Different risk profiles for hip fractures and distal forearm fractures: A prospective study

Graafmans, W.C.; Ooms, Marius; Bezemer, P.D.; Bouter, Lex M.; Lips, Paul

doi:10.1007/bf01629573

Cited by 95 publications

(66 citation statements)

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“…Although deficiencies in physical performance have been long suspected in patients who sustain distal radial fractures, the strength of this association has been difficult to prove 3,4,6 . This study provides quantitative evidence that there is compromised postural stability in older patients who have sustained distal radial fractures.…”

Section: Discussionmentioning

confidence: 99%

“…However, describing those patients as being at risk for distal radial fractures is not as intuitive 6,7 . Some functional measures of physical performance, such as the Timed Up and Go test and contralateral grip strength, are decreased in patients who have sustained a distal radial fracture 3,8,9 .…”

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confidence: 99%

“…The Disclosure of Potential Conflicts of Interest forms are provided with the online version of the article. falls 3,4,6,10 . Thus, the patients most at risk for distal radial fractures may be those who have had a subtle decline of physical performance and postural control but are not yet debilitated enough to have a decrease in activity level 8 .…”

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confidence: 99%

“…Thus, the patients most at risk for distal radial fractures may be those who have had a subtle decline of physical performance and postural control but are not yet debilitated enough to have a decrease in activity level 8 . Providing evidence that physical decline increases risk of distal radial fractures in older individuals has proven to be challenging 3,4,6 . Despite their frequent use, many "functional" performance tests lack sensitivity in detecting impaired postural control in the osteoporotic population 11 .…”

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confidence: 99%

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Postural Stability in Older Adults with a Distal Radial Fracture

Louer

Boone

Guthrie

et al. 2016

The Journal of Bone and Joint Surgery

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Background: The physical risk factors leading to distal radial fractures are poorly understood. The goal of this study was to compare postural stability between older adults with and without a prior distal radial fragility fracture. Methods: This case-control evaluation was performed at a single tertiary institution. The fracture cohort comprised 23 patients treated for a low-energy distal radial fracture within 6 to 24 months prior to this study. Twenty-three age and sex-matched control participants, without a prior fragility fracture, were selected from an outpatient clinic population. All participants completed a balance assessment with a computerized balance platform device. Dynamic motion analysis (DMA) scores ranging from 0 to 1,440 points are produced, with lower scores indicating better postural stability. Participants also completed validated questionnaires for general health quality (EuroQol-5D-3L [EQ-5D-3L]) and physical activity (Physical Activity Scale for the Elderly [PASE]) and comprehensive health and demographic information including treatment for compromised balance or osteoporosis. Statistical analysis compared data between cases and controls using either the Student t test or the Mann-Whitney U test. Results: There were no significant differences (p > 0.05) in age, sex, body mass index, physical activity score, or EQ-5D-3L general health visual analog scale score between participants with or without prior distal radial fracture. The fracture cohort demonstrated poorer balance, with higher DMA scores at 933 points compared with 790 points for the control cohort (p = 0.008). Nineteen patients (83%) in the fracture cohort reported having dual x-ray absorptiometry (DXA) scans within 5 years prior to this study, but only 2 patients (9%) had ever been referred for balance training with physical therapy. Conclusions: Older adults who sustain low-energy distal radial fractures demonstrate impaired postural stability compared with individuals of a similar age who have not sustained such fractures. Following a distal radial fracture, these patients may benefit from interventions to improve postural stability. Level of Evidence: Prognostic Level III. See Instructions for Authors for a complete description of levels of evidence.

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Section: Discussionmentioning

confidence: 99%

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confidence: 99%

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Postural Stability in Older Adults with a Distal Radial Fracture

Louer

Boone

Guthrie

et al. 2016

The Journal of Bone and Joint Surgery

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“…Hip fractures tend to occur in less active individuals falling indoors from a standing height with little forward momentum, and they tend to fall sideways or straight down on their hip [21][22][23]. However, distal forearm or humerus fractures tend to occur among more active older individuals who are, correspondingly, more likely to be outdoors and have a greater forward momentum when they fall [24][25][26]. This may also explain why hip fracture incidence shows little to no seasonal change, while the winter/summer seasonal swing is pronounced in distal forearm and humerus fractures, and more so in men than in women [27].…”

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confidence: 99%

Fragility fractures: the future epidemic and its challenges

Bischoff‐Ferrari

2012

Skeletal Radiol

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Fragility fractures contribute significantly to the morbidity and mortality of older individuals, and in a growing segment of the senior population a marked increase in these fractures is expected in the next 20 years [1,2]. The most rapidly growing segment of the senior population consists of men and women aged 85 years and older [2]. This translates in a rising number of all fragility fractures, especially those of the hip.Hip fractures are the most serious and most frequent fractures occurring among seniors aged 75 years and older [3,4], and an estimated 1 in 3 women, and 1 in 6 men will have sustained a hip fracture by their 90th decade [5]. Muscle weakness [6] and falling [7] are closely related to fragility fractures, and are critical in understanding them. Both muscle weakness and falling have been linked to the broad prevalence of vitamin D deficiency among the senior population.Severe vitamin D deficiency (serum concentrations < 10 ng/ml or < 25 nmol/l 25-hydroxyvitamin D) in the senior population causes secondary hyperparathyroidism, osteoporosis, and osteomalacia [8]. Histological osteomalacia, characterized by the accumulation of unmineralized matrix or osteoid in the skeleton, has been found to be common in several hip fracture case studies (12-44 %) [9][10][11][12][13][14]. At the same time it is well recognized that severe vitamin D deficiency is prevalent in about 60 % of hip fracture patients [15,16] and that vitamin D supplementation reduces the risk of hip fracture by 30 % [17]. Thus, it is conceivable that a significant number of hip fractures occurring in seniors are explained by osteomalacic changes that soften the bone. Additionally, as a primary clinical sign of osteomalacia, muscle weakness may contribute to the risk of fracture [18], and vitamin D supplementation may not only mineralize bone, but has been shown to reduce the risk of falling by up to 34 % [19,20].Apart from hip fractures, the two other most common fragility fractures at non-vertebral sites are distal forearm and proximal humerus fractures, and, similar to hip fractures, distal forearm and proximal humerus fractures show a steep increase with age [3]. Notably, the circumstances of these fractures are strikingly different. Hip fractures tend to occur in less active individuals falling indoors from a standing height with little forward momentum, and they tend to fall sideways or straight down on their hip [21][22][23]. However, distal forearm or humerus fractures tend to occur among more active older individuals who are, correspondingly, more likely to be outdoors and have a greater forward momentum when they fall [24][25][26]. This may also explain why hip fracture incidence shows little to no seasonal change, while the winter/summer seasonal swing is pronounced in distal forearm and humerus fractures, and more so in men than in women [27]. Men aged 65 years and older are at a 51 % greater risk of sustaining a distal forearm fracture and a 23 % greater risk of sustaining a proximal humerus fracture in the winter compared w...

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Gout and Risk of Fracture in Women: A Prospective Cohort Study

Paik

Kim

Feskanich

et al. 2017

Arthritis & Rheumatology

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Objective Uric acid may be linked to bone health through its anti-oxidant or pro-oxidant effects, thereby affecting bone resorption and formation, or through inhibition of vitamin D activation and higher parathyroid hormone level. Prior studies on the relation between uric acid and bone mineral density have demonstrated conflicting results. To date, there are no prospective studies examining the relation between gout, a disease characterized by hyperuricemia and inflammation, and hip or wrist fracture risk in women. Methods We conducted a prospective observational study of gout and risk of incident wrist and hip fracture in women participating in the Nurses’ Health Study (n=103,799 at baseline with 14 years of follow-up for the wrist fracture analysis and 22 years of follow-up for the hip fracture analysis). Gout history and wrist and hip fracture were assessed by biennial questionnaires. Cox proportional-hazards models were used to simultaneously adjust for potential confounders. Results There were 3,769 incident wrist fractures (1990–2004) and 2,147 incident hip fractures (1990–2012), with 107 wrist and 117 hip fractures among participants with gout. The multivariable-adjusted relative risk of wrist fracture in women with a history of gout compared with women without gout was 1.12 (95% CI 0.92 to 1.36). The multivariable-adjusted relative risk of hip fracture in women with a history of gout compared with women without gout was 1.38 (95% CI 1.14 to 1.68). Conclusion A history of gout is associated with a modestly increased risk of hip fracture but not significantly associated with risk of wrist fracture in women.

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Different risk profiles for hip fractures and distal forearm fractures: A prospective study

Cited by 95 publications

References 24 publications

Postural Stability in Older Adults with a Distal Radial Fracture

Postural Stability in Older Adults with a Distal Radial Fracture

Fragility fractures: the future epidemic and its challenges

Gout and Risk of Fracture in Women: A Prospective Cohort Study

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