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Eshetie TC, Caughey GE, Whitehead C, Crotty M, Corlis M, Visvanathan R, Wesselingh S, Inacio MC. The risk of fractures after entering long-term care facilities. Bone 2024; 180:116995. [PMID: 38145862 DOI: 10.1016/j.bone.2023.116995] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/28/2023] [Revised: 12/14/2023] [Accepted: 12/19/2023] [Indexed: 12/27/2023]
Abstract
BACKGROUND Stratifying residents at increased risk for fractures in long-term care facilities (LTCFs) can potentially improve awareness and facilitate the delivery of targeted interventions to reduce risk. Although several fracture risk assessment tools exist, most are not suitable for individuals entering LTCF. Moreover, existing tools do not examine risk profiles of individuals at key periods in their aged care journey, specifically at entry into LTCFs. PURPOSE Our objectives were to identify fracture predictors, develop a fracture risk prognostic model for new LTCF residents and compare its performance to the Fracture Risk Assessment in Long term care (FRAiL) model using the Registry of Senior Australians (ROSA) Historical National Cohort, which contains integrated health and aged care information for individuals receiving long term care services. METHODS Individuals aged ≥65 years old who entered 2079 facilities in three Australian states between 01/01/2009 and 31/12/2016 were examined. Fractures (any) within 365 days of LTCF entry were the outcome of interest. Individual, medication, health care, facility and system-related factors were examined as predictors. A fracture prognostic model was developed using elastic nets penalised regression and Fine-Gray models. Model discrimination was examined using area under the receiver operating characteristics curve (AUC) from the 20 % testing dataset. Model performance was compared to an existing risk model (i.e., FRAiL model). RESULTS Of the 238,782 individuals studied, 62.3 % (N = 148,838) were women, 49.7 % (N = 118,598) had dementia and the median age was 84 (interquartile range 79-89). Within 365 days of LTCF entry, 7.2 % (N = 17,110) of individuals experienced a fracture. The strongest fracture predictors included: complex health care rating (no vs high care needs, sub-distribution hazard ratio (sHR) = 1.52, 95 % confidence interval (CI) 1.39-1.67), nutrition rating (moderate vs worst, sHR = 1.48, 95%CI 1.38-1.59), prior fractures (sHR ranging from 1.24 to 1.41 depending on fracture site/type), one year history of general practitioner attendances (≥16 attendances vs none, sHR = 1.35, 95%CI 1.18-1.54), use of dopa and dopa derivative antiparkinsonian medications (sHR = 1.28, 95%CI 1.19-1.38), history of osteoporosis (sHR = 1.22, 95%CI 1.16-1.27), dementia (sHR = 1.22, 95%CI 1.17-1.28) and falls (sHR = 1.21, 95%CI 1.17-1.25). The model AUC in the testing cohort was 0.62 (95%CI 0.61-0.63) and performed similar to the FRAiL model (AUC = 0.61, 95%CI 0.60-0.62). CONCLUSIONS Critical information captured during transition into LTCF can be effectively leveraged to inform fracture risk profiling. New fracture predictors including complex health care needs, recent emergency department encounters, general practitioner and consultant physician attendances, were identified.
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Affiliation(s)
- Tesfahun C Eshetie
- Registry of Senior Australians, South Australian Health and Medical Research Institute, Adelaide, South Australia, Australia; UniSA Clinical & Health Sciences, University of South Australia, Adelaide, South Australia, Australia; UniSA Allied Health and Human Performance, University of South Australia, Adelaide, South Australia, Australia.
| | - Gillian E Caughey
- Registry of Senior Australians, South Australian Health and Medical Research Institute, Adelaide, South Australia, Australia; UniSA Allied Health and Human Performance, University of South Australia, Adelaide, South Australia, Australia; Adelaide Medical School, University of Adelaide, Adelaide, South Australia, Australia
| | - Craig Whitehead
- College of Medicine and Public Health, Flinders University, Adelaide, SA, Australia; Southern Adelaide Local Health Network, SA Health, Adelaide, SA, Australia
| | - Maria Crotty
- College of Medicine and Public Health, Flinders University, Adelaide, SA, Australia; Southern Adelaide Local Health Network, SA Health, Adelaide, SA, Australia
| | - Megan Corlis
- Australian Nursing and Midwifery Federation (SA Branch), Adelaide, South Australia, Australia
| | - Renuka Visvanathan
- Adelaide Geriatrics Training and Research with Aged Care (GTRAC) Centre, Adelaide Medical School, Faculty of Health and Medical Sciences, University of Adelaide, Adelaide, SA, Australia; Aged and Extended Care Services, The Queen Elizabeth Hospital and Basil Hetzel Institute for Translational Research, Central Adelaide Local Health Network, SA Health, South Australia, Australia
| | - Steve Wesselingh
- South Australian Health and Medical Research Institute, Adelaide, SA, Australia
| | - Maria C Inacio
- Registry of Senior Australians, South Australian Health and Medical Research Institute, Adelaide, South Australia, Australia; UniSA Allied Health and Human Performance, University of South Australia, Adelaide, South Australia, Australia
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Tomasiuk JM, Nowakowska-Płaza A, Wisłowska M, Głuszko P. Osteoporosis and diabetes - possible links and diagnostic difficulties. Reumatologia 2023; 61:294-304. [PMID: 37745139 PMCID: PMC10515121 DOI: 10.5114/reum/170048] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2023] [Accepted: 07/26/2023] [Indexed: 09/26/2023] Open
Abstract
Objectives In this review, the authors aimed to clarify the relationship between the occurrence of osteoporosis and diabetes, analyze the differences between the pathogenesis of osteoporosis in different types of diabetes and propose the most effective diagnostic strategy and fracture risk assessment in diabetic patients. Material and methods A analysis of publications in MEDLINE, COCHRANE and SCOPUS databases was performed, searching for reports on the diagnostics, fracture risk assessment, prevention, and treatment of osteoporosis in patients with diabetes mellitus (DM) published in the years 2016-2022. The key words for the search were: diabetes, osteoporosis, and low-energy fracture. Results Bone complications of T1DM are more severe than T2DM, because of the lack of anabolic effect of insulin on bones. In T2DM the risk of fractures is elevated; however, identifying the mechanisms underlying the increased risk of fractures in T2DM is not clear. The FRAX tool is not appropriate for assessing the fracture risk in young patients with T1DM. It is quite useful in older patients with T2DM, but in these patients the calculated fracture risk may be underestimated. In T2DM the fracture risk often does not correspond to BMD value as measured by dual-energy X-ray absorptiometry (DXA). Diagnostic tools such as the trabecular bone score may play a significant role in this group of patients. Conclusions: Optimal strategies to identify and treat high risk individuals require further research and proper definition. The diagnostic criteria for osteoporosis should be clearly defined as well as fracture risk assessment and choice of anti-osteoporotic medication. In all cases of secondary osteoporosis, treatment of the underlying disease is the most important. The relationship between high risk of fractures and diabetes is inseparable, and its full understanding seems to be the key to effective management.
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Affiliation(s)
- Joanna Magdalena Tomasiuk
- Department of Rheumatology, National Institute of Geriatric, Rheumatology and Rehabilitation, Warsaw, Poland
| | - Anna Nowakowska-Płaza
- Department of Rheumatology, National Institute of Geriatric, Rheumatology and Rehabilitation, Warsaw, Poland
| | - Małgorzata Wisłowska
- Department of Rheumatology, National Institute of Geriatric, Rheumatology and Rehabilitation, Warsaw, Poland
| | - Piotr Głuszko
- Department of Rheumatology, National Institute of Geriatric, Rheumatology and Rehabilitation, Warsaw, Poland
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Hua CL, Cornell PY, White EM, Thomas KS. Injury-related emergency department use among assisted living residents with Alzheimer's disease and related dementias. J Am Geriatr Soc 2023; 71:538-545. [PMID: 36572964 PMCID: PMC9957931 DOI: 10.1111/jgs.18207] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2022] [Revised: 09/21/2022] [Accepted: 09/24/2022] [Indexed: 12/28/2022]
Abstract
BACKGROUND Injuries are a leading cause of emergency department (ED) visits among older adults, and individuals with Alzheimer's disease and related dementias (ADRD) may be at particular risk. We compared injury-related ED use among assisted living (AL) residents with and without ADRD and assessed differences in the risk of injury-related ED visits among individuals with ADRD residing in ALs with memory care designation versus general AL. METHODS Using Medicare claims, we identified a cohort of fee-for-service beneficiaries who lived in AL in 2018 and resided in one of 20 states with site-specific information on memory care designation (n = 116,754). Outcomes included all injury-related ED visits and injury-related ED visits resulting in hospitalization in the calendar year 2018. We fit multilevel models of the association between ADRD and outcomes, adjusting for resident demographic characteristics and chronic conditions, license type characteristics, and AL characteristics, with random intercepts at the AL and license type levels. Among residents with ADRD, we examined whether memory care licensure was associated with injury-related ED visits. RESULTS The adjusted risk of injury-related ED use during the year was 20.1% (95% CI: 19.6%, 20.6%) for residents with ADRD compared to 16.1% for residents without ADRD (95% CI: 15.7%, 16.5%; p < 0.001). The adjusted risk of injury-related ED use ending in hospitalization was 4.9% (95% CI: 4.6%, 5.1%) for AL residents with ADRD and 3.9% for residents without ADRD (95% CI: 3.8%, 4.1%; p < 0.001). There were no significant differences in injury-related ED visits between residents with ADRD in ALs with memory care designation and residents in general AL. CONCLUSIONS Injury-related ED visits are common among AL residents with ADRD and residents in memory care, but residents in memory care AL experienced similar risks of injury as those in general AL. Further research should identify modifiable factors that can prevent injury among AL residents with ADRD.
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Affiliation(s)
- Cassandra L. Hua
- Department of Veterans Affairs Medical Center, Providence, Rhode Island
- School of Public Health, Brown University, Providence, Rhode Island
| | - Portia Y. Cornell
- Department of Veterans Affairs Medical Center, Providence, Rhode Island
- School of Public Health, Brown University, Providence, Rhode Island
| | | | - Kali S. Thomas
- Department of Veterans Affairs Medical Center, Providence, Rhode Island
- School of Public Health, Brown University, Providence, Rhode Island
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Kuhnow J, Hoben M, Weeks LE, Barber B, Estabrooks CA. Factors Associated with Falls in Canadian Long Term Care Homes: a Retrospective Cohort Study. Can Geriatr J 2022; 25:328-335. [PMID: 36505912 PMCID: PMC9684024 DOI: 10.5770/cgj.25.623] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/05/2022] Open
Abstract
Background Half of Canadians living in long-term care (LTC) homes will fall each year resulting in consequences to independence, quality of life, and health. The objective in this study was to analyze factors that contribute to, or are protective against, falls in Canadian LTC homes. Methods We analyzed of a retrospective cohort of a stratified random sample of Canadian LTC homes in Western Canada from 2011-2017. We accessed variables from the RAI-MDS 2.0 to assess the association of the dependent variable "fall within the last 31-180 days" with multiple independent factors, using generalized estimating equation models. Results A total of 28,878 LTC residents were analyzed. Factors found to increase the odds of falling were other fractures (OR 3.64 [95% confidence interval; CI 3.27, 4.05]), hip fractures (OR 3.58 [3.27, 3.93]), moderately impaired cognitive skills (OR 2.45 [2.28, 2.64]), partial support to balance standing (OR 2.44 [2.30, 2.57]), wandering (OR 2.31 [2.18, 2.44]). Conclusion A range of factors identified were associated with falls for people living in LTC homes. Individual physical ability represented the largest group of independent factors contributing to falls. Residents who experience any fracture or an acute change in behaviour, mobility, or activities of daily living (ADL) should be considered at increased risk of falls.
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Affiliation(s)
- Jason Kuhnow
- Faculty of Medicine, Dalhousie University, Halifax, NS
| | - Matthias Hoben
- School of Health Policy & Management, York University, Toronto, ON
| | - Lori E. Weeks
- School of Nursing, Dalhousie University, Halifax, NS
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Han S, Park J, Jang HD, Han K, Lee C, Kim W, Hong JY. Changes in Underweight Status and Risk of Hip Fracture: A Korean Nationwide Population-Based Cohort Study. J Clin Med 2022; 11:jcm11071913. [PMID: 35407521 PMCID: PMC8999678 DOI: 10.3390/jcm11071913] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2022] [Revised: 03/24/2022] [Accepted: 03/28/2022] [Indexed: 11/25/2022] Open
Abstract
Being underweight is associated with a high risk of hip fracture. However, the impact of change in underweight status on the risk of hip fracture is unknown. This study is performed to investigate the relationship between change in underweight status and risk of hip fracture. This study included 1,713,225 subjects aged ≥40 years who underwent two consecutive national health screenings between 2007 and 2009. We prospectively assessed the risk of hip fracture between 2010 and 2018 according to changes in underweight status. We divided the participants into four groups according to the change in underweight status: consistent non-underweight (non-underweight to non-underweight), became non-underweight (underweight to non-underweight), became underweight (non-underweight to underweight), and consistent underweight (underweight to underweight). Compared with the consistent non-underweight group, the became non-underweight (0.74/1000 person years (PY) increase in incidence rate (IR); adjusted hazard ratio (HR) 1.72; 95% confidence interval (CI) 1.42−2.07), became underweight (1.71/1000 PY increase in IR; adjusted HR 2.22; 95% CI 1.96−2.53), and consistent underweight (1.3/1000 PY increase in IR; adjusted HR 2.18; 95% CI 1.89−2.53) groups had a significantly increased risk of hip fracture (p < 0.001). Change in underweight status was significantly associated with a risk of hip fracture.
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Affiliation(s)
- Sangsoo Han
- Department of Emergency Medicine, Soonchunhyang University Bucheon Hospital, 170 Jomaru-ro, Bucheon 14584, Korea;
| | - Jiwon Park
- Department of Orthopedics, Korea University Ansan Hospital, 123, Jeokgeum-ro, Danwon-gu, Ansan-si 15355, Korea; (J.P.); (W.K.)
| | - Hae-Dong Jang
- Department of Orthopaedic Surgery, Soonchunhyang University Bucheon Hospital, 170 Jomaru-ro, Bucheon 14584, Korea;
| | - Kyungdo Han
- Department of Statistics and Actuarial Science, Soongsil University, 369 Sangdo-ro, Dongjak-gu, Seoul 06978, Korea;
| | - Choungah Lee
- Department of Emergency Medicine, Hallym University Dongtan Sacred Heart Hospital, 7 Keunjaebong-gil, Hwaseong-si 18450, Korea;
| | - Wonseok Kim
- Department of Orthopedics, Korea University Ansan Hospital, 123, Jeokgeum-ro, Danwon-gu, Ansan-si 15355, Korea; (J.P.); (W.K.)
| | - Jae-Young Hong
- Department of Orthopedics, Korea University Ansan Hospital, 123, Jeokgeum-ro, Danwon-gu, Ansan-si 15355, Korea; (J.P.); (W.K.)
- Correspondence: ; Tel.: +82-31-412-6577
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Bai Y, McArthur C, Ioannidis G, Giangregorio L, Straus S, Papaioannou A. Strategies for the implementation of an electronic fracture risk assessment tool in long term care: a qualitative study. BMC Geriatr 2021; 21:467. [PMID: 34418976 PMCID: PMC8379826 DOI: 10.1186/s12877-021-02388-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2021] [Accepted: 07/12/2021] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Older adults in long-term care (LTC) homes experience high rates of fractures, which are detrimental to their quality of life. The purpose of this study is to identify and make recommendations on strategies to implementing an evidence-based Fracture Risk Clinical Assessment Protocol (CAP) in LTC. METHODS Following the Behaviour Change Wheel framework, we conducted six focus group interviews with a total of 32 LTC stakeholders (e.g. LTC physicians) to identify barriers and facilitators, suggest implementation strategies, and discuss whether the identified strategies were affordable, practicable, effective, acceptable, safe, and if they promote equity (APEASE). The interviews were transcribed verbatim and analyzed using thematic content analysis. RESULTS Themes of implementation strategies that met the APEASE criteria were minimizing any increase in workload, training on CAP usage, education for residents and families, and persuasion through stories. Other strategy themes identified were culture change, resident-centred care, physical restructuring, software features, modeling in training, education for staff, social rewards, material rewards, public benchmarking, and regulations. CONCLUSIONS To implement the Fracture Risk CAP in LTC, we recommend using implementation strategies centred around minimizing any increase in workload, training on CAP usage, providing education for residents and families, and persuading through stories. Through improving implementation of the fracture risk CAP, results from this work will improve identification and management of LTC residents at high fracture risk and could inform the implementation of guidelines for other conditions in LTC homes.
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Affiliation(s)
- Yuxin Bai
- McMaster University, 1280 Main Street West, L8S 4L8 Hamilton, Ontario Canada
- GERAS Centre for Aging Research, 88 Maplewood Avenue, L8M 1W9 Hamilton, Ontario Canada
| | - Caitlin McArthur
- Dalhousie University, PO Box 15000, 6299 South St, NS B3H 4R2 Halifax, Canada
| | - George Ioannidis
- McMaster University, 1280 Main Street West, L8S 4L8 Hamilton, Ontario Canada
- GERAS Centre for Aging Research, 88 Maplewood Avenue, L8M 1W9 Hamilton, Ontario Canada
| | - Lora Giangregorio
- University of Waterloo, 200 University Avenue West, N2L 3G1 Waterloo, Ontario Canada
- Schlegel-UW Research Institute for Aging, 150 Laurelwood Drive, N2J 0E2 Waterloo, Ontario Canada
| | - Sharon Straus
- University of Toronto, 27 King’s College Circle, M5S 1A4 Toronto, Ontario Canada
| | - Alexandra Papaioannou
- McMaster University, 1280 Main Street West, L8S 4L8 Hamilton, Ontario Canada
- GERAS Centre for Aging Research, 88 Maplewood Avenue, L8M 1W9 Hamilton, Ontario Canada
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Association between BMI variability and risk of fracture among Korean men and women: a population based study. Arch Osteoporos 2021; 16:67. [PMID: 33839996 DOI: 10.1007/s11657-021-00918-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/02/2020] [Accepted: 02/22/2021] [Indexed: 02/03/2023]
Abstract
UNLABELLED In Korean adults aged 50 years and older, the overall risk of fractures increased with greater BMI variability among both men and women, specifically, spinal fractures for men and both spinal and hip fractures for women. PURPOSE The bone-health-related outcome, such as fractures due to BMI fluctuation, has been understudied within Asian populations. In this large-scale, population-based cohort study in Korea, we aimed to investigate the relationship between variability in body mass index (BMI) and the risk of fractures. METHODS The study included 166,932 subjects aged ≥ 50 years from the National Health Insurance Service-Health Screening Cohort. The BMI variability value from three follow-up examinations during 2002-2007 was categorized into quartiles. The hazard ratios (HRs) with 95% confidence intervals (CIs) for the effects of BMI variability on the risk of admission from hip, spine, and upper extremity fractures during 2008-2015 were evaluated using a Cox proportional hazards regression analysis. RESULTS Compared to those in the lowest BMI variability (1st quartile), men in the highest BMI variability (4th quartile) showed an increased risk of spinal fractures (aHR 1.21, 95% CI 1.07-1.36) with a significant linear trend (P for trend = 0.021). Compared to those in the lowest BMI variability (1st quartile), women in the highest BMI variability (4th quartile) showed an increased risk of hip and spinal fractures (aHR 1.35, 95% CI 1.05-1.69; aHR 1.16, 95% CI 1.05-1.28) with significant linear trends (P for trend = 0.021; P for trend = 0.003, respectively). There was no association between BMI variability and incidents of upper extremity fractures for men or women. CONCLUSION Association between BMI variability and increased fracture risk depended on sex and fracture types. BMI maintenance, instead of high BMI fluctuation, may be beneficial in terms of lowering the overall fracture risk for Korean adults over 50 years old.
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Factors That Predict 1-Year Incident Hip and Non-Hip Fractures for Home Care Recipients: A Linked-Data Retrospective Cohort Study. J Am Med Dir Assoc 2020; 22:1035-1042. [PMID: 33008757 DOI: 10.1016/j.jamda.2020.08.023] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2020] [Revised: 08/14/2020] [Accepted: 08/19/2020] [Indexed: 12/22/2022]
Abstract
OBJECTIVES The purpose of our study was to identify factors that predict 1-year incident hip and major osteoporotic non-hip fractures (ie, wrist, spine, pelvis, humerus) for home care recipients while accounting for the competing risk of death. DESIGN We conducted a retrospective cohort study with linked population data. SETTING AND PARTICIPANTS All home care recipients in Ontario, Canada, receiving services for more than 6 months with an admission assessment between April 1, 2011, and March 31, 2015, were included. METHODS Clinical data from the Resident Assessment Instrument Home Care were linked to fracture data from the Discharge Abstract Database and the National Acute Care Reporting System. Competing risk proportional hazard regressions using the Fine and Grey method were performed to model the association between potential risk factors and fracture. RESULTS Previous fall, previous fracture, cognitive impairment, unsteady gait, alcohol use, tobacco use, and Parkinson disease were consistently associated with all fracture types. Cognitive impairment (hazard ratio 2.09; 95% confidence interval 1.86-2.36) and wandering [1.66 (1.06-1.27)] were most predictive of hip fractures and being female [1.86 (1.76-1.98)] and experiencing a previous fracture [1.86 (1.76-1.98)] were most predictive of non-hip fractures. Risk factors unique to non-hip fractures as compared with hip fractures were locomotion ability outdoors and psychotropic medication use. CONCLUSIONS AND IMPLICATIONS Our results indicate that, in addition to typical fracture risk factors, home care recipients have unique characteristics that increase their risk. Fracture risk assessment tools and subsequent prevention strategies should be modified to accurately identify home care recipients at risk for imminent 1-year fracture.
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Tanaka R, Ishikawa Y, Yamasaki T, Diez A. Accuracy of classifying the movement strategy in the functional reach test using a markerless motion capture system. J Med Eng Technol 2019; 43:133-138. [PMID: 31232123 DOI: 10.1080/03091902.2019.1626504] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
The purpose of this study was to examine the accuracy of classifying the movement strategy in the functional reach test (FRT) using a markerless motion capture system (MLS) on the basis of values acquired with a marker-based motion capture system (MBS). Sixty young, injury-free individuals participated in this study. The task action involved reaching forward in the standing position. Using the Microsoft Kinect v2 as an MLS and Vicon as a MBS, the coordinates of the hip joints, knee joints and ankle joints were measured. The hip and ankle joint angles during the task were calculated from the coordinate data. These angles between MLS and MBS were compared using a paired t-test. The accuracy of movement strategy defined using MLS was examined based on the MBS. A t-test showed a significant difference in both the hip and ankle joint angles between systems (p < .01). However, in case of using data of left ankle joint, indices of the classification accuracy of MLS were 0.825 for sensitivity, 1.000 for specificity, infinity for positive likelihood ratio and 0.175 for negative likelihood ratio. The results for the right joint angle were similar to those of the left joint angle. Although the absolute measures in the hip and joint angles obtained using MLS differ from MBS, the MLS may be useful for accurately classifying the movement strategy adopted in the FRT.
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Affiliation(s)
- Ryo Tanaka
- a Graduate School of Integrated Arts and Sciences , Hiroshima University , Higashihiroshima , Japan.,b Department of Rehabilitation , Hiroshima International University , Higashihiroshima , Japan
| | - Yuki Ishikawa
- b Department of Rehabilitation , Hiroshima International University , Higashihiroshima , Japan
| | - Takahiro Yamasaki
- b Department of Rehabilitation , Hiroshima International University , Higashihiroshima , Japan
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Berry SD, Zullo AR, Lee Y, Mor V, McConeghy KW, Banerjee G, D'Agostino RB, Daiello L, Dosa D, Kiel DP. Fracture Risk Assessment in Long-term Care (FRAiL): Development and Validation of a Prediction Model. J Gerontol A Biol Sci Med Sci 2019; 73:763-769. [PMID: 28958013 DOI: 10.1093/gerona/glx147] [Citation(s) in RCA: 35] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2017] [Accepted: 08/02/2017] [Indexed: 11/13/2022] Open
Abstract
Background Strategies used to predict fracture in community-dwellers may not be useful in the nursing home (NH). Our objective was to develop and validate a model (Fracture Risk Assessment in Long-term Care [FRAiL]) to predict the 2-year risk of hip fracture in NH residents using readily available clinical characteristics. Methods The derivation cohort consisted of 419,668 residents between May 1, 2007 and April 30, 2008 in fee-for service Medicare. Hip fractures were identified using Part A diagnostic codes. Resident characteristics were obtained using the Minimum Data Set and Part D claims. Multivariable competing risk regression was used to model 2-year risk of hip fracture. We validated the model in a remaining 1/3 sample (n = 209,834) and in a separate cohort in 2011 (n = 858,636). Results Mean age was 84 years (range 65-113 years) and 74.5% were female. During 1.8 years mean follow-up, 14,553 residents (3.5%) experienced a hip fracture. Fifteen characteristics in the final model were associated with an increased risk of hip fracture including dementia severity, ability to transfer and walk independently, prior falls, wandering, and diabetes. In the derivation sample, the concordance index was 0.69 in men and 0.71 in women. Calibration was excellent. Results were similar in the internal and external validation samples. Conclusions The FRAiL model was developed specifically to identify NH residents at greatest risk for hip fracture, and it identifies a different pattern of risk factors compared with community models. This practical model could be used to screen NH residents for fracture risk and to target intervention strategies.
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Affiliation(s)
- Sarah D Berry
- Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts.,Hebrew SeniorLife, Institute for Aging Research, Boston, Massachusetts
| | - Andrew R Zullo
- Department of Health Services, Policy, and Practice, Brown University School of Public Health, Providence, Rhode Island
| | - Yoojin Lee
- Department of Health Services, Policy, and Practice, Brown University School of Public Health, Providence, Rhode Island
| | - Vincent Mor
- Department of Health Services, Policy, and Practice, Brown University School of Public Health, Providence, Rhode Island
| | - Kevin W McConeghy
- Department of Health Services, Policy, and Practice, Brown University School of Public Health, Providence, Rhode Island
| | - Geetanjoli Banerjee
- Department of Health Services, Policy, and Practice, Brown University School of Public Health, Providence, Rhode Island
| | - Ralph B D'Agostino
- Department of Mathematics and Statistics, Boston University, Massachusetts
| | - Lori Daiello
- Department of Health Services, Policy, and Practice, Brown University School of Public Health, Providence, Rhode Island
| | - David Dosa
- Department of Health Services, Policy, and Practice, Brown University School of Public Health, Providence, Rhode Island
| | - Douglas P Kiel
- Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts.,Hebrew SeniorLife, Institute for Aging Research, Boston, Massachusetts
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Tseng OL, Dawes MG, Spinelli JJ, Gotay CC, McBride ML. Utilization of bone mineral density testing among breast cancer survivors in British Columbia, Canada. Osteoporos Int 2017; 28:3439-3449. [PMID: 28993862 DOI: 10.1007/s00198-017-4218-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/13/2017] [Accepted: 09/06/2017] [Indexed: 10/18/2022]
Abstract
UNLABELLED Breast cancer survivors are at high osteoporosis risk. Bone mineral density testing plays a key role in osteoporosis management. We analyzed a historical utilization of bone mineral density testing in breast cancer survivors. The utilization remained low in the 1995-2008 period. Lower socio-economic status and rural residency were associated with lower utilization. INTRODUCTION To evaluate the utilization of bone mineral density (BMD) testing for female breast cancer survivors aged 65+ surviving ≥ 3 years in British Columbia, Canada. METHODS A retrospecitve population-based data linkage study. Trends in proportion of survivors with ≥ 1 BMD test for each calendar year from 1995 to 2008 were evaluated with a serial cross-sectional analysis. Associations between factors (socio-demographic and clinical) and BMD testing rates over the period 2006-2008 for 7625 survivors were evaluated with a cross-sectional analysis and estimated as adjusted prevalence ratios (PRadj) using log-binomial models. RESULTS Proportions of survivors with ≥ 1 BMD test increased from 1.0% in 1995 to 10.1% in 2008. The BMD testing rate in 2006-2008 was 26.5%. Socio-economic status (SES) and urban/rural residence were associated with BMD testing rates in a dose-dependent relationship (p for trend< 0.01). Survivors with lower SES (PRadj = 0.66-0.78) or rural residence (PRadj = 0.70) were 20-30% less likely to have BMD tests, compared with survivors with the highest SES or urban residence. BMD testing rates were also negatively associated with older age (75+) (PRadj = 0.47; 95% CI = 0.42, 0.52), nursing home residency (0.05; 0.01, 0.39), recent osteoporotic fractures (0.21; 0.14, 0.32), and no previous BMD tests (0.26; 0.23, 0.29). CONCLUSION Utilization of BMD testing was low for breast cancer survivors in BC, Canada. Lower SES and rural residence were associated with lower BMD testing rates. IMPLICATION FOR CANCER SURVIVORS Female breast cancer survivors, especially those with lower SES or rural residence, should be encouraged to receive BMD tests as recommended by Canadian guidelines.
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Affiliation(s)
- O L Tseng
- Cancer Control Research Program, British Columbia Cancer Agency (BCCA), Vancouver, British Columbia, Canada.
- Department of Family Practice, University of British Columbia, 3rd floor David Strangway Building, 5950 University Boulevard Building, Vancouver, British Columbia, V6T 1Z3, Canada.
| | - M G Dawes
- Department of Family Practice, University of British Columbia, 3rd floor David Strangway Building, 5950 University Boulevard Building, Vancouver, British Columbia, V6T 1Z3, Canada
| | - J J Spinelli
- Cancer Control Research Program, British Columbia Cancer Agency (BCCA), Vancouver, British Columbia, Canada
- School of Population and Public Health, University of British Columbia, Vancouver, Canada
| | - C C Gotay
- Cancer Control Research Program, British Columbia Cancer Agency (BCCA), Vancouver, British Columbia, Canada
- School of Population and Public Health, University of British Columbia, Vancouver, Canada
| | - M L McBride
- Cancer Control Research Program, British Columbia Cancer Agency (BCCA), Vancouver, British Columbia, Canada
- School of Population and Public Health, University of British Columbia, Vancouver, Canada
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Macri JC, Iaboni A, Kirkham JG, Maxwell C, Gill SS, Vasudev A, Whitehead M, Seitz DP. Association between Antidepressants and Fall-Related Injuries among Long-Term Care Residents. Am J Geriatr Psychiatry 2017; 25:1326-1336. [PMID: 28943234 DOI: 10.1016/j.jagp.2017.08.014] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/11/2017] [Revised: 08/11/2017] [Accepted: 08/24/2017] [Indexed: 01/21/2023]
Abstract
OBJECTIVES Antidepressants are associated with an increased risk of falls although little is known of the comparative risks of different types of antidepressants or individuals who are at greatest risk for falls. We examined the association between new use of antidepressants and fall-related injuries among older adults in long-term care (LTC). DESIGN, SETTING, PARTICIPANTS This was a matched, retrospective cohort study involving LTC residents in Ontario, Canada, from 2008 to 2014. New users of antidepressants were matched to non-users of antidepressants. MEASUREMENTS The primary outcome was any fall resulting in an emergency department (ED) visit or hospitalization within 90 days after exposure. Secondary outcomes included hip fractures, wrist fractures, and falls reported in LTC. Multivariate logistic regression was used to estimate the odds ratio (OR) and 95% confidence interval associated with antidepressants and outcomes. RESULTS New users of any antidepressant had an increased risk of ED visits or hospitalization for falls within 90 days when compared with individuals not receiving antidepressants (5.2% versus 2.8%; adjusted OR: 1.9, 95% CI: 1.7-2.2). Antidepressants were also associated with an increased risk of all secondary outcomes. The increased risk of fall-related injuries was evident among selective-serotonin reuptake inhibitors, serotonin-norepinephrine reuptake inhibitors, trazodone, and across multiple patient subgroups. CONCLUSIONS New use of antidepressants is associated with significantly increased risk of falls and fall-related injuries among LTC residents across different patient subgroups and antidepressant classes. The potential risk of fall-related outcomes should be carefully considered when initiating antidepressants among older adults in LTC.
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Affiliation(s)
- Jennifer C Macri
- Department of Psychiatry, Queen's University, Providence Care-Mental Health Services, Kingston, Canada; Department of Biomedical and Molecular Sciences, Queen's University, Kingston, Canada; Department of Public Health, Queen's University, Kingston, Canada
| | - Andrea Iaboni
- Department of Psychiatry, University of Toronto, Toronto Rehabilitation Institute, Toronto, Canada
| | - Julia G Kirkham
- Department of Psychiatry, Queen's University, Providence Care-Mental Health Services, Kingston, Canada
| | - Colleen Maxwell
- Schools of Pharmacy and Public Health and Health Systems, University of Waterloo, Waterloo, Canada
| | - Sudeep S Gill
- Department of Medicine, Queen's University, Kingston, Canada
| | - Akshya Vasudev
- Department of Psychiatry, Western University, London, Canada
| | - Marlo Whitehead
- Institute for Clinical Evaluative Sciences, Queen's University, London, Canada
| | - Dallas P Seitz
- Department of Psychiatry, Queen's University, Providence Care-Mental Health Services, Kingston, Canada; Institute for Clinical Evaluative Sciences, Queen's University, London, Canada.
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Ioannidis G, Jantzi M, Bucek J, Adachi JD, Giangregorio L, Hirdes J, Pickard L, Papaioannou A. Development and validation of the Fracture Risk Scale (FRS) that predicts fracture over a 1-year time period in institutionalised frail older people living in Canada: an electronic record-linked longitudinal cohort study. BMJ Open 2017; 7:e016477. [PMID: 28864698 PMCID: PMC5588955 DOI: 10.1136/bmjopen-2017-016477] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/22/2023] Open
Abstract
OBJECTIVES To develop and validate our Fracture Risk Scale (FRS) over a 1-year time period, using the long-term care (LTC) Resident Assessment Instrument Minimum Data Set Version 2.0 (RAI-MDS 2.0). DESIGN A retrospective cohort study. SETTING LTC homes in Ontario, Canada. PARTICIPANTS Older adults who were admitted to LTC and received a RAI-MDS 2.0 admission assessment between 2006 and 2010. RESULTS A total of 29 848 LTC residents were enrolled in the study. Of these 22 386 were included in the derivation dataset and 7462 individual were included in the validation dataset. Approximately 2/3 of the entire sample were women and 45% were 85 years of age or older. A total of 1553 (5.2%) fractures were reported over the 1-year time period. Of these, 959 (61.8%) were hip fractures. Following a hip fracture, 6.3% of individuals died in the emergency department or as an inpatient admission and did not return to their LTC home. Using decision tree analysis, our final outcome scale had eight risk levels of differentiation. The percentage of individuals with a hip fracture ranged from 0.6% (lowest risk level) to 12.6% (highest risk level). The area under the curve of the outcome scale was similar for the derivation (0.67) and validation (0.69) samples, and the scale exhibited a good level of consistency. CONCLUSIONS Our FRS predicts hip fracture over a 1-year time period and should be used as an aid to support clinical decisions in the care planning of LTC residents. Future research should focus on the transformation of our scale to a Clinical Assessment Protocol and to assess the FRS in other healthcare settings.
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Affiliation(s)
- George Ioannidis
- Department of Medicine, McMaster University, Hamilton, Ontario, Canada
- Geriatric Education and Research in Ageing Sciences Centre, Hamilton, Ontario, Canada
| | - Micaela Jantzi
- Department of Health Studies and Gerontology, University of Waterloo, Waterloo, Ontario, Canada
| | - Jenn Bucek
- Department of Health Studies and Gerontology, University of Waterloo, Waterloo, Ontario, Canada
| | - Jonathan D Adachi
- Department of Medicine, McMaster University, Hamilton, Ontario, Canada
- Geriatric Education and Research in Ageing Sciences Centre, Hamilton, Ontario, Canada
| | - Lora Giangregorio
- Department of Kinesiology, University of Waterloo, Waterloo, Ontario, Canada
| | - John Hirdes
- Department of Health Studies and Gerontology, University of Waterloo, Waterloo, Ontario, Canada
| | - Laura Pickard
- Department of Medicine, McMaster University, Hamilton, Ontario, Canada
- Geriatric Education and Research in Ageing Sciences Centre, Hamilton, Ontario, Canada
| | - Alexandra Papaioannou
- Department of Medicine, McMaster University, Hamilton, Ontario, Canada
- Geriatric Education and Research in Ageing Sciences Centre, Hamilton, Ontario, Canada
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Severe Spastic Contractures and Diabetes Mellitus Independently Predict Subsequent Minimal Trauma Fractures Among Long-Term Care Residents. J Am Med Dir Assoc 2016; 17:1025-1030. [PMID: 27520785 DOI: 10.1016/j.jamda.2016.06.029] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2016] [Revised: 06/28/2016] [Accepted: 06/28/2016] [Indexed: 12/14/2022]
Abstract
OBJECTIVE The study aimed to examine the epidemiology of hypertonic contractures and its relationship with minimal trauma fracture (MTF), and to determine the incidence and predictors of (MTF) in long-term care residents. DESIGN This was a longitudinal cohort study of prospectively collected data. Participants were followed from March 2007 to March 2016 or until death. SETTING A 300-bed long-term care hospital in Hong Kong. PARTICIPANTS All long-term care residents who were in need of continuous medical and nursing care for their activities of daily living. MEASUREMENTS Information on patients' demographic data, severe contracture defined as a decrease of 50% or more of the normal passive range of joint movement of the joint, and severe limb spasticity defined by the Modified Ashworth Scale higher than grade 3, medical comorbidities, functional status, cognitive status, nutritional status including body mass index and serum albumin, past history of fractures, were evaluated as potential risk factors for subsequent MTF. RESULTS Three hundred ninety-six residents [148 males, mean ± standard deviation (SD), age = 79 ± 16 years] were included for analysis. The presence of severe contracture was highly prevalent among the study population: 91% of residents had at least 1 severe contracture, and 41% of residents had severe contractures involving all 4 limbs. Moreover, there were a significant proportion of residents who had severe limb spasticity with the elbow flexors (32.4%) and knee flexors (33.9%) being the most commonly involved muscles. Twelve residents (3%) suffered from subsequent MTF over a median follow-up of 33 (SD = 30) months. Seven out of these 12 residents died during the follow-up period, with a mean survival of 17.8 months (SD = 12.6) after the fracture event. The following 2 factors were found to independently predict subsequent MTF in a multivariate Cox regression: bilateral severe spastic knee contractures (hazard ratio = 16.5, P < .0001, confidence interval 4.8-56.4) and diabetes mellitus (hazard ratio = 4.0. P = .018, confidence interval 1.3-12.7). CONCLUSIONS Severe spasticity and contractures are common morbidities in long-term care residents, and bilateral severe spastic knee contractures and diabetes mellitus are 2 independent predictors of subsequent MTF. Spasticity management and prevention of contractures, combined with educational programs for caregivers to identify the high-risk residents and apply proper handling techniques during routine care, may be helpful in reducing the risk of MTF in long-term care residents. Further large-scale longitudinal studies are needed to confirm these findings.
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Abstract
This prospective, observational study characterizes the circumstances that led to falls in long-term care (LTC) residents and describes the characteristics of residents who fractured following a fall. Staff recorded the location of the fall, time of day, activity the participant was doing prior, and if an injury occurred. Descriptive statistics were used to describe the falls, and a generalized linear model was used to determine differences between the circumstances. Of the 101 LTC residents who participated, 41 per cent experienced at least one fall. Residents were significantly more likely to have fallen in the bedroom and while walking. Of the 17 falls resulting in fractures, most occurred in the bedroom and bathroom, during the early morning; most residents who fractured were female with cognitive impairment. To monitor falls comprehensively, ambulatory monitoring that avoids privacy issues in bedrooms or bathrooms may be needed. Interventions should target walking or the bedroom setting.
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Rural-urban differences in the prevalence of cognitive impairment in independent community-dwelling elderly residents of Ojiya city, Niigata Prefecture, Japan. Environ Health Prev Med 2016; 21:422-429. [PMID: 27262968 DOI: 10.1007/s12199-016-0542-2] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2016] [Accepted: 05/26/2016] [Indexed: 10/21/2022] Open
Abstract
BACKGROUND This study aimed to examine rural-urban differences in the prevalence of cognitive impairment in Japan. METHODS We targeted 592 residents aged 65 years and older who did not use long-term care insurance services in one rural and two urban areas in Ojiya City, Japan. Of these, 537 (90.7 %) participated in the study. The revised Hasegawa's dementia scale (HDS-R) was used to assess cognitive function, and cognitive impairment was defined as a HDS-R score ≤20. Lifestyle information was obtained through interviews. The prevalence of cognitive impairment was compared according to the levels of predictor variables by odds ratios (ORs) calculated by a logistic regression analysis. RESULTS Mean age of participants was 75.7 years (SD 7.0). The prevalence of cognitive impairment was 20/239 (8.4 %) in the rural area and 6/298 (2.0 %) in the urban areas, for a total of 26/537 (4.8 %) overall. Men tended to have a higher prevalence of cognitive impairment (P = 0.0628), and age was associated with cognitive impairment (P for trend <0.0001). The rural area had a significantly higher prevalence of cognitive impairment (age- and sex-adjusted OR = 4.04, 95 % CI: 1.54-10.62) than urban areas. This difference was significant after adjusting for other lifestyle factors. CONCLUSIONS The prevalence of cognitive impairment was higher in the rural area relative to urban areas in Ojiya city. This regional difference suggests the existence of potentially modifiable factors other than lifestyle in relation to cognitive impairment.
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Papaioannou A, Kennedy CC, Ioannidis G, Cameron C, Croxford R, Adachi JD, Mursleen S, Jaglal S. Comparative trends in incident fracture rates for all long-term care and community-dwelling seniors in Ontario, Canada, 2002-2012. Osteoporos Int 2016; 27:887-897. [PMID: 26801930 PMCID: PMC5096943 DOI: 10.1007/s00198-015-3477-3] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/21/2015] [Accepted: 12/29/2015] [Indexed: 01/25/2023]
Abstract
SUMMARY In this population-based study, we compared incident fracture rates in long-term care (LTC) versus community seniors between 2002 and 2012. Hip fracture rates declined more rapidly in LTC than in the community. An excess burden of fractures occurred in LTC for hip, pelvis, and humerus fractures in men and hip fractures only in women. INTRODUCTION This study compares trends in incident fracture rates between long-term care (LTC) and community-dwelling seniors ≥65 years, 2002-2012. METHODS This is a population-based cohort study using administrative data. Measurements were age/sex-adjusted incident fracture rates and rate ratios (RR) and annual percent change (APC). RESULTS Over 11 years, hip fracture rates had a marked decline occurring more rapidly in LTC (APC, -3.49 (95% confidence interval (CI), -3.97, -3.01)) compared with the community (APC, -2.93 (95% CI, -3.28, -2.57); p < 0.05 for difference in slopes). Humerus and wrist fracture rates decreased; however, an opposite trend occurred for pelvis and spine fractures with rates increasing over time in both cohorts (all APCs, p < 0.05). In 2012, incident hip fracture rates were higher in LTC than the community (RRs: women, 1.55 (95% CI, 1.45, 1.67); men, 2.18 (95% CI, 1.93, 2.47)). Higher rates of pelvis (RR, 1.48 (95% CI, 1.22, 1.80)) and humerus (RR, 1.40 (95% CI, 1.07, 1.84)) fractures were observed in LTC men, not women. In women, wrist (RR, 0.76 (95% CI, 0.71, 0.81)) and spine (RR, 0.52 (95% CI, 0.45, 0.61)) fracture rates were lower in LTC than the community; in men, spine (RR, 0.75 (95% CI, 0.57, 0.98) but not wrist fracture (RR, 0.91 (95% CI, 0.67, 1.23)) rates were significantly lower in LTC than the community. CONCLUSION Previous studies in the community have shown declining hip fracture rates over time, also demonstrated in our study but at a more rapid rate in LTC. Rates of humerus and wrist fractures also declined. An excess burden of fractures in LTC occurred for hip fractures in women and for hip, pelvis, and humerus fractures in men.
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Affiliation(s)
- A Papaioannou
- GERAS Centre, Hamilton Health Sciences, 88 Maplewood Avenue, Hamilton, ON, L8M 1W9, Canada.
- Division of Geriatrics, Department of Medicine, McMaster University, 88 Maplewood Avenue, Hamilton, ON, L8M 1W9, Canada.
| | - C C Kennedy
- GERAS Centre, Hamilton Health Sciences, 88 Maplewood Avenue, Hamilton, ON, L8M 1W9, Canada
| | - G Ioannidis
- GERAS Centre, Hamilton Health Sciences, 88 Maplewood Avenue, Hamilton, ON, L8M 1W9, Canada
- Division of Geriatrics, Department of Medicine, McMaster University, 88 Maplewood Avenue, Hamilton, ON, L8M 1W9, Canada
- Division of Rheumatology, Department of Medicine, McMaster University, 1280 Main Street West, Hamilton, ON, L8S 4K1, Canada
| | - C Cameron
- International Centre for Disability and Rehabilitation, University of Toronto, 500 University Avenue, Toronto, ON, M5G 1V7, Canada
| | - R Croxford
- Institute for Clinical Evaluative Sciences, University of Toronto, 155 College Street, Suite 424, Toronto, ON, M5T 3M6, Canada
| | - J D Adachi
- Division of Rheumatology, Department of Medicine, McMaster University, 1280 Main Street West, Hamilton, ON, L8S 4K1, Canada
| | - S Mursleen
- GERAS Centre, Hamilton Health Sciences, 88 Maplewood Avenue, Hamilton, ON, L8M 1W9, Canada
| | - S Jaglal
- Department of Physical Therapy, University of Toronto, 160-500 University Avenue, Toronto, ON, M5G 1V7, Canada
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Bonafede M, Shi N, Barron R, Li X, Crittenden D, Chandler D. Predicting imminent risk for fracture in patients aged 50 or older with osteoporosis using US claims data. Arch Osteoporos 2016; 11:26. [PMID: 27475642 PMCID: PMC4967418 DOI: 10.1007/s11657-016-0280-5] [Citation(s) in RCA: 75] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/30/2016] [Accepted: 07/07/2016] [Indexed: 02/03/2023]
Abstract
UNLABELLED Patient characteristics contributing to imminent risk for fracture, defined as risk of near-term fracture within the next 12 to 24 months, have not been well defined. In patients without recent fracture, we identified factors predicting imminent risk for vertebral/nonvertebral fracture, including falls, age, comorbidities, and other potential fall risk factors. PURPOSE Several factors contribute to long-term fracture risk in patients with osteoporosis, including age, bone mineral density, and fracture history. Some patients may be at imminent risk for fracture, defined here as a risk of near-term fracture within 12-24 months. Many patient characteristics contributing to imminent risk for fracture have not been well defined. This case-control study used US commercial and Medicare supplemental insured data for women and men without recent fracture to identify factors associated with imminent risk for fracture. METHODS Patients included were aged ≥50 with osteoporosis, had a vertebral or nonvertebral fracture claim (index date; fracture group) or no fracture claim (control group) from January 1, 2006, to September 30, 2012, continuously enrolled and without fracture in the 24 months before index. Potential risk factors during the period before fracture were assessed. RESULTS Using data from 12 months before fracture, factors significantly associated with imminent risk for fracture were previous falls, older age, poorer health status, specific comorbidities (psychosis, Alzheimer's disease, central nervous system disease), and other fall risk factors (wheelchair use, psychoactive medication use, mobility impairment). Similar findings were observed with data from 24 months before fracture. CONCLUSIONS In patients with osteoporosis and no recent fracture, falls, older age, poorer health status, comorbidities, and other potential fall risk factors were predictive of imminent risk for fracture. Identification of factors associated with imminent risk for vertebral/nonvertebral fracture may help identify and risk stratify those patients most in need of immediate and appropriate treatment to decrease fracture risk.
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Affiliation(s)
| | - N. Shi
- Truven Health Analytics, Cambridge, MA USA
| | - R. Barron
- Amgen Inc., One Amgen Center Drive, Thousand Oaks, CA USA
| | - X. Li
- Amgen Inc., One Amgen Center Drive, Thousand Oaks, CA USA
| | | | - D. Chandler
- Amgen Inc., One Amgen Center Drive, Thousand Oaks, CA USA
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