The impact of osteoporosis, falls, fear of falling, and efficacy expectations on exercise among community-dwelling older adults

The management of osteoporosis in hospitalized patients with fragility hip fractures in western Saudi Arabia: a real-world tertiary center experience

Osteoporotic fractures, especially fragility hip fractures, are major causes of mortality and morbidity in the elderly. There is a significant gap in the diagnosis and treatment of osteoporosis in patients with fragility fractures. Vitamin D use increased by 18.2% post-admission, while calcium use rose by 21.1%. Additionally, the prescription of bisphosphonates, an osteoclast inhibitor, increased by 1.2% post-admission. The study highlights the urgent need for improved management practices and more proactive care strategies to address osteoporosis and its complications.

INTRODUCTION

Osteoporotic fractures are a major cause of fragility hip fractures, and in Saudi Arabia, the high prevalence of osteoporosis and high costs highlight the need for comprehensive care. This study aimed to evaluate the management of osteoporosis in hospitalized patients with fragility hip fractures in western Saudi Arabia.

METHODS

This retrospective cohort study examined medical records from individuals with fragility hip fractures at King Abdulaziz Medical City in Saudi Arabia, Jeddah, from 2004 to 2024. Data was collected from electronic health records, including demographics, clinical features, comorbidities, fall history, osteoporosis diagnosis, and medication usage.

RESULTS

The study included 314 patients, with a mean age of 73 years and 31.2% being between 71 and 80 years old. The majority were females, with a mean BMI of 26.6 kg/m2. The most common comorbidity was renal failure. The prevalence of pre-admission diagnosis of osteoporosis was 14%. Post-admission DEXA-BMD use was reported by 16.6%. Vitamin D (41.1%) and calcium (42.4%) were higher in post-admission management compared to pre-admission management.

CONCLUSION

The study found that most hospitalized patients with fragility hip fractures were female, overweight, had a history of falls, and suffered from renal failure. This study opens new areas for future research that could increase our understanding of osteoporosis management.

Kinesiophobia and associated factors in postmenopausal osteoporosis: a controlled study

OBJECTIVE

This study aimed to evaluate kinesiophobia levels in patients with osteoporosis compared to healthy controls and investigate the associations with pain, depression, anxiety, fear of falling, and quality of life.

METHODS

The study involved 60 postmenopausal osteoporosis patients and 60 healthy controls aged 50 years and above. Kinesiophobia was assessed using the Tampa Scale for Kinesiophobia, while quality of life, psychological symptoms, and fear of falling were evaluated using the Quality of Life Questionnaire of the European Foundation for Osteoporosis, Hospital Anxiety and Depression Scale, and Tinetti Falls Efficacy Scale.

RESULTS

Kinesiophobia levels were significantly higher in the osteoporosis group compared to controls (p<0.05). Positive correlations were observed between kinesiophobia and Falls Efficacy Scale (r=0.278, p=0.002), as well as with Quality of Life Questionnaire of the European Foundation for Osteoporosis physical function scores (r=0.185, p=0.043). No significant relationship was found between kinesiophobia and depression or anxiety scores.

CONCLUSION

Kinesiophobia is notably higher in osteoporosis patients compared to healthy individuals, correlating with an increased fear of falling and reduced physical function. Early identification and management of kinesiophobia are essential to prevent reduced physical activity and associated risks, such as decreased bone mineral density and higher fracture risk.

Clinical features of fallers and non-fallers: finding best-performing combinations of physical performance measurements to discriminate physical impairments between fallers and non-fallers among older adults with and without osteoporosis

Is osteoporosis related to worst outcomes after fall accidents? After a fall accident, there were no differences in walking and balance between individuals with/without osteoporosis. Gains in fat tissue, higher pain, and difficulty to walk were related to previous falls, regardless of osteoporosis.

PURPOSE

Impairments are expected after an accidental fall in the older age; whoever, it is still unclear if patients suffering from osteoporosis are in higher risks of fall accidents and if such accidents would cause worst outcomes compared with older adults without osteoporosis. The objective of this study was to discriminate fallers and non-fallers via a combination of physical performance measurements of older adults (65 + years) with and without osteoporosis.

METHODS

Older adults (n = 116) were screened for a previous fall accident and tested during (i) quiet stance; (ii) single- and dual-task walking; (iii) 8-Foot Up-and-Go; (iv) Mini BESTest; (v) 2-min step-in-place and (vi) 30-s chair stand. Evaluation of average daily pain intensity and total body fat% were obtained.

RESULTS

Forty-four subjects (38%) reported a previous fall accident. There was, however, no association between osteoporosis and previous fall. Fallers had a higher daily pain intensity, higher body fat%, slower walking speed during a cognitive dual-task test and worse performance at the 8-Foot Up-and-Go test and the Mini BESTest compared to non-fallers.

CONCLUSIONS

Although the presence of osteoporosis might not increase the risk of fall accidents, healthcare professionals should expect that accidental falls in older adults are associated with higher body fat%, higher daily pain intensity and problems performing daily activities such as walking.

Knowledge, Attitudes, Practices, and Awareness Levels Among Indian Postmenopausal Women About Osteoporosis and Its Relationship With Sociodemographic Factors: A Cross-Sectional Study From Northern India

Background Osteoporosis is a silent disease and can be prevented by providing correct and appropriate information to the individuals at risk. Therefore, we aim to find out the levels of knowledge, attitudes, and behaviors of postmenopausal women, the highest-risk group. Methods Between May 2021 and December 2023, a cross-sectional study was done in the Military Hospital in Ambala, India, in 1326 postmenopausal women of age between 45 and 70 years who visited the outpatient department of orthopedics and who previously had a measure of bone mineral density (BMD) or estimation of BMD. All patients participating in the study received a questionnaire that assessed the level of knowledge, attitudes, and behaviors related to osteoporosis. The Osteoporosis Knowledge Assessment Tool (OKAT) was used to assess these parameters. Results The mean age was 60±3.1 years. The mean score for osteoporosis awareness was 6/20 points. A total of 983 (73.13%) had no knowledge about osteoporosis, and 221 (16.66%) had higher knowledge. Knowledge about osteoporosis was low with a mean knowledge score of 7.44±3.16 and a median of 7.2. It was found that those who graduated had some knowledge regarding osteoporosis with the help of either a hospital staff or a family member who had a history of osteoporosis. Conclusions Even among postmenopausal women who know they are at risk and should have BMD, knowledge, attitudes, and behaviors about osteoporosis were found to be quite low. In addition, education and mass communications are needed to increase awareness among women of this age about improving bone health.

Costs and Survival of Patients having Experienced a Hospitalized Fall-Related Injury in France: A Population-Based Study

OBJECTIVES

To assess the annual costs 2 years before and 2 years after a hospitalized fall-related injury (HFRI) and the 2-year survival among the population 75+ years old.

DESIGN

We performed a population-based, retrospective cohort study using the French national health insurance claims database.

SETTING AND PARTICIPANTS

Patients 75+ years old who had experienced a fall followed by hospitalization, identified using an algorithm based on International Classification of Diseases codes. Data related to a non-HFRI population matched on the basis of age, sex, and geographical area were also extracted.

METHODS

Cost analyses were performed from a health insurance perspective and included direct costs. Survival analyses were conducted using Kaplan-Meier curves and Cox regression. Descriptive analyses of costs and regression modeling were carried out. Both regression models for costs and on survival were adjusted for age, sex, and comorbidities.

RESULTS

A total of 1495 patients with HFRI and 4484 non-HFRI patients were identified. Patients with HFRI were more comorbid than the non-HFRI patients over the entire periods, particularly in the year before and the year after the HFRI. Patients with HFRI have significantly worse survival probabilities, with an adjusted 2.14-times greater risk of death over 2-year follow-up and heterogeneous effects determined by sex. The annual incremental costs between patients with HFRI and non-HFRI individuals were €1294 and €2378, respectively, 2 and 1 year before the HFRI, and €11,796 and €1659, respectively, 1 and 2 years after the HFRI. The main cost components differ according to the periods and are mainly accounted for by paramedical acts, hospitalizations, and drug costs. When fully adjusted, the year before the HFRI and the year after the HFRI are associated with increase in costs.

CONCLUSIONS AND IMPLICATIONS

We have provided real-world estimates of the cost and the survival associated with patients with HFRI. Our results highlight the urgent need to manage patients with HFRI at an early stage to reduce the significant mortality as well as substantial additional cost management. Special attention must be paid to the fall-related increasing drugs and to optimizing management of comorbidities.

Application of medical-nurse integration health education in aged patients undergoing percutaneous vertebroplasty

This study was designed to explore the effect of medical-nurse integration health education in aged patients undergoing percutaneous vertebroplasty. A total of 72 aged patients with osteoporotic vertebral compression fractures, who obtained percutaneous vertebroplasty from June 2019 to May 2022 were selected in this study. Patients were divided into control group (n = 36) and experimental group (n = 36) according to the time of hospitalization. The patients in control group received routine health education, while the patients in the experimental group received medical-nurse integration health education. We evaluated participants on 4 key aspects, their understanding of relevant knowledge, compliance with functional exercise, residual lower back pain rate, and satisfaction with the health education received. Our study found that patients in the experimental group had a significantly higher mastery rate of health education knowledge compared to those in the control group (88.89% vs 50.00%, P < .001). Additionally, compliance with the functional exercise program was higher in the experimental group, with over 80% of patients fully compliant, compared to only about 44.4% in the control group (P = .001). The average Japanese Orthopaedic Association score of the observation group 1 week after operation was higher than that of the control group (P < .05). Moreover, most patients in the experimental group were very satisfied with the medical-nurse integration health education, while most patients in the control group were only satisfied (P < .001). For aged patients with osteoporotic vertebral compression fractures treated by percutaneous vertebroplasty, medical-nurse integration health education could be an effective method to improve the ability of patients to obtain relevant education, enhance the compliance of patients for functional exercise and increase patient satisfaction to the education, and reduce residual low back pain in patients.

Virtual Reality Exergaming Capability to Change Muscle Strategy During the Limits of Stability Test and Reduce Fear of Falling in Primary Osteoporotic Women

Objective: Muscle strength and balance impairment change the control strategy and increase the probability of falling. This study aimed to investigate the effect of 6-week strength-balance training through virtual reality exergaming (VRE) on muscle strategy during the limits of stability (LOS) test, fear of falling, and quality of life (QOL) in osteoporotic women. Materials and Methods: Twenty volunteer postmenopausal women with osteoporosis were randomly allocated to the VRE (n = 10) and traditional training (TRT as control, n = 10) groups. The VRE and TRT strength-balance training was performed for 6 weeks and three sessions per week. Before and after exercise, the muscle activity (onset time, peak root means square [PRMS]) and hip/ankle activity ratio were assessed by the wireless electromyography system. The muscle activities of the dominant leg were recorded during LOS functional test. The fall efficacy scale and QOL were assessed. Paired t-test was used to compare results within groups, and an independent t-test was used to compare the percentage changes in parameters between the two groups. Results: The VRE improved the onset time and PRMS. The VRE significantly reduced the hip/ankle activity ratio in the LOS test's forward, backward, and right directions (P < 0.05). No significant change was seen in all directions of the LOS functional test in the TRT group (P > 0.05). VRE reduced the fall efficacy scale (P = 0.042). Both VRT and TRT improved the total QOL score (P = 0.010). Conclusion: VRE was more effective in decreasing the onset time and hip/ankle ratio of muscle activation. The VRE is recommended to induce a better ability to reduce the fear of falling and control balance during functional activity in osteoporotic women. Clinical Trial Registration number: IRCT20101017004952N9.

Risk of developing age-related macular degeneration in patients with osteoporosis: a population-based, longitudinal follow-up study

Osteoporosis was suggested to be associated with higher odds of age-related macular degeneration. However, the temporal relationship between osteoporosis and age-related macular degeneration has not been explored. This population-based longitudinal follow-up study showed an increased risk of age-related macular degeneration in both men and women with osteoporosis.

PURPOSE

To investigate the long-term risk of age-related macular degeneration (AMD) in patients with osteoporosis.

METHODS

This is a retrospective cohort study using the Longitudinal Health Insurance Database 2005, a subset of Taiwan's National Health Insurance research database. A total of 23,611 individuals aged 50 to 79 who were diagnosed with osteoporosis between January 1, 2002 and December 31, 2006, were enrolled in the osteoporosis group. An exactly equal number of propensity score-matched individuals without osteoporosis comprised the comparison group. The variables used in propensity score matching included age, sex, comorbidities, and socioeconomic status. Cox proportional hazard regression analysis was used to evaluate the association between osteoporosis and AMD. The main outcome measure is the occurrence of newly diagnosed AMD.

RESULTS

The hazard ratio (HR) of AMD in the osteoporosis group was 1.34 times higher than in the comparison group (95% confidence interval [CI] 1.22-1.47, p < 0.05). The AMD-free survival rate of the osteoporosis group was significantly lower than that of the comparison group (p < 0.0001). Sex-stratified analysis revealed a significantly increased risk of AMD in both osteoporotic men (HR 1.45; 95% CI 1.20-1.76, p = 0.0002) and women (HR 1.31; 95% CI 1.17-1.46, p < 0.0001) compared with their non-osteoporotic counterparts.

CONCLUSION

This longitudinal follow-up study revealed an increased risk of developing AMD in both men and women with osteoporosis.

Body Fat Percentage and the Long-term Risk of Fractures. The EPIC-Norfolk Prospective Population Cohort Study

BACKGROUND

This cohort study aimed to determine the association between body fat percentage (BF%), incident fractures and calcaneal broadband ultrasound attenuation (BUA).

METHODS

Participants were drawn from the EPIC-Norfolk Prospective Population Cohort Study (median follow-up = 16.4 years). Cox models analysed the relationship between BF% and incident fractures (all and hip). Linear and restricted cubic spline (RCS) regressions modelled the relationship between BF% and BUA.

RESULTS

14,129 participants (56.2 % women) were included. There were 1283 and 537 incident all and hip fractures respectively. The participants had a mean (standard deviation) age of 61.5 (9.0) years for women and 62.9 (9.0) years for men. Amongst men, BF% was not associated with incident all fractures. While BF% < 23 % (median) was not associated with hip fractures, BF% > 23 % was associated with increased risk of hip fractures by up to 50 % (hazard ratio (95 % confidence interval) = 1.49 (1.06-2.12)). In women, BF% < 39 % (median) was associated with up to 32 % higher risk of all fractures (1.32 (1.13-1.44)), while BF% > 35 % was not associated with this outcome. Higher BF% was associated with lower risk of incident hip fractures in women. Higher BF% was associated with higher BUA amongst women. Higher BF% up to ~23 % was associated with higher BUA amongst men.

CONCLUSIONS

Higher BF% is associated with lower risk of fractures in women. While there was no association between BF% and all fractures in men, increasing BF% >23 % was associated with higher risk of hip fractures in men. This appears to be independent of estimated bone mineral density. Fracture prevention efforts need to consider wider physical, clinical, and environmental factors.

Outcome Expectations and Older Adults with Knee Osteoarthritis: Their Exercise Outcome Expectations in Relation to Perceived Health, Self-Efficacy, and Fear of Falling

Outcome expectations are a determinant of exercise engagement and adherence. However, the factors that influence outcome expectations for exercise remain poorly understood for people with knee osteoarthritis. In this paper, a cross-sectional study was conducted by recruiting 211 older adults from three clinics in Southern Taiwan. This study explored older adults with knee osteoarthritis exercise outcome expectations and perceived health, self- efficacy, and fear of falling. The older adults completed the Outcome Expectations for Exercise Scale (OEES), the pain and physical function subscales of Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), the Perceived Health Status Scale, the Self-Efficacy for Exercise scale (SEE- C), the Activities-Specific Balance Confidence Scale (ABC), the Geriatric Depression Scale (GDS). Multiple logistic regression models were used to determine associations between outcome expectations for exercise and physical and psychosocial outcomes in the knee OA population. Among the participants of the cross-sectional study, the mean age was 72.04 (SD = 5.53) years, and 71.6% were female. Higher outcome expectations for exercise were associated with higher physical function (OR = 0.98; 95% CI [0.96−1.99]; p = 0.007), better perceived health (OR = 1.30; 95% CI [1.12−1.51]; p < 0.001), greater self-efficacy (OR =1.03; 95% CI [1.01−1.04]; p = 0.006), and less fear of falling (OR = 3.33; 95% CI [1.21−9.19]; p = 0.020). Thus, the results indicated that outcome expectations for exercise among the participants were significantly associated with physical function, perceived health, self-efficacy, and fear of falling. These findings suggest the importance of personal factors in the design of interventions to promote exercise behavior changes among elderly patients with Knee Osteoarthritis.

Dyspnea and outcome expectations are associated with physical activity in persons with pneumoconiosis: a cross-sectional study

Background

There are various reports on factors associated with physical activity in patients with chronic respiratory diseases. However, there are no studies on the relationship between physical activity and psychological or environmental factors. In this study, we investigated the relationship between physical activity and psychological and environmental factors using questionnaires for patients with pneumoconiosis.

Methods

This cross-sectional study included patients with pneumoconiosis who underwent a pneumoconiosis health examination in 2019. A self-administered questionnaire was used to conduct the study. Physical activity was evaluated using the International Physical Activity Questionnaire, and subjective symptoms [dyspnea and quality of life (QOL)], environmental factors (environment around home and life space), psychological factors (depression, stage of change, self-efficacy, decisional balance, and outcome expectations), and others (e.g., experience with pulmonary rehabilitation) were investigated.

Results

The number of respondents in the study was 185 (men: 171, women: 14). Age, dyspnea, stage of change, self-efficacy, outcome expectations, QOL, depression, decisional balance, and life space were significantly correlated with physical activity. In the multivariate analysis, outcome expectations and dyspnea were extracted as independent factors. In the path analysis, outcome expectations and dyspnea had a direct influence on physical activity. Dyspnea directly impacted not only physical activity but also outcome expectations, stage of change, QOL, life space, and depression.

Conclusions

Dyspnea and outcome expectations were associated with physical activity in patients with pneumoconiosis. To improve physical activity in pneumoconiosis patients, it was suggested that it may be necessary to improve dyspnea and promote an understanding of physical activity.

Transient versus stable nature of fear of falling over 24 months in community-older persons with falls- data of the EU SCOPE project on Kidney function

BACKGROUND

Fear of falling (FoF) is an important risk factor for falls among older people. The objectives of our investigations were: a.) to present characteristics of older community-dwelling (CD) fallers with persistent or transient FoF (P-FoF or T-FoF) over 12 months, and b.) to investigate clinical predictors of P-FoF and T-FoF and c.) to explore differences between P-FoF and T-FoF.

METHODS

Our series consisted of 389 older people reporting a fall or injurious fall at baseline and during 24 months follow-up participating in a multicenter prospective study. T-FoF was defined as participants reported "not at all" at baseline and "somewhat/fairly/very concerned" at follow-up, or "not at all" at follow-up, and "somewhat/fairly/very concerned" at baseline, and P-FoF was defined as participants answered "somewhat/fairly/very concerned" in both assessments at baseline and at follow-up. The association between risk factors and T-FoF or P-FoF was investigated by logistic regression analysis.

RESULTS

The mean age of fallers in our sample was 79.0 years (SD 6.0), and 54.2% were females. Out of 389 older adults with a fall history at baseline, 83 participants (21.3%) did not report any FoF over time, P-FoF and T-FoF were observed in 42.7% and 35.9% of participants, respectively. After adjusting for potential confounders (e.g. age, gender), osteoporosis (OR = 2.04, 95%CI = 1.03-4.05) and impaired physical performance (OR = 2.38, 95%CI = 1.12-5.03) were significant predictors of T-FoF vs No-FoF. Osteoporosis (OR = 2.68, 95%CI = 1.31-5.48), depressive symptoms (OR = 3.54, 95%CI = 1.23-10.1) and living alone (OR = 2.44, 95%CI = 1.17-5.06) were significantly associated with P-FoF vs No-FoF. When comparing T-FoF and P-FoF, female gender (OR = 1.95, 95%CI = 1.16-3.27), BMI (OR = 1.08, 95%CI = 1.02-1.14), overall comorbidity (OR = 1.07, 95%CI = 1.02-1.13) and depression (OR = 2.55, 95%CI = 1.33-4.88) were significant predictors of P-FoF.

CONCLUSIONS

T-FoF and P-FoF may be predicted by different sets of risk factors among older fallers. Thus, fallers should be screened for FoF especially when carrying specific risk factors, including female gender, osteoporosis, depression, living alone, impaired physical performance, BMI, comorbidity. These findings may be helpful in designing tailored intervention to blunt the risks related to consequence of FoF among older people experiencing falls.

TRIAL REGISTRATION

The SCOPE study was registered prospectively at clinicaltrials.gov (NCT02691546; 25/02/2016).

Knowledge, health belief, and associated factors towards the prevention of osteoporosis among post-menopausal women in Metu Town, southwest Ethiopia: A community-based cross-sectional study

INTRODUCTION

Osteoporosis is a condition where bones lose mass and strength. It is a common cause of morbidity and mortality in women, especially those of post-menopausal age. It is estimated that 30% of postmenopausal women globally suffer from osteoporosis. This study aimed to assess knowledge, health beliefs, and associated factors towards the prevention of osteoporosis among post-menopausal women in Metu Town, southwest Ethiopia, 2021.

METHODS

A community-based cross-sectional study was conducted among 422 post-menopause women. A simple random sampling technique was employed to select study participants. Data was collected using a structured interviewer-administered questionnaire. Bivariate and multivariate analyses were condcuted to identify factors significantly associated with the outcome variable.

RESULTS

The results showed that 38.4% and 44.5% of participants had adequate knowledge and positive health beliefs towards the prevention of osteoporosis. Age, marital status, educational status, employment status, and self and family history of osteoporosis were significantly associated with knowledge. Age, educational status, self and family history of osteoporosis, and sources of information were significantly associated with health beliefs.

CONCLUSION

More than 40% of participants had adequate knowledge and positive health beliefs. Being younger, better educated, and having a personal and family history of osteoporosis increased the odds of having adequate knowledge and positive health beliefs. Being employed and getting information from families and friends had a significant association with higher odds of adequate knowledge and positive health beliefs.

[Physical rehabilitation of patients with osteoporosis]

Osteoporosis is one of the most common diseases, which along with cardiovascular pathology, diabetes mellitus and oncological diseases has a leading place in the structure of morbidity and mortality of the population. The combination of pharmacological and non-pharmacological methods is fundamental for the treatment and prevention of osteopenia and osteoporosis. This article presents rehabilitation methods that are of great importance for improving the functioning of the musculoskeletal system, the quality of life of patients with osteoporosis. Physical rehabilitation is aimed at stopping the destruction of bone tissue, strengthening it, eliminating pain, reducing stress from the affected areas and restoring the normal function of joints and bones. The proposed types of physical activity not only increase bone strength and strengthen muscle mass, but also reduce the risk of falling - a leading cause of osteoporotic fractures. Exercise programs designed for patients with osteoporosis should include strength and exercise exercises, as well as exercises for flexibility, posture correction, coordination of movements and balance. Training should be regular, varied and of a certain duration. The article considers the advantages and disadvantages of each type of activity.

Center of pressure displacement characteristics differentiate fall risk in older people: A systematic review with meta-analysis

Falling is the second most prevalent cause of accidental death in the world. Currently available clinical tests to assess balance in older people are insufficiently sensitive to screen for fall risk in this population. Laboratory tests that record the center of pressure (COP) trajectory could overcome this problem but despite their widespread use, the choice of COP trajectory features for use as a biomarker of fall risk lacks consensus. This systematic review and meta-analysis aimed at identifying the best COP characteristics to predict risk of falling in older adults. More than 4000 articles were screened; 44 (7176 older adults) were included in this study. Several COP parameters emerged as good indices to discriminate fallers from non-fallers. From sensitivity analysis, Sway area per unit time, anteroposterior mean velocity, and radial mean velocity were the best traditional features. In this study, identification of older people with a high fall risk was demonstrated using quiet-standing recordings. Such screening would also be useful for routine follow-up of balance changes in older fallers in clinical practice.

Differences in Physical Activity and Sedentary Behavior Patterns of Postmenopausal Women With Normal vs. Low Total Hip Bone Mineral Density

Purpose: Recent evidence suggests that sedentary behavior (SB) may be associated with bone health. This study compares free-living physical activity (PA) and SB distribution patterns of postmenopausal women with normal vs. low total hip bone mineral density (BMD). Methods: Sixty nine post-menopausal women [mean (min-max) age: 61 (46-79) years] wore ActiGraph GT3X+ activity monitors on the bilateral ankles for 7 days in free-living. Participants were split into two groups: those with normal hip BMD (T-scores ≥-1.0; N = 34) and those with low hip BMD (T-scores <-1.0; N = 35) as defined by the World Health Organization. Daily active time, step counts, sedentary time, sedentary break number, and median sedentary bout length were estimated from ankle acceleration data. The distribution and accumulation patterns of time spent in sedentary bouts, sedentary breaks, and stepping bouts, and sedentary break and stepping bout lengths' variability were also investigated. Group differences were assessed using two-sampled t-tests and Mann-Whitney U-tests with significance levels of 0.5. Results: Significant between group differences (p < 0.05) were in total daily active time [median (IQR): 257 (209-326) vs. 249 (199-299) min], step count [14,188 (10,938-18,646) vs. 13,204 (10,337-16,630) steps], sedentary time [669 (584-731) vs. 687 (615-753) min], and sedentary break number [93 (68-129) breaks vs. 88 (64-113) breaks], as well as median sedentary bout length [15.1 (11.9-22.1) vs. 15.8 (12.1-24.9) min]. Participants' sedentary bouts were found to be power law distributed with 52% of sedentary time occurring in bouts ≥20 min for the normal BMD group, and 58% for the low BMD group. Significant differences were observed between groups in sedentary bouts' and sedentary breaks' power distribution exponents (p < 0.0001) and patterns of sedentary and stepping time accumulation using the Gini index (p ≤ 0.0014). Variability was significantly lower for sedentary break and stepping bout lengths for the low BMD group (p ≤ 0.0001). Participants with lower hip BMD have longer sedentary bouts with shorter and less complex activity bouts compared to participants with normal hip BMD. Conclusion: The results suggest healthier hip BMD may be associated with PA distributed more evenly throughout the day with shorter sedentary bouts. PA distribution should be considered in exercise-based bone health management programs.

Wearable inertial sensors to measure gait and posture characteristic differences in older adult fallers and non-fallers: A scoping review

BACKGROUND

Wearable inertial sensors have grown in popularity as a means of objectively assessing fall risk. This review aimed to identify gait and posture differences among older adult fallers and non-fallers which can be measured with the use of wearable inertial sensors. In addition to describing the number of sensors used to obtain measures, the concurrent anatomical locations, how these measures compare to current forms of clinical fall risk assessment tests and the setting of tests.

METHODS

Following the development of a rigorous search strategy, MEDLINE, Web of Science, Cochrane, EMBASE, PEDro, and CINAHL were systematically searched for studies involving the use of wearable inertial sensors, to determine gait and postural based differences among fallers or those at high fall risk compared with non-fallers and low fall risk adults aged 60 years and older.

RESULTS

Thirty five papers met the inclusion criteria. One hundred and forty nine gait and posture characteristic differences were identified using wearable inertial sensors. There were sensor derived measures which significantly and strongly correlated with traditional clinical tests. The use of a single wearable inertial sensor located at the lower posterior trunk, was most the most effective location and enough to ascertain multiple pertinent fall risk factors.

CONCLUSION

This review identified the capabilities of identifying fall risk factors among older adults with the use of wearable inertial sensors. The lightweight portable nature makes inertial sensors an effective tool to be implemented into clinical fall risk assessment and continuous unsupervised home monitoring, in addition to, outdoor testing.

Associations of Health-Related Quality of Life, Fear of Falling and Objective Measures of Physical Function with Bone Health in Postmenopausal Women with Low Bone Mass

Health-related quality of life (HRQoL) and physical function deteriorate with age and may adversely impact bone health in older adults. We determined associations of objective measures of physical function and HRQoL with bone health in postmenopausal women with low areal bone mineral density (aBMD). Fifty postmenopausal women (64.4 7.7 years old, mean standard deviation) with low spine, hip or femoral neck aBMD (T- or Z-score < -1.0) on dual-energy X-ray absorptiometry (DXA) participated. Femoral surface BMD, trabecular, integral and cortical volumetric BMD (vBMD) measurements were obtained using 3D-SHAPER software on DXA. Distal tibial vBMD and microarchitecture were assessed using high-resolution peripheral quantitative computed tomography (HRpQCT). Participants completed self-administered EuroQol-5D (EQ-5D) and modified falls efficacy scale (MFES) questionnaires, and physical function assessments. Stair climb power was positively associated with bone parameters at the hip, femoral neck, and distal tibia (all p < 0.05) in multivariable linear regression. EQ-5D demonstrated no significant associations with bone parameters and MFES was positively associated only with distal tibial cortical vBMD and cortical von Mises stress (both p < 0.05). Objective measures of physical function, particularly muscle power, are more consistently associated with bone parameters compared with self-administered HRQoL questionnaires.

Environmental predictors of objectively measured out-of-home time among older adults with cognitive decline

BACKGROUND

Older adults with cognitive decline are vulnerable to various health problems. Going out of home for longer time could be beneficial for their health. Identifying modifiable predictors is essential for developing effective strategies that would increase time spent out-of-home by older adults. This study examined social and physical environmental predictors of objectively measured out-of-home time spent among older adults with cognitive decline.

METHODS

This study was a secondary analysis of a randomized controlled trial (n = 147). Out-of-home time per day was measured by a Global Positioning System at baseline and 1-year follow-up. Baseline data of social environment (living alone, social network [Japanese version of the Lubben Social Network Scale]), objective physical environment (road network distance from each home address to nearest supermarket store, convenience store, and public transportation), and demographic factors (gender, age, education, driving status, fear of falling) were examined as potential predictors.

RESULTS

After adjusting main effects of allocation group, time of measures, and their interactive effect, a mixed model showed that younger age (p = 0.044), current driving status (p = 0.039), and stronger social network (p = 0.003) were predictors of out-of-home time. However, none of the physical environmental factors significantly predicted outdoor time.

CONCLUSIONS

The present study found that social network was a predictor of objectively measured out-of-home time among older adults with global cognitive decline. A sufficient social network might help increase out-of-home time among them. However, the influence of physical environment on out-of-home time might be small.

Osteoporosis, Fear of Falling, and Restrictions in Daily Living. Evidence From a Nationally Representative Sample of Community-Dwelling Older Adults

Background: There is a lack of studies examining the relationship between osteoporosis and fear of falling as well as the association of osteoporosis and restrictions in daily life due to fear of falling. Thus, the aim of this study was to investigate whether there is an association between the presence of osteoporosis and fear of falling as well as restrictions in daily life due to fear of falling. Methods: Cross-sectional data were used from a population-based sample of community-dwelling individuals in the second half of life (40 to 95 years; n = 7,808) in Germany. GP-diagnosed osteoporosis was used. Fear of falling as well as the restrictions in daily life due to fear of falling were collected in self-administered questionnaires. Multiple regression models controlling for sociodemographic, lifestyle, and health-related variables were used to determine the association between osteoporosis and the outcome measures. Results: Logistic regressions showed that osteoporosis was associated with increased fear of falling in the total sample and in both sexes. In addition, regressions showed that osteoporosis was associated with restrictions in daily life due to fear of falling in the total sample and in women, but not in men. Conclusions: The present study showed that osteoporosis is associated with fear of falling and with restrictions in daily life due to fear of falling. Because effective interventions to treat the fear of falling are available, our study might help to address this target group more accurately.

Knowledge of risk factors and prevention of osteoporosis: the Israeli women's health at midlife study

Wide disparities in knowledge of risk factors and prevention of osteoporosis were demonstrated among midlife Israeli minority women (Arabs and immigrants from the former USSR) compared to Jewish long-time residents. Women who believed osteoporosis to be a serious disease and those who felt susceptible to it reported better knowledge.

PURPOSE

The main goals of this study were to assess knowledge of risk factors and preventive measures for osteoporosis in middle-aged women and to evaluate the relationship of knowledge to personal risk factors and personal perceptions about osteoporosis.

METHODS

Face-to-face interviews with women aged 45-64 years were conducted during 2004-2006 within three population groups: long-term Jewish residents (LTJRs), immigrants from the former Soviet Union, and Arab women. The survey instrument included five knowledge statements related to the risk after menopause, the risk of smoking, family history of fractures, decreased risk by physical activity, and by use of medications.

RESULTS

The findings indicated wide disparities in knowledge about risk factors and preventive behavior of osteoporosis between the two minority groups (immigrants from the former Soviet Union and Arab women) and the majority group of midlife Israeli women. Knowledge of osteoporosis was related to perceived severity of the disease and partly to perceived susceptibility to osteoporosis. Past diagnosis of osteoporosis, current or past smoking status, and BMI were unrelated to knowledge in multivariate analyses.

CONCLUSIONS

There is a need to improve knowledge of osteoporosis especially among less educated and minority women. Subjective perception of risk was more strongly related to knowledge than actual risk factors and should be targeted in public campaigns. The efforts should be aimed at strengthening women's perception of their own susceptibility to osteoporosis and of the severity of this disease.

Implementation of a fall screening program in a high risk of fracture population

Fall prevention is an important way to prevent fractures in person with osteoporosis. We developed and implemented a fall screening program in the context of routine osteoporosis care. This program was found to be feasible and showed that a significant proportion of persons with osteoporosis are at risk of falling.

PURPOSE

Falls are the most common cause of fracture in persons with osteoporosis. However, osteoporosis care rarely includes assessment and prevention of falling. We thus sought to assess the feasibility of a fall screening and management program integrated into routine osteoporosis care.

METHODS

The program was developed and offered to patients with osteoporosis or osteopenia seen at an outpatient clinic between May 2015 and May 2016. Feasibility was measured by physical therapist time required to conduct screening and ease of integrating the screening program into the usual clinic workflow. Self-report responses and mobility testing were conducted to describe the fall and fracture risk profile of osteoporosis patients screened. Effects on fall-related care processes were assessed via chart abstraction of patient participation in fall prevention exercise.

RESULTS

Of the 154 clinic patients who presented for a clinic visit, 68% met screening criteria and completed in two thirds of persons. Screening was completed in a third of the time typically allotted for traditional PT evaluations and did not interfere with clinic workflow. Forty percent of those screened reported falling in the last year, and over half had two or more falls in the past year. Over half reported a balance or lower extremity impairment, and over 40% were below norms on one or more performance tests. Most patients who selected a group exercise fall prevention program completed all sessions while only a quarter completed either supervised or independent home-based programs.

CONCLUSIONS

Implementation of a fall risk screening program in an outpatient osteoporosis clinic appears feasible. A substantial proportion of people with osteoporosis screened positive for being at risk of falling, justifying integration of fall prevention into routine osteoporosis care.

Outcome Expectations and Osteoarthritis: Association of Perceived Benefits of Exercise With Self-Efficacy and Depression

OBJECTIVE

Outcome expectancy is recognized as a determinant of exercise engagement and adherence. However, little is known about which factors influence outcome expectations for exercise among people with knee osteoarthritis (OA). This is the first study to examine the association of outcome expectations for exercise with demographic, physical, and psychosocial outcomes in individuals with knee OA.

METHODS

We performed a cross-sectional analysis of the baseline data from a randomized trial of tai chi versus physical therapy in participants with symptomatic knee OA. Knee pain was evaluated using the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC). Outcome expectations for exercise, self-efficacy, depression, anxiety, stress, and social support were measured using standard instruments. Logistic regression models were utilized to determine associations with outcome expectations.

RESULTS

There were 262 participants, with a mean age of 59.8 years and a mean body mass index of 32.1 kg/m2 ; 69.1% of the participants were female, 51.5% were white, the mean disease duration was 8.6 years, and the mean WOMAC knee pain and function scores were 260.8 and 906.8, respectively. Higher outcome expectations for exercise were associated with greater self-efficacy (odds ratio [OR] 1.25 [95% confidence interval (95% CI) 1.11-1.41]; P = 0.0004), as well as with fewer depressive symptoms (OR 0.84 for each 5-point increase [95% CI 0.73-0.97]; P = 0.01). Outcome expectancy was not significantly associated with sex, race, education, pain, function, radiographic severity, social support, anxiety, or stress.

CONCLUSION

Our results suggest significant associations between outcome expectations for exercise and self-efficacy and depression. Future studies should examine how these relationships longitudinally affect long-term clinical outcomes of exercise-based treatment for knee OA.

"You Have to Keep Moving, Be Active": Perceptions and Experiences of Habitual Physical Activity in Older Women With Osteoporosis

BACKGROUND

Physical activity (PA) is essential for older adults with osteoporosis, and health care professionals play important roles in promoting PA and encouraging patients to make healthy choices. However, many factors influence habitual PA, and there is only limited knowledge about the perceptions and experiences of PA among older women with osteoporosis.

OBJECTIVES

The purpose of this study was to describe perceptions and experiences of PA and the factors that influence habitual PA among older adults with osteoporosis, impaired balance, and fear of falling.

DESIGN

This was a qualitative interview study applying interpretive content analysis with an inductive approach.

METHODS

Informants were a purposeful sample of 18 women, aged 66 to 86 years, with osteoporosis, impaired balance, and fear of falling. Individual, semistructured, face-to-face interviews were recorded, transcribed, condensed, and coded to find subthemes and themes.

RESULTS

The overall theme found was "Physical activity--a tool for staying healthy with osteoporosis." This overall theme comprised 2 main themes interpreting the challenges and possibilities of being physically active with osteoporosis. These themes were not separate but rather linked to each other like 2 sides of the same coin, with factors that could act as both barriers to and facilitators of PA. Personal preferences and osteoporosis-related concerns influenced habitual PA, and individualization was perceived as important.

LIMITATIONS

Some results may be context specific and limit the transferability to people with other cultural or socioeconomic backgrounds.

CONCLUSIONS

The women perceived that PA was an important tool to maintain health with osteoporosis and believed that they had a responsibility to use this tool. They had adapted to disease-specific limitations and developed strategies to overcome challenges and barriers to PA. Lack of PA promotion and conflicting advice about PA from physicians created uncertainty. Encouragement and guidance from physical therapists, individually or in groups, were very important.