) is/are associated.

    Reprint requests to Piet Geusens, Biomedical Research Institute, Limburgs Universitair Centrum, Diepenbeek 3590, Belgium, e-mail: [email protected]

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    a. Hologic Europe NV, Horizon Pk, Leuvensesteenweg, 510, Bus 31, 1930 Zaventem, Belgium.

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