prediction of hip fracture in elderly men and women by fall-related factors
DESCRIPTION
Prediction of Hip Fracture in Elderly Men and Women by Fall-related Factors. ND Nguyen, C Pongchaiyakul, JR Center, JA Eisman, TV Nguyen Bone and Mineral Research Program Garvan Institute of Medical Research. Background. - PowerPoint PPT PresentationTRANSCRIPT
Prediction of Hip Fracture in Prediction of Hip Fracture in Elderly Elderly
Men and Women by Fall-related Men and Women by Fall-related Factors Factors
ND Nguyen, C Pongchaiyakul, JR Center, JA Eisman, TV Nguyen
Bone and Mineral Research Program Garvan Institute of Medical Research
Background• Various risk factors for hip fracture, including low
bone mineral density (BMD), have been identified in women, the situation in men remained unknown.
• Hip fracture is largely resulted from a fall.• It is not known whether fall-related factors (muscle
strength, postural instability) predict hip fracture.
Aims
• To assess the predictiveness and association between fall-related factors and hip fracture in elderly men and women
Study Design and MethodsStudy design
Longitudinal population-based epidemiological study
Setting Dubbo city, Australia
Participants960 women and 689 men aged 60+ (as at 1989) of Caucasian background
Outcome measure Incidence of hip fracture: ascertained by X-ray report
Risk factors– Femoral neck BMD: by DEXA– Postural sway: by sway-meter – Quadriceps strength: maximum isometric contraction
Data analysis• Incidence of hip fracture was expressed per 1000
person-years assuming a the Poisson distribution.• Cox’s proportional hazards model was used to estimate
relative risk (RR)• Individual risk factors were dichotomized into presence
or absence. A combined risk score was derived as the sum of all individual risk factors for each individual.
ResultsWomen
Men
Rat
es o
f Hip
Fra
ctur
e (p
er 1
000
pers
on-y
ears
)
0
2
4
6
8
10
12
14
16
18
20
Women Men
• Duration of follow-up: 12 y (6, 13) • 115 (86 F, 29M) hip fractures were ascertained
Results
Incidence of hip fracture per 1000 person-yrs
* mean ± SD; ‡ n (%); † median (Q1, Q3); a significant difference between hip fracture and no fracture at P<0.001 for both sexes
Women MenHip fractures No fractures Hip fractures No fractures(n=86) (n=874) (n=29) (n=660)
Age (y)* a 78.0 ± 7.7 70.3 ± 7.4 77.9 ± 7.5 69.8 ± 6.1Height (cm)* a 155.5 ± 6.6 160.0 ± 6.2 169.5 ± 7.5 173.6 ±6.9Weight (kg)* a 55.4 ± 11.0 66.2 ± 12.4 72.0 ± 14.2 78.9 ± 2.4BMI (kg/m2)* a 23 ± 4 26 ± 5 25 ± 4 26 ± 4FNBMD (g/cm2)* a 0.64 ± 0.10 0.80 ± 0.13 0.73 ± 0.17 0.93 ± 0.15Prior fracture (yes)‡ a 18 (20.9) 85 (9.7) 9 (31.0) 39 (4.7)Fall in the last 12 mo‡ a 55 (64.0) 407 (34.0) 13 (44.0) 191 (24. 0)Body sway (mm2)† a 2208 (1010,14840) 1128 (714,1972) 3355 (1066,21700) 1036 (63,1760)Quadriceps strength (kg)† a 14 (10, 18) 20 (14, 25) 24 (14, 30) 34 (26, 44)
Calcium intake (mg/d)† 528 (369, 791) 564 (408, 793) 483 (333, 783) 596 (412, 804)Menarche age (y)† a 14 (13, 15) 13 (12, 14)Menopause age (y)† 48 (41, 51) 48 (3, 51)
Table 1: Baseline characteristics of participants as at 1989
Risk factors for hip fracture after adjustment for FNBMD and sex
0 1 2 3 4 5 6 7 8 9 10
Quadriceps strength (Q1 vs others, kg)
Postural sway (Q4 vs others, mm2)
Fall in the previous year
Prior fracture
Age (+ 5y)
Risk factors:
Relative risk
Femoral neck BMD (-0.12 g/cm2)
Incidence of hip fracture by FNBMD (T-scores) and number of risk factors
0
10
20
30
40
50
60
Rat
e of
Hip
frac
ture
(per
100
0 pe
rson
-yea
rs)
Numbe
r of r
isk sc
ore
FNBMD (T-score)
3
2
1
> -1.0-2.4 to -1.1
< -2.5
50.2
32.7
6.6
11.4
4.5
1.1
0.3
0.0
3.2