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Azevedo DC, Hoff LS, Kowalski SC, de Andrade CAF, Trevisani VFM, de Melo AKG. Risk factors for osteoporotic hip fracture among community-dwelling older adults: a real-world evidence study. Adv Rheumatol 2024; 64:8. [PMID: 38233892 DOI: 10.1186/s42358-024-00350-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2023] [Accepted: 01/09/2024] [Indexed: 01/19/2024] Open
Abstract
BACKGROUND Hip fractures in the older adults lead to increased morbidity and mortality. Although a low bone mineral density is considered the leading risk factor, it is essential to recognize other factors that could affect the risk of hip fractures. This study aims to evaluate the contribution of clinical characteristics, patient-reported outcomes, and muscle and aerobic capacity for hip fractures in community-dwelling older adults. METHODS This is a retrospective cohort study with real world-data from subjects ≥ 60 years old attending an outpatient clinic in Minas Gerais, Brazil, from May 1, 2019, to August 22, 2022. Data about clinical characteristics (multimorbidity, medications of long-term use, sedative and or tricyclic medications, number of falls), patient-reported outcomes (self-perception of health, self-report of difficulty walking, self-report of vision problems, and self-report of falls) and muscle and aerobic capacity (calf circumference, body mass index, and gait speed) were retrieved from an electronic health record. The association of each potential risk factor and hip fracture was investigated by a multivariable logistic regression analysis adjusted for age and sex. RESULTS A total of 7,836 older adults were included with a median age of 80 years (IQR 72-86) and 5,702 (72.7%) were female. Hip fractures occurred in 121 (1.54%) patients. Multimorbidity was associated with an increased risk of hip fracture (OR = 1.12, 95%CI 1.06-1.18) and each episode of fall increased the chance of hip fracture by 1.7-fold (OR = 1.69, 95%CI 1.52-1.80). Patient-reported outcomes associated with increased fracture risk were regular or poor self-perception of health (OR = 1.59, 95%CI 1.06-2.37), self-report of walking difficulty (OR = 3.06, 95%CI 1.93-4.84), and self-report of falls (OR = 2.23, 95%CI 1.47-3.40). Body mass index and calf circumference were inversely associated with hip fractures (OR = 0.91, 95%CI 0.87-0.96 and OR = 0.93, 95%CI 0.88-0.97, respectively), while slow gait speed increased the chance of hip fractures by almost two-fold (OR = 1.80, 95%CI 1.22-2.66). CONCLUSION Our study reinforces the importance of identified risk factors for hip fracture in community-dwelling older adults beyond bone mineral density and available fracture risk assessment tools. Data obtained in primary care can help physicians, other health professionals, and public health policies to identify patients at increased risk of hip fractures.
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Affiliation(s)
- Daniela Castelo Azevedo
- Data Science and Epidemiology, Clínica Mais 60 Saúde, Rua Juiz de Fora, 1071 - Barro Preto, Belo Horizonte, MG, 30180-060, Brazil.
| | | | - Sergio Candido Kowalski
- Department of Health Research Methods, Evidence, and Impact (HEI), Faculty of Health Sciences, McMaster University, Hamilton, ON, Canada
- Department of Medical Clinic, Universidade Federal do Paraná, Curitiba, Brazil
| | - Carlos Augusto Ferreira de Andrade
- Department of Epidemiology and Quantitative Methods in Health, National School of Public Health Sergio Arouca (ENSP)/ Oswaldo Cruz Foundation (FIOCRUZ), Rio de Janeiro, RJ, Brazil
- Faculty of Medicine, Vassouras University, Rio de Janeiro, RJ, Brazil
| | - Virgínia Fernandes Moça Trevisani
- Department of Emergency Medicine and Evidence Based Health Program, Universidade Federal de São Paulo, São Paulo, SP, Brazil
- Department of Rheumatology, Universidade de Santo Amaro, São Paulo, SP, Brazil
| | - Ana Karla Guedes de Melo
- Department of Rheumatology, Hospital Universitário Lauro Wanderley/Universidade Federal da Paraíba, João Pessoa, PB, Brazil
- Evidence Based Health Program, Universidade Federal de São Paulo, São Paulo, SP, Brazil
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Lee Y, Je S, Kim HR, Lee JK, Choi E, Baek JK, Kim H, Yun BH, Seo SK. Association between Fractures and Low Muscle Mass in Korean Menopausal Women: Data from Korean National Health and Nutrition Survey (2010-2011). J Menopausal Med 2023; 29:66-72. [PMID: 37691314 PMCID: PMC10505518 DOI: 10.6118/jmm.23006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2023] [Revised: 08/07/2023] [Accepted: 08/11/2023] [Indexed: 09/12/2023] Open
Abstract
OBJECTIVES This study used the Korean National Health and Nutrition Examination Survey (KNHANES) to determine the association between fractures and low muscle mass. METHODS This cross-sectional study used the 2010-2011 KNHANES data. Low muscle mass was defined as (appendicular skeletal muscle mass [kg]/Height² [m²]) < 5.45 kg/m², which is < 2 SD below the sex-specific mean of a young reference group. Patients with T-scores between -1.0 and -2.5 indicated osteopenia, whereas those with T-scores lower than -2.5 indicated osteoporosis. RESULTS Out of 1,306 women enrolled in the study, 330 were diagnosed with low muscle mass according to the abovementioned diagnostic criterion. The prevalence of fractures at various sites was significantly higher in postmenopausal women with low muscle mass than in those without low muscle mass (relative risk [RR], 1.64; odds ratio [OR], 1.62; 95% confidence interval [CI], 1.06-2.48; P = 0.027). Furthermore, the prevalence of fractures was increased by the presence of osteopenia or osteoporosis in addition to low muscle mass (RR, 1.59; OR, 1.60; 95% CI, 1.02-2.49; P = 0.039) and by osteoporosis only (RR, 2.12; OR, 2.29; 95% CI, 1.11-4.70; P = 0.025). CONCLUSIONS Fracture was more prevalent in postmenopausal women with low muscle mass than in those without low muscle mass. This finding is consistent in a subgroup analysis that included women who had osteoporosis or osteopenia. Moreover, the risk of fractures increased as low muscle mass worsened.
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Affiliation(s)
- Yeojin Lee
- Department of Obstetrics and Gynecology, Yonsei University College of Medicine, Seoul, Korea
| | - Songhyeon Je
- Department of Obstetrics and Gynecology, Yonsei University College of Medicine, Seoul, Korea
| | - Hae-Rim Kim
- College of Natural Science, School of Statistics, University of Seoul, Seoul, Korea
| | - Jae Kyung Lee
- Department of Obstetrics and Gynecology, Yonsei University College of Medicine, Seoul, Korea
| | - Euna Choi
- Department of Obstetrics and Gynecology, Yonsei University College of Medicine, Seoul, Korea
| | - Jin Kyung Baek
- Department of Obstetrics and Gynecology, Yonsei University College of Medicine, Seoul, Korea
| | - Heeyon Kim
- Department of Obstetrics and Gynecology, Yonsei University College of Medicine, Seoul, Korea
| | - Bo Hyon Yun
- Department of Obstetrics and Gynecology, Yonsei University College of Medicine, Seoul, Korea
| | - Seok Kyo Seo
- Department of Obstetrics and Gynecology, Yonsei University College of Medicine, Seoul, Korea.
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Dent E, Daly RM, Hoogendijk EO, Scott D. Exercise to Prevent and Manage Frailty and Fragility Fractures. Curr Osteoporos Rep 2023; 21:205-215. [PMID: 36976491 PMCID: PMC10105671 DOI: 10.1007/s11914-023-00777-8] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/30/2023] [Indexed: 03/29/2023]
Abstract
PURPOSE OF REVIEW This review identifies exercise-based recommendations to prevent and manage frailty and fragility fractures from current clinical practice guidelines. We also critically assess recently published literature in relation to exercise interventions to mitigate frailty and fragility fractures. RECENT FINDINGS Most guidelines presented similar recommendations that included the prescription of individually tailored, multicomponent exercise programs, discouragement of prolonged sitting and inactivity, and combining exercise with optimal nutrition. To target frailty, guidelines recommend supervised progressive resistance training (PRT). For osteoporosis and fragility fractures, exercise should include weight-bearing impact activities and PRT to target bone mineral density (BMD) at the hip and spine, and also incorporate balance and mobility training, posture exercises, and functional exercise relevant to activities of daily living to reduce falls risk. Walking as a singular intervention has limited benefits for frailty and fragility fracture prevention and management. Current evidence-based clinical practice guidelines for frailty, osteoporosis, and fracture prevention recommend a multifaceted and targeted approach to optimise muscle mass, strength, power, and functional mobility as well as BMD.
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Affiliation(s)
- Elsa Dent
- Research Centre for Public Health, Equity & Human Flourishing, Torrens University Australia, Adelaide, SA, Australia
| | - Robin M Daly
- Institute for Physical Activity and Nutrition, School of Exercise and Nutrition Sciences, Deakin University, Geelong, Australia
| | - Emiel O Hoogendijk
- Department of Epidemiology & Data Science, Amsterdam UMC - Location VU University Medical Center, Amsterdam, the Netherlands.
- Department of General Practice, Amsterdam UMC - Location VU University Medical Center, Amsterdam, the Netherlands.
- Amsterdam Public Health Research Institute, Ageing and Later Life Research Program, Amsterdam, the Netherlands.
| | - David Scott
- Institute for Physical Activity and Nutrition, School of Exercise and Nutrition Sciences, Deakin University, Geelong, Australia
- Department of Medicine, School of Clinical Sciences at Monash Health, Monash University, Clayton, Australia
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Kara M, Özçakar L. Sarcopenia, osteoporosis, and fractures: what we see mainly depends on how we look? Osteoporos Int 2023; 34:425-426. [PMID: 36469085 DOI: 10.1007/s00198-022-06418-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/06/2022] [Accepted: 05/02/2022] [Indexed: 12/07/2022]
Affiliation(s)
- M Kara
- Department of Physical and Rehabilitation Medicine, Hacettepe University Medical School, Zemin Kat FTR AD, Sıhhiye, Ankara, Turkey.
| | - L Özçakar
- Department of Physical and Rehabilitation Medicine, Hacettepe University Medical School, Zemin Kat FTR AD, Sıhhiye, Ankara, Turkey
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Harris RJ, Parimi N, Cawthon PM, Strotmeyer ES, Boudreau RM, Brach JS, Kwoh CK, Cauley JA. Response letter to "sarcopenia, osteoporosis and fractures: what we see". Osteoporos Int 2023; 34:427. [PMID: 36469084 DOI: 10.1007/s00198-022-06620-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/31/2022] [Accepted: 11/02/2022] [Indexed: 12/12/2022]
Affiliation(s)
- Rebekah J Harris
- Department of Epidemiology, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PA, USA.
- VA Boston Healthcare System, 150 South Huntington Ave, Boston, MA, 02130, USA.
| | - Neeta Parimi
- Research Institute, California Pacific Medical Center, San Francisco, CA, USA
| | - Peggy M Cawthon
- Research Institute, California Pacific Medical Center, San Francisco, CA, USA
| | - Elsa S Strotmeyer
- Department of Epidemiology, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PA, USA
| | - Robert M Boudreau
- Department of Epidemiology, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PA, USA
| | - Jennifer S Brach
- Department of Physical Therapy, University of Pittsburgh, Pittsburgh, PA, USA
| | - C Kent Kwoh
- Department of Medicine, University of Arizona, Tucson, AZ, USA
| | - Jane A Cauley
- Department of Epidemiology, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PA, USA
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