Imminent fall risk after fracture

Schene, Merle R; Wyers, Caroline E; Driessen, Annemariek M H; Souverein, Patrick C; Gemmeke, Marle; van den Bergh, Joop P; Willems, Hanna C

doi:10.1093/ageing/afad201

Cited by 4 publications

(2 citation statements)

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“…The lack of association with mortality outcomes in our study might be explained by the low mortality incidence during follow-up. The survival of 95.5% was the same as the 6-year survival of 65-year-olds in the general Dutch population (95.8%) [56], indicating a healthy subset of fracture patients, who generally have an increased mortality risk [3].…”

Section: Discussionmentioning

confidence: 99%

“…Fractures are associated with short-and long-term disability and a decrease in quality of life [2]. Fracture patients have a high imminent risk of falls, subsequent fractures, and mortality [3]. Therefore, adequate and early secondary fall and fracture prevention is essential to lower the risk of subsequent falls, fractures, and mortality post-fracture [4,5].…”

Section: Introductionmentioning

confidence: 99%

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The “Can Do, Do Do” Framework Applied to Assess the Association between Physical Capacity, Physical Activity and Prospective Falls, Subsequent Fractures, and Mortality in Patients Visiting the Fracture Liaison Service

Schene,

Wyers,

Driessen

et al. 2024

JPM

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The “can do, do do” framework combines measures of poor and normal physical capacity (PC, measured by a 6 min walking test, can do/can’t do) and physical activity (PA, measured by accelerometer, do do/don’t do) into four domains and is able to categorize patient subgroups with distinct clinical characteristics, including fall and fracture risk factors. This study aims to explore the association between domain categorization and prospective fall, fracture, and mortality outcomes. This 6-year prospective study included patients visiting a Fracture Liaison Service with a recent fracture. Outcomes were first fall (at 3 years of follow-up, measured by fall diaries), first subsequent fracture, and mortality (at 6 years). Cumulative incidences of all three outcomes were calculated. The association between domain categorization and time to the three outcomes was assessed by uni- and multivariate Cox proportional hazard analysis with the “can do, do do” group as reference. The physical performance of 400 patients with a recent fracture was assessed (mean age: 64 years; 70.8% female), of whom 61.5%, 20.3%, and 4.9% sustained a first fall, sustained a subsequent fracture, or had died. Domain categorization using the “can do, do do” framework was not associated with time to first fall, subsequent fracture, or mortality in the multivariate Cox regression analysis for all groups. “Can’t do, don’t do” group: hazard ratio [HR] for first fall: 0.75 (95% confidence interval [CI]: 0.45–1.23), first fracture HR: 0.58 (95% CI: 0.24–1.41), and mortality HR: 1.19 (95% CI: 0.54–6.95). Categorizing patients into a two-dimensional framework seems inadequate to study complex, multifactorial outcomes. A personalized approach based on known fall and fracture risk factors might be preferable.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

The “Can Do, Do Do” Framework Applied to Assess the Association between Physical Capacity, Physical Activity and Prospective Falls, Subsequent Fractures, and Mortality in Patients Visiting the Fracture Liaison Service

Schene,

Wyers,

Driessen

et al. 2024

JPM

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Physical performance and sarcopenia assessment in patients with a recent fracture visiting the Fracture Liaison Service

Schene,

Willems,

Driessen

et al. 2024

Osteoporos Int

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Summary Impaired physical performance is associated with increased fracture risk. Performance on four physical functioning tests and prevalence of sarcopenia were assessed for 1789 fracture patients and compared to reference data. Performance was low on all tests, especially for patients with a hip, major or ≥ 1 prevalent vertebral fracture. Purpose Introduction Impaired physical performance and sarcopenia are associated with increased fracture risk. This study aims to assess physical performance and the prevalence of sarcopenia in patients with a recent clinical fracture attending the Fracture Liaison Service (FLS) compared to population means. Methods In this cross-sectional study, chair stand test (CST), handgrip strength (HGS), timed-up-and-go (TUG), 6-min walking-test (6MWT), and sarcopenia (following EWGSOP2) were assessed. The proportion of patients with impaired/poor performance compared to reference data was calculated (Z-score: ≥ − 2SD to < − 1 (impaired) and < − 2 SD (poor)). Associations of fracture type, sex, age, and time since fracture with Z-scores were assessed using linear regression analyses. Results A total of 1789 consecutive FLS patients were included (median age (IQR): 66 (59–74), 70.7% females, 3.9 (± 1.6) months after fracture). The prevalence of impaired/poor performance for CST, HGS, TUG, and 6MWT was 39.2%, 30.4%, 21.9%, and 71.5%, respectively (expected proportion of 16%) and 2.8% had sarcopenia. Lower Z-scores ( P < 0.001) were found for hip, major, and ≥ 1 prevalent vertebral fracture (VF) in CST (major: regression coefficient ( B ) (95%CI) = − 0.25 [− 0.34, − 0.16]; hip: B = − 0.32 [− 0.47, − 0.17], VF: B = − 0.22 [− 0.34, − 0.11]), TUG; (major: B = − 0.54 [− 0.75, − 0.33]; hip: B = − 1.72 [− 2.08, -1.35], VF: B = − 0.61 [− 0.88, − 0.57]), 6MWT (major: B = − 0.34 [− 0.47, − 0.21]; hip: B = − 0.99 [− 1,22, − 0.77], VF: B = − 0.36 [− 0.53, − 0.19]). Conclusions Physical performance is significantly lower in FLS patients compared to healthy peers, especially in patients with hip, major or prevalent VF. These findings underline the need to assess and improve the physical performance of FLS patients, despite a low prevalence of sarcopenia. Supplementary Information The online version contains supplementary material available at 10.1007/s00198-023-07009-w.

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The Fracture Phenotypes in Women and Men of 50 Years and Older with a Recent Clinical Fracture

Geusens,

van den Bergh,

Roux

et al. 2024

Curr Osteoporos Rep

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Imminent fall risk after fracture

Cited by 4 publications

References 50 publications

The “Can Do, Do Do” Framework Applied to Assess the Association between Physical Capacity, Physical Activity and Prospective Falls, Subsequent Fractures, and Mortality in Patients Visiting the Fracture Liaison Service

The “Can Do, Do Do” Framework Applied to Assess the Association between Physical Capacity, Physical Activity and Prospective Falls, Subsequent Fractures, and Mortality in Patients Visiting the Fracture Liaison Service

Physical performance and sarcopenia assessment in patients with a recent fracture visiting the Fracture Liaison Service

The Fracture Phenotypes in Women and Men of 50 Years and Older with a Recent Clinical Fracture

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