Incremental Predictive Value of Sarcopenia for Incident Fracture in an Elderly Chinese Cohort: Results From the Osteoporotic Fractures in Men (MrOs) Study

ObjectivesWe examined whether sarcopenia is predictive of incident fractures among older men, whether the inclusion of sarcopenia in models adds any incremental value to bone mineral density (BMD), and whether sarcopenia is associated with a higher risk of fractures in elderly with osteoporosis.MethodsA cohort of 2000 community-dwelling men aged ≥65 years were examined for which detailed information regarding demographics, socioeconomic, medical history, clinical, and lifestyle factors were documented. Body composition and BMD were measured using dual energy X-ray absorptiometry. Sarcopenia was defined according to the Asian Working Group for Sarcopenia (AWGS) algorithm. Incident fractures were documented during the follow-up period from 2001 to 2013, and related to sarcopenia and its component measures using Cox proportional hazard regressions. The contribution of sarcopenia for predicting fracture risk was evaluated by receiver operating characteristic analysis, net reclassification improvement (NRI), and integrated discrimination improvement (IDI).ResultsDuring an average of 11.3 years of follow-up, 226 (11.3%) men sustained at least 1 incident fracture, making the incidence of fractures 1200.6/100,000 person-years. After multivariate adjustments, sarcopenia was associated with increased fracture risk (hazard ratio [HR], 1.87, 95% confidence interval [CI], 1.26–2.79) independent of BMD and other clinical risk factors. The addition of sarcopenia did not significantly increase area under curve or IDI but significantly improved the predictive ability on fracture risk over BMD and other clinical risk factors by 5.12% (P < .05) using the NRI approach. In addition, the combination of osteoporosis and sarcopenia (sarco-osteoporosis) resulted in a significantly increased risk of fractures (HR, 3.49, 95% CI, 1.76–6.90) compared with those with normal BMD and without sarcopenia.ConclusionsThis study confirms that sarcopenia is a predictor of fracture risk in this elderly men cohort, establishes that sarcopenia provides incremental predictive value for fractures over the integration of BMD and other clinical risk factors, and suggests that the combination of osteoporosis and sarcopenia could identify a subgroup with a particularly high fracture risk.     

Effects of Dementia on Postoperative Outcomes of Older Adults With Hip Fractures: A Population-Based Study

ObjectiveTo evaluate the association between dementia and postoperative outcomes of older adults with hip fractures.DesignPopulation-based, retrospective cohort study.SettingProvince of Ontario, Canada.ParticipantsAll individuals with hip fractures who underwent hip fracture surgery in Ontario, Canada between April 1, 2003 and March 31, 2010 were identified. Physician-diagnosed dementia, prior to hip fracture, was identified using a diagnostic algorithm in the administrative databases.MeasurementsThe preoperative characteristics of older adults with and without dementia were compared separately for individuals admitted to hospital from community or long-term care (LTC). Multivariable regression was used to compare postoperative health service utilization, time with LTC admission, and mortality for individuals with and without dementia.ResultsA total of 45,602 older adults had hip fractures and individuals with dementia accounted for 23.9% and 83.5% of all hip fractures from the community and LTC settings, respectively. Compared with those without dementia, individuals with dementia were less likely to be admitted to rehabilitation facilities. Among community-dwelling older adults, dementia was associated with an increased risk of LTC admission [hazard ratio (HR) = 2.49, 95% confidence interval (CI): 2.38–2.61, P < .0001]. Dementia was also associated with a higher mortality for older adults from community (HR = 1.47, 95% CI: 1.41–1.52, P < .0001) and LTC (HR = 1.10; 95% CI: 1.02–1.18, P = .005) settings.ConclusionsDementia is common among older adults with hip fractures and associated with poor prognosis following hip fracture surgery. Specialized services targeting the growing number of older adults with dementia may help to prevent hip fractures and optimize postoperative care for this vulnerable population.     

Risk Factors and 120-Day Functional Outcomes of Delirium After Hip Fracture Surgery: A Prospective Cohort Study Using the UK National Hip Fracture Database (NHFD)

ObjectivesTo identify risk factors of postoperative delirium among hip fracture patients with normal preoperative cognition, and examine associations with returning home or recovery of mobility.DesignProspective cohort study.Setting and ParticipantsWe used the National Hip Fracture Database (NHFD) to identify patients presenting with hip fracture in England (2018–2019), but excluded those with abnormal cognition [abbreviated mental test score (AMTS) < 8] on presentation.MethodsWe examined the results of routine delirium screening performed using the 4 A's Test (4AT), to assess alertness, attention, acute change, and orientation in a 4-item mental test. Associations between 4AT score and return home or to outdoor mobility at 120 days were estimated, and risk factors identified for abnormal 4AT scores: (1) 4AT ≥4 suggesting delirium and (2) 4AT = 1–3 being an intermediate score not excluding delirium.ResultsOverall, 63,502 patients (63%) had a preoperative AMTS ≥8, in whom a postoperative 4AT score ≥4 suggestive of delirium was seen in 4454 (7%). These patients were less likely to return home [odds ratio (OR), 0.46; 95% CI, 0.38–0.55] or regain outdoor mobility (OR, 0.63; 95% CI, 0.53–0.75) by 120 days. Multiple factors including any deficit in preoperative AMTS and malnutrition were associated with higher risk of 4AT ≥4, while use of preoperative nerve blocks was associated with lower risk (OR, 0.88; 95% CI, 0.81–0.95). Poorer outcomes were also seen in 12,042 (19%) patients with 4AT = 1–3; additional risk factors associated with this score included socioeconomic deprivation and surgical procedure types that were not compliant with National Institute of Health and Care Excellence guidance.Conclusion and ImplicationsDelirium after hip fracture surgery significantly reduces the likelihood of returning home or to outdoor mobility. Our findings underline the importance of measures to prevent postoperative delirium, and aid the identification of high-risk patients for whom delirium prevention might potentially improve outcomes.     

Factors Associated With Hospital Presentation of Self-Harm Among Older Canadians in Long-Term Care: A 12-Year Cohort Study

ObjectivesThis study aimed to examine the incidence of, and factors associated with, hospital presentation for self-harm among older Canadians in long-term care (LTC).DesignRetrospective cohort study.Setting and ParticipantsThe LTC data were collected using Resident Assessment Instrument–Minimum Data Set (RAI-MDS) and Resident Assessment Instrument–Home Care (RAI-HC), and linked to the Discharge Abstract Database (DAD) with hospital records of self-harm diagnosis. Adults aged 60+ at first assessment between April 1, 2003, and March 31, 2015, were included.MethodsAdjusted hazard ratios (HRs) of self-harm for potentially relevant factors, including demographic, clinical, and psychosocial characteristics, were calculated using Fine & Gray competing risk models.ResultsRecords were collated of 465,870 people in long-term care facilities (LTCF), and 773,855 people receiving home care (HC). Self-harm incidence per 100,000 person-years was 20.76 [95% confidence interval (CI) 20.31–25.40] for LTCF and 46.64 (44.24–49.12) for HC. In LTCF, the strongest risks were younger age (60–74 years vs 90+: HR, 6.00; 95% CI, 3.24–11.12), psychiatric disorders (bipolar disorder: 3.46; 2.32–5.16; schizophrenia: 2.31; 1.47–3.62; depression: 2.29; 1.80–2.92), daily severe pain (2.01; 1.30–3.11), and daily tobacco consumption (1.78; 1.29–2.45). For those receiving HC, the strongest risk factors were younger age (60–74 years vs 90+: 2.54; 1.97–3.28), psychiatric disorders (2.20; 1.93–2.50), daily tobacco consumption (2.08; 1.81–2.39), and frequent falls (1.98; 1.46–2.68). All model interactions between setting and factors were significant.Conclusions and ImplicationsThere was lower incidence of hospital presentation for self-harm for LTCF residents than HC recipients. We found sizable risks of self-harm associated with several modifiable risk factors, some of which can be directly addressed by better treatment and care (psychiatric disorders and pain), whereas others require through more complex interventions that target underlying factors and causes (tobacco and falls). The findings highlight a need for setting- and risk-specific prevention strategies to address self-harm in the older populations.     

High BMI and the risk of lower extremity fractures in fertile-aged women: A nationwide register-based study in Finland

ObjectivesBoth high and low body mass index (BMI) is known to be associated with increased risk for osteoporotic fractures in the postmenopausal population. However, the association between BMI and risk for fracture in the fertile-aged (15–49 years) population is not well studied. We aim to examine how increased BMI affects the risk for fracture leading to hospitalization after delivery in fertile-aged women.Material and methodsIn this nationwide registry-based study, data on all women aged 15–49 years with fractures leading to hospitalization were retrieved from the Care Register for Health Care for the years 2004–2018. The data were linked with data from the National Birth Register, where the BMI status is collected for each pregnancy. Cox regression was used to examine the effect of increased BMI on the risk for fracture within five years after delivery. Risks were analyzed separately for upper extremity, spine and pelvis, and lower extremity fractures. The results were interpreted with hazard ratios (HR), adjusted hazard ratios (aHR), and 95% confidence intervals (CI).ResultsA total of 529 992 pregnant women with 3276 fractures leading to hospitalization within 5-year follow-up were included in this study. Of these, a total of 548 fractures required surgical treatment. Patients with BMI of 30 kg/m² or more had a higher rate of fractures in the lower extremity (≥50%). In lower extremity fractures, risk for fracture increased with increasing BMI. The risk fracture was highest in the group with BMI of 35–40 kg/m² (overall lower extremity aHR 2.43 95% CI 1.92–3.06; knee aHR 2.04, 95% CI 1.45–2.87; ankle aHR 3.01, 95% CI 2.16–4.20).ConclusionsHigher BMI was associated to the increased risk for lower extremity fractures, especially ankle fractures, within five years of delivery. Information gained from this study is important in the clinical setting, as patients can be informed of the negative effect of obesity on the post-delivery risk for fractures.     

Prospective Analysis of Health and Mortality Risk in Veteran and Non-Veteran Participants in the Women's Health Initiative

BackgroundThe health of postmenopausal women veterans is a neglected area of study. A stronger empirical evidence base is needed, and would inform the provision of health care for the nearly 1 million U.S. women veterans currently 50 years of age or older. To this end, the present work compares salient health outcomes and risk of all-cause mortality among veteran and non-veteran participants of the Women's Health Initiative (WHI).MethodsThis study features prospective analysis of long-term health outcomes and mortality risk (average follow-up, 8 years) among the 3,706 women veterans and 141,009 non-veterans who participated in the WHI Observational Study or Clinical Trials. Outcome measurements included confirmed incident cases of cardiovascular disease (CVD), cancer, diabetes, hip fractures, and all-cause mortality.ResultsWe identified 17,968 cases of CVD, 19,152 cases of cancer, 18,718 cases of diabetes, 2,817 cases of hip fracture, and 13,747 deaths. In Cox regression models adjusted for age, sociodemographic variables, and health risk factors, veteran status was associated with significantly increased risk of all-cause mortality (hazard ratio [HR], 1.13; 95% CI, 1.03–1.23), but not with risk of CVD (HR, 1.00; 95% CI, 0.90–1.11), cancer (HR, 1.04; 95% CI, 0.95–1.14), hip fracture (HR, 1.16; 95% CI, 0.94–1.43), or diabetes (HR, 1.00; 95% CI, 0.89–1.1).ConclusionsWomen veterans' postmenopausal health, particularly risk for all-cause mortality, warrants further consideration. In particular, efforts to identify and address modifiable risk factors associated with all-cause mortality are needed.     

Fracturas de cadera en pacientes tratados con fármacos antipsicóticos. Estudio de cohortes históricas en Cataluña

ObjectiveTo evaluate the incidence of hip fracture in patients with antipsychotic treatment, comparing it with that of individuals who have not been treated with antipsychotics.DesignRetrospective cohort study of patients treated with antipsychotic drugs (TAP) and patients without known treatment (non-TAP). The observation period was 2006–2014.SiteAll primary care teams in Catalonia of the Catalan Health Institute (ICS).ParticipantsPatients older than 44 years with TAP lasting at least 3 months. Control cohort: random selection of non-TAP patients matching for baseline comorbidities and other variables. A total of 22,010 are analyzed.Main measurements Incidence rate (1000× person-years: PY) of hip fracture in each group (TAP and non-TAP). Cox regression models to estimate adjusted risks (hazard ratio: HR).ResultsThe hip fracture incidence rate was higher in TAP patients (5.83 vs 3.58 fractures per 1000 PY), and is higher in all strata according to sex, age and type of diagnosis. The risk of suffering a hip fracture was 60% higher (HR: 1.60 95% CI: 1.34–1.92) in the TAP group than in the non-TAP group. The risk was higher in the group with schizophrenia (HR: 3.57 95% CI: 1.75–7.30), followed by bipolar disorder (HR: 2.61; 95% CI: 1.39–4.92) and depression (HR: 1.51; 95% CI: 1.21–1.88).ConclusionsPatients with antipsychotic treatment have a higher risk of hip fracture than those who have not been treated with antipsychotics.     

Sarcopenia Combined With FRAX Probabilities Improves Fracture Risk Prediction in Older Chinese Men

ObjectivesTo examine whether the inclusion of sarcopenia in prediction models adds any incremental value to fracture risk assessment tool (FRAX).Design, Setting, and ParticipantsData from a prospective cohort of 4000 community-dwelling Chinese men and women aged 65 years and older with adjudicated fracture outcomes were analyzed.MeasurementsAt baseline, femoral neck bone mineral density (BMD) was assessed, as were the clinical risk factors included in FRAX, along with additional appendicular skeletal muscle mass, grip strength, and gait speed. Sarcopenia was defined according to the Asian Working Group for Sarcopenia algorithm. Incident fractures were documented during the follow-up period from 2001 to 2013.ResultsOf 4000 participants, 565 experienced at least 1 type of incident fracture and 132 experienced a hip fracture during a follow-up of 10.2 years. Hazard ratios (HRs) for 1-unit increase in FRAX score without BMD in men were 1.12 [95% confidence interval (CI) 1.08–1.16] for all fractures combined and 1.19 (95% CI 1.13–1.27) for hip fracture, and in women were 1.04 (95% CI 1.03–1.06) for all fractures combined and 1.08 (95% CI 1.06–1.11) for hip fracture. Similar to results of the FRAX score without BMD, HRs for 1-unit increase in FRAX score with BMD in men were 1.04 (95% CI 1.03–1.06) for all fractures combined and 1.19 (95% CI 1.13–1.25) for hip fracture, and in women were 1.04 (95% CI 1.03–1.05) for all fractures combined and 1.06 (95% CI 1.05–1.08) for hip fracture. Sarcopenia was significantly associated with all fractures combined (Adjusted HR 1.87; 95% CI 1.30–2.68) and hip fracture (Adjusted HR 2.67; 95% CI 1.46–4.90) in men but not in women. The discriminative values for fracture, as measured by the area under the receiver operating characteristic curve, were 0.60–0.73 and 0.62–0.76 for FRAX without and with BMD, respectively. Adding sarcopenia did not significantly improve the discriminatory capacity over FRAX (P > .05). Using reclassification techniques, sarcopenia significantly enhanced the integrated discrimination improvement by 0.6% to 1.2% and the net reclassification improvement by 7.2% to 20.8% in men, but it did not contribute to predictive accuracy in women.ConclusionsSarcopenia added incremental value to FRAX in predicting incident fracture in older Chinese men.     

Risk Factors for Hip Fracture and a Possible Effect Modification by Hormone Replacement Therapy. The Danish Nurse Cohort Study

Objective: To identify risk factors for hip fracture and to examine whether hormone replacement therapy (HRT) modifies the effect of these risk factors. Design: Prospective cohort study. Setting: The Danish Nurse Cohort Study. Participants: 14,015 female nurses aged 50 years and above who in 1993 completed a questionnaire on general health and lifestyle issues, reproductive history including information on HRT, and family history of osteoporosis and personal history of a wrist fracture. Outcome measures: End-point was the first-ever hip fracture registered in the Danish National Hospital Register during the period from 1993 to 1999. Results: During the follow-up period 245 hip fractures were identified. Ever users of HRT had a lower risk of hip fracture (hazard ratio 0.69; 0.50–0.94). Women reporting a poor health (hazard ratio 2.01; 1.30–3.11), restrictions in daily activities (hazard ratio 1.52; 1.05–2.21), low body mass index (hazard ratio 1.65; 0.98–2.77), and leisure time sedentary physical activity (hazard ratio 1.88; 1.30–2.70) were main identified risk factors for hip fracture. HRT did not modify the effect of risk factors on the risk of hip fracture. Conclusion: This study confirms that women with a frail health are at increased hip fracture risk and that ever use of HRT decreases the risk of hip fracture. HRT did not modify the effect of these risk factors, indicating that the preventive effect of this therapy is independent of risk factors.     

The Impact of COVID-19 on the Prevalence,Mortality, and Associated Risk Factors for Mortality in Patients with Hip Fractures: A Meta-Analysis

ObjectiveThis study aimed to assess (1) the prevalence of COVID-19 in patients with hip fracture; (2) the mortality rate of patients with hip fracture associated with COVID-19; (3) risk factors associated with mortality in patients with hip fracture; and (4) the effects of COVID-19 on surgical outcomes of patients with hip fracture.DesignMeta-analysis.Setting and ParticipantsPatients with hip fractures during COVID-19.MethodsPubMed, Web of Science, and Embase were systematically reviewed. The outcomes included the prevalence of COVID-19, case fatality rate, 30-day mortality, cause of death, risk factors associated with the mortality of patients with hip fracture, time to surgery, surgical time, and length of hospitalization. Risk ratio or weight mean difference with 95% confidence intervals were used to pool the estimates.ResultsA total of 60 studies were included in this meta-analysis. The pooled estimate showed that the prevalence of COVID-19 was 21% in patents with hip fractures. Patients with hip fracture with COVID-19 had an increased 30-day mortality risk compared with those without the infection. The main causes of death were respiratory failure, COVID-19–associated pneumonia, multiorgan failure, and non–COVID-19 pneumonia. The hospitalization was longer in patients with COVID-19 when compared with those without the infection, but was shorter in patients during the pandemic period. The surgery time and time to surgery were not significantly different between patients during or before the pandemic period and in those with or without COVID-19.Conclusions and ImplicationsThe 30-day mortality rate was significantly higher in patients with hip fracture with COVID-19 infection than those without. Patients with COVID-19 had a higher all-cause mortality rate than those without. This information can be used by the medical community to guide the management of patients with hip fracture with COVID-19.     

Risk of Hospitalized Falls and Hip Fractures in 22,103 Older Adults Receiving Mental Health Care vs 161,603 Controls: A Large Cohort Study

ObjectivesTo investigate the risk of hospitalized fall or hip fracture among older adults using mental health services.DesignRetrospective cohort study.Setting and ParticipantsResidents of a South London catchment aged >60 years receiving specialist mental health care between 2008 and 2016.MeasuresFalls and/or a hip fracture leading to hospitalization were ascertained from linked national records. Incidence rates and incidence rate ratios (IRRs) were age- and gender-standardized to the catchment population. Multivariable survival analyses were applied investigating falls and/or hip fractures as outcomes.ResultsIn 22,103 older adults, incidence rates were 60.1 per 1000 person-years for hospitalized falls and 13.7 per 1000 person-years for hip fractures, representing standardized IRRs of 2.17 [95% confidence interval (CI) 2.07-2.28] and 4.18 (3.79-4.60), respectively. The IRR for falls was high in those with substance-use disorder [IRR = 6.72 (5.35-8.33)], bipolar disorder [IRR = 3.62 (2.50-5.05)], depression [IRR = 2.28 (2.00-2.59)], and stress-related disorders [IRR = 2.57 (2.10-3.11)]. Hip fractures were increased in all populations (IRR > 2.5), with greatest risk in substance use disorders [IRR = 12.64 (7.22-20.52)], dementia [IRR = 4.38 (3.82-5.00)], and delirium [IRR = 4.03 (3.00-5.29)]. Comparing mental disorder subgroups with each other, after the adjustment for 25 potential confounders, patients with dementia and substance use had a significantly increased risk of falls, and patients with dementia also had an increased risk of hip fractures.Conclusion and ImplicationsOlder people using mental health services have more than double the incidence of falls and 4 times the incidence of hip fractures compared to the general population. Although incidences differ between diagnostic subgroups, all groups have a higher incidence than the general population. Targeted interventions to prevent falls and hip fractures among older adult mental health service users are urgently needed.     

Effects of high-intensity progressive resistance training and targeted multidisciplinary treatment of frailty on mortality and nursing home admissions after hip fracture: a randomized controlled trial

RationaleExcess mortality and residual disability are common after hip fracture.HypothesisTwelve months of high-intensity weight-lifting exercise and targeted multidisciplinary interventions will result in lower mortality, nursing home admissions, and disability compared with usual care after hip fracture.DesignRandomized, controlled, parallel-group superiority study.SettingOutpatient clinicParticipantsPatients (n = 124) admitted to public hospital for surgical repair of hip fracture between 2003 and 2007.InterventionTwelve months of geriatrician-supervised high-intensity weight-lifting exercise and targeted treatment of balance, osteoporosis, nutrition, vitamin D/calcium, depression, cognition, vision, home safety, polypharmacy, hip protectors, self-efficacy, and social support.OutcomesFunctional independence: mortality, nursing home admissions, basic and instrumental activities of daily living (ADLs/IADLs), and assistive device utilization.ResultsRisk of death was reduced by 81% (age-adjusted OR [95% CI] = 0.19 [0.04–0.91]; P < .04) in the HIPFIT group (n = 4) compared with usual care controls (n = 8). Nursing home admissions were reduced by 84% (age-adjusted OR [95% CI] = 0.16 [0.04–0.64]; P < .01) in the experimental group (n = 5) compared with controls (n = 12). Basic ADLs declined less (P < .0001) and assistive device use was significantly lower at 12 months (P = .02) in the intervention group compared with controls. The targeted improvements in upper body strength, nutrition, depressive symptoms, vision, balance, cognition, self-efficacy, and habitual activity level were all related to ADL improvements (P < .0001–.02), and improvements in basic ADLs, vision, and walking endurance were associated with reduced nursing home use (P < .0001–.05).ConclusionThe HIPFIT intervention reduced mortality, nursing home admissions, and ADL dependency compared with usual care. Australian New Zealand Clinical Trials Registry (ACTN12605000164695).     

Plasma retinol and total carotenes and fracture risk after long-term supplementation with high doses of retinol

ObjectiveObservational studies suggest that moderate intakes of retinol and increased circulating retinol levels may increase fracture risk. Easy access to supplements, combined with an aging population, makes this a potentially important association. The aim of this study was to investigate plasma retinol and total carotene concentrations in relation to fracture risk after long-term supplementation with retinol and/or beta-carotene in 998 adults between 1990 and 2007.MethodsParticipants were 663 men and 335 women in a cancer prevention program who were initially randomized to a retinol (7.5 mg RE/d) or beta-carotene (30 mg/d) supplement between 1990 and 1996. After 1996, all participants received the retinol supplement only. Plasma retinol and total carotene, medication use and various lifestyle factors were measured at annual clinic visits. Fractures were identified by self-report in 2007. The risk for any fracture or osteoporotic fracture was modeled using Cox proportional hazard models.ResultsOver a median follow-up of 7.8 y, 123 participants with plasma samples reported an incident fracture. Although plasma retinol concentrations were markedly higher than those reported in observational studies, no association was observed between plasma retinol and risk for any fracture (hazard ratio [HR], 0.86 μmol/L; 95% confidence interval [CI], 0.65–1.14) or osteoporotic fracture (HR, 0.97 μmol/L; 95% CI, 0.66–1.43). A lower risk for any fracture was suggested with increasing plasma total carotenes (HR, 0.85 μmol/L; 95% CI, 0.71–1.01).ConclusionsThis study does not support earlier reports of an increased fracture risk associated with increased plasma retinol concentration. The potential for carotenes to prevent fractures deserves further investigation.     

Is Health-Related Quality of Life an Independent Prognostic Factor for 12-Month Mortality and Nursing Home Placement Among Elderly Patients Hospitalized via the Emergency Department?

ObjectivesTo assess whether health-related quality of life is an independent prognostic factor for mortality or nursing home placement in frail elderly patients.DesignA prospective, multicenter study with a 12-month follow-up.SettingNine French hospitals.ParticipantsA total of 1306 patients aged 75 and older hospitalized through an emergency department.MeasurementsData obtained from sociodemographic characteristics, Comprehensive Geriatric Assessment and the Duke Health Profile (DHP) were used into a Cox model to identify prognostic variables for 12-month mortality and institutionalization.ResultsCrude mortality and nursing home placement rates were 34.1% (n = 445) and 16.1% (n = 210), respectively. Independent prognostic factors identified for mortality were: Comorbidity level (moderate: hazard ratio [HR] [95% confidence interval (CI)] = 1.40 [1.09–1.78]; severe: 2.70 [1.63–4.46]), dependence for activities of daily living (1.68 [1.06–2.67]), pressure sore risk (1.49 [1.16–1.90]), risk of malnutrition (2.09 [1.46–3.00]), delirium (2.25 [1.75–2.90]), and 10-point increase in the DHP perceived health score (0.96 [0.93–0.99]). Independent prognostic factors identified for nursing home placement were the following: living alone at home (1.82 [1.30–2.55]), having 2 children or more (0.71 [0.51–0.99]), dependence for activities of daily living (2.48 [1.39–4.44]), dementia (1.93 [1.39–2.69]), unplanned hospital readmission during follow-up (2.05 [1.45–2.91]), and 10-point increase in the DHP social health score (0.90 [0.83–0.99]). Balance troubles and risk of malnutrition were no more significant when adjusted for the DHP scores and other clinical variables.ConclusionThe perceived health and social health scores of the DHP were independent prognostic factors of survival and nursing home placement among hospitalized elderly patients, respectively. When associated with Comprehensive Geriatric Assessment, they could help screen frail patients to set up as early as possible targeted interventions to restore/maintain modifiable prognostic factors, such as nutritional status, functional ability, and social support.     

Pelvic Fracture Rates in Community-Living People With and Without Disability and in Residents of Nursing Homes

ObjectivesThere are limited data on the epidemiology of pelvic fractures. The purpose of this study was to calculate incidence rates of pelvic fractures leading to hospital admission and to compare incidence rates between residents of nursing homes and community-dwelling persons with and without care need.MethodsData were retrieved from a database of the largest health insurance company in Bavaria, Germany. Between 2004 and 2009, 10,170 pelvic fractures were observed in 751,101 women and 491,098 men. Age- and gender-specific incidence rates were calculated. Incidence rates were further stratified by setting (nursing home versus community) and functional status (no care need versus care need for those in the community). In addition, the average cumulative risk for a pelvic fracture at different ages was calculated.ResultsThe incidence rate increased from 0.54 and 0.38 per 1000 person-years in women and men aged 65 to 69 years to 9.35 and 4.45 per 1000 person-years in women and men aged 90 years and older, respectively. Persons living in a nursing home or living at home with care need had considerably higher incidence rates than community-dwelling older persons without care need. The average cumulative risk at the age of 65 years for an incident pelvic fracture until the age of 90 years was 6.9% in women and 2.8% in men.ConclusionThe incidence of pelvic fractures leading to hospital admission is higher in women than in men and rises dramatically with increasing age. Persons with care need have a particularly high risk for pelvic fracture.     

Preventive strategy of fall for the prevention of fractures in older people: a review of the evidence

This review aims to examine the effectiveness of fall-related strategies for fracture prevention among elderly population. Previous studies were reviewed using PubMed and Japan Centra Revuo Medicina databases. Our five research questions concerned prediction of fracture using history of accidental falls, fracture risk management, and effectiveness of exercise programs, home modification and usage of hip protector. We used "accidental falls" and "fractures" as search strategies. Obtained results were as follows: a) History of falls predicts future hip fracture. b) Exercise programs including balance training have positive effects for fracture prevention. c) Fracture risk evaluation and management reduce the number of hip fractures among elderly population. d) Environmental hazard assessment and necessary home modification are effective in preventing fractures especially among elderly population with the history of falls. e) The hip protector is a beneficial device for the prevention of hip fractures among elderly people at high risk of falling.     

Proton-pump inhibitor use and hip fractures in men: a population-based case-control study

PurposeTo estimate the association between proton-pump inhibitor (PPI) use and hip fracture.MethodsWe conducted a case-control study of 6774 pairs of men aged 45 years or older, matched on age, race, and medical center. Cases sustained incident hip fractures in 1997–2006. Fracture date was index date for each case-control pair. PPI exposure was identified from electronic pharmacy records, 1991–2006. PPI use was measured as (1) ever versus never; (2) adherence; (3) duration; and (4) recentness. Omeprazole and pantoprazole were analyzed separately using conditional logistic regression, adjusted for comorbidities. Nonusers were the referent group.ResultsEight hundred ninety-six (13.2%) cases and 713 (10.5%) controls used omeprazole before index date (matched odds ratio [OR], 1.13; 95% confidence interval [CI], 1.01–1.27). Greatest adherence (medication possession ratio > 80%) (OR, 1.33; 95% CI, 1.09–1.62), highest tertile of duration (OR, 1.23; 95% CI, 1.02–1.48), and recent use (OR, 1.22; 95% CI, 1.02–1.47) were associated with hip fracture. Six hundred ninety-four (10.2%) cases and 576 (8.5%) controls had used pantoprazole (OR, 1.10; 95% CI, 0.97–1.24). Longest duration (OR, 1.25; 95% CI, 1.02–1.53) and most recent use (OR, 1.38; 95% CI, 1.12–1.71) were associated with hip fracture. Our study suggests that PPI use and hip fractures are associated, with risk increasing with longer duration and more recent use.     

Motoric Cognitive Risk Syndrome and Risk for Falls,Their Recurrence,and Postfall Fractures: Results From a Prospective Observational Population-Based Cohort Study

ObjectiveMotoric cognitive risk syndrome (MCR) is a predementia stage associated with increased risk for falls. There are conflicting results regarding its association with recurrent falls and no information about its association with postfall fractures. The aim of the study was to examine the association of MCR and its components [ie, slow walking speed and subjective cognitive complaint (SCC)] with the occurrence of falls, their recurrence, and postfall fractures in older community-dwelling adults.DesignObservational prospective and longitudinal cohort study.Setting and participantsFrench community-dwelling older women (n = 5958) recruited in the EPIDémiologie de l'OStéoporose (EPIDOS) study.MeasuresMCR was defined as both the presence of SCC and slow walking speed in women free of major neurocognitive disorders. Falls (≥1), recurrent falls (≥2), and postfall fractures (any fractures and hip fractures) were prospectively recorded using mail and/or phone call questionnaires every 4 months over 4 years.ResultsAt baseline, the prevalence of SCC was 43.1% (n = 2569), slow walking speed 5.7% (n = 341), and MCR 9.9% (n = 591). Overall, 25.7% (n = 1533) of participants reported any fall during the follow-up. The incidence of postfall hip fractures was higher in participants with MCR compared to healthy participants and those with SCC (P ≤ .001). Cox regression models revealed that only participants with MCR had a significantly high risk for falls [hazard ratio (HR) = 1.22, P = .021], recurrent falls (HR = 1.46 with P = .030), and postfall hip fractures (HR = 2.54, P ≤ .001).Conclusions/ImplicationsThere is an increased risk for falls, their recurrence, and postfall hip fractures associated with MCR but not with its individual components. This finding underscores the clinical interest of MCR for the detection of older adults at risk for falls and their related adverse events in order to start early appropriate interventions for fall reduction.