A selection strategy was developed for fracture reduction programs in frail older people

Chen, Jian Sheng; Sambrook, Philip N.; Simpson, Judy M.; March, Lyn M.; Cumming, Robert G.; Seibel, Markus J.; Lord, Stephen R.; Cameron, Ian D.

doi:10.1016/j.jclinepi.2009.08.018

« Previous Next »Journal of Clinical Epidemiology
Volume 63, Issue 6 , Pages 679-685, June 2010

A selection strategy was developed for fracture reduction programs in frail older people

Jian Sheng Chen
- Institute of Bone and Joint Research, Royal North Shore Hospital, St Leonards, New South Wales 2065, Australia
- Corresponding author. Tel.: +61-2-99267328; fax: +61-2-99061859.
Philip N. Sambrook
- Institute of Bone and Joint Research, Royal North Shore Hospital, St Leonards, New South Wales 2065, Australia
Judy M. Simpson
- School of Public Health, University of Sydney, Edward Ford Building A27, University of Sydney, New South Wales 2006, Australia
Lyn M. March
- Institute of Bone and Joint Research, Royal North Shore Hospital, St Leonards, New South Wales 2065, Australia
Robert G. Cumming
- Centre for Education and Research on Ageing, Concord Hospital, Building 18, Concord, New South Wales 2139, Australia
Markus J. Seibel
- Anzac Research Institute, Concord Hospital, Concord, New South Wales 2139, Australia
Stephen R. Lord
- Prince of Wales Medical Research Institute, University of New South Wales, Barker Street, Randwick, New South Wales 2031, Australia
Ian D. Cameron
- Rehabilitation Studies Unit, University of Sydney, PO Box 6, Ryde, New South Wales 2112, Australia

Accepted 4 August 2009. published online 18 November 2009.

Abstract

Objectives

The aims of this study were to develop and evaluate a simple index for assessing the risk of fractures after a fall and to propose a selection strategy for identifying elderly individuals at high risk of both falls and fall-related fractures.

Study Design and Setting

Two thousand five institutionalized older men and women were assessed for clinical risk factors and then followed up for falls and fall-related fractures for up to 2 years.

Results

Our fracture risk index is derived from seven previously identified significant independent risk factors: weight, lower leg length, balance, cognitive function, type of institution, fracture history, and falls in the past year. The fracture rate was 6.5 times greater in the one-sixth of the falls with the highest index (9.7/100 falls) than in the lowest sixth (1.5/100 falls). Our proposed approach (based on balance, risk of falls, and the fracture risk index) selected a group of older people with high risk of both falls and fall-related fracture. The fracture incidence rate was 144% higher, and the falls incidence rate was 31% higher in the selected residents than in the remainder.