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Habibi Ghahfarrokhi S, Mohammadian-Hafshejani A, Sherwin CMT, Heidari-Soureshjani S. Relationship between serum vitamin D and hip fracture in the elderly: a systematic review and meta-analysis. J Bone Miner Metab 2022; 40:541-553. [PMID: 35639176 DOI: 10.1007/s00774-022-01333-7] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/17/2021] [Accepted: 04/03/2022] [Indexed: 11/26/2022]
Abstract
INTRODUCTION This study investigated the relationship between serum 25-hydroxyvitamin D (25OHD) levels and the occurrence of hip fractures in the elderly using a systematic review and meta-analysis approach. MATERIALS AND METHODS PubMed, Web of Science, and Scopus were used to identify studies that outlined an association between serum 25OHD and the occurrence of a hip fracture in a geriatric patient. The analysis calculated odds ratios (OR) for a hip fracture using a random-effects model. RESULTS In this study, 28 studies were included, 61,744 elderlies and 9767 cases (15.81%) of hip fractures. In the lowest vs. highest categories of vitamin D in the elderly, pooled OR of hip fractures was 1.80 (95% CI 1.56-2.07, P ≤ 0.001), and modified OR was equal to 1.40 (95% CI 1.20-1.63 P ≤ 0.001). A subgroup analysis showed that the OR of a hip fracture was 2.16 (1.49-3.11, P ≤ 0.001) in case-control studies; 1.52 (1.29-1.79, P = 0.001) in cohort studies; and 1.41 (1.18-1.70, P ≤ 0.001) in case-cohort studies. CONCLUSION Low serum vitamin D levels in the elderly are associated with an increase in the odds of hip fracture.
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Affiliation(s)
- Shahrzad Habibi Ghahfarrokhi
- Department of Social Medicine, Modeling in Health Research Center, Shahrekord University of Medical Sciences, Social Determinants of Health Research Center, Shahrekord, Iran
- Deputy of Research and Technology Kashani Boulevard, Shahrekord University of Medical Sciences, Shahrekord, Iran
| | - Abdollah Mohammadian-Hafshejani
- Deputy of Research and Technology Kashani Boulevard, Shahrekord University of Medical Sciences, Shahrekord, Iran
- Department of Epidemiology and Biostatistics, School of Public Health, Shahrekord University of Medical Sciences, Shahrekord, Iran
| | - Catherine M T Sherwin
- Pediatric Clinical Pharmacology, Department of Pediatrics, Wright State University Boonshoft School of Medicine, Dayton Children's Hospital, Dayton, OH, USA
- Dayton Children's Hospital, 1 Childrens Plz, Dayton, OH, 45404-1873, USA
| | - Saeid Heidari-Soureshjani
- Deputy of Research and Technology Kashani Boulevard, Shahrekord University of Medical Sciences, Shahrekord, Iran.
- Modeling in Health Research Center, Shahrekord University of Medical Sciences, Shahrekord, Iran.
- Circuit of Research and Technology, Shahrekord University of Medical Sciences, Shahrekord, Iran.
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Wang N, Chen Y, Ji J, Chang J, Yu S, Yu B. The relationship between serum vitamin D and fracture risk in the elderly: a meta-analysis. J Orthop Surg Res 2020; 15:81. [PMID: 32103764 PMCID: PMC7045381 DOI: 10.1186/s13018-020-01603-y] [Citation(s) in RCA: 26] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/03/2020] [Accepted: 02/17/2020] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND The incidence of osteoporotic fractures has increased rapidly, and because of the poor prognosis and high mortality associated with osteoporotic fractures, they remain a prospective research area globally. One way to reduce their incidence is to investigate their intervention risk factors in the elderly. Hence, this study explores the correlation between serum 25-hydroxyvitamin D [25(OH)D] levels and osteoporotic fractures in elderly patients through a meta-analysis. METHODS We conducted our literature search mainly in PubMed and Embase for identifying studies that investigated the relationship between serum 25(OH)D levels and the risk for osteoporotic fractures. We performed categorical analysis, heterogeneity checks, publication bias analysis, and subgroup analyses. RESULTS In total, 20 studies were included, of which 4 were case-cohort studies and 16 were cohort studies. A total of 41,738 patients from 20 studies were included in the meta-analysis, of which 5916 had fractures, including 3237 hip fractures. By combining the lowest and highest categories of relative risks (RRs) and 95% confidence intervals (CIs), it was suggested that lower serum 25-hydroxyvitamin D levels may be a risk factor for fractures. RR (95% CI) for total and hip fractures were 1.11 (0.99, 1.24) and 0.89 (0.80, 0.98) after adjustments. CONCLUSIONS Our study showed that compared to low serum 25(OH)D levels, high serum 25(OH)D levels reduce the risk of hip fractures in the patients aged 60 years or older. In contrast, serum 25(OH)D has no significant relationship with total fracture risk.
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Affiliation(s)
- Ning Wang
- Shandong University of Traditional Chinese Medicine, Jingshi Road16369, Jinan, 250014 China
| | - Yungang Chen
- Department of Orthopaedics, Affiliated Hospital of Shandong University of Traditional Chinese Medicine, Jingshi Road16369, Jinan, 250014 China
| | - Jindou Ji
- Shandong University of Traditional Chinese Medicine, Jingshi Road16369, Jinan, 250014 China
| | - Jinlei Chang
- Shandong University of Traditional Chinese Medicine, Jingshi Road16369, Jinan, 250014 China
| | - Shengwen Yu
- Shandong University of Traditional Chinese Medicine, Jingshi Road16369, Jinan, 250014 China
| | - Bo Yu
- Department of Orthopaedics, Affiliated Hospital of Shandong University of Traditional Chinese Medicine, Jingshi Road16369, Jinan, 250014 China
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Grigoriou EV, Trovas G, Papaioannou N, Makras P, Kokkoris P, Dontas I, Makris K, Tournis S, Dedoussis GV. Serum 25-hydroxyvitamin D status, quantitative ultrasound parameters, and their determinants in Greek population. Arch Osteoporos 2018; 13:111. [PMID: 30324335 DOI: 10.1007/s11657-018-0526-5] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/18/2018] [Accepted: 09/27/2018] [Indexed: 02/03/2023]
Abstract
UNLABELLED Vitamin D deficiency and quantitative ultrasound measurements are associated with bone fragility. We assessed these parameters and their correlates. 87.7% of the population has vitamin D inadequacy and this correlated with lifestyle factors. These results contribute to epidemiological data needed for population guidelines for bone health. PURPOSE Vitamin D deficiency and quantitative ultrasound (QUS) parameters are among the most important clinical risk factors of bone fragility. Few data are available for Greek population. The aim of the study was to evaluate the serum 25-hydroxyvitamin D [25(OH)D] level and their determinants, as well as QUS parameters in Greek population. METHODS OSTEOS is an observational cross-sectional study conducted from June 2010 to July 2012. Nine hundred seventy adults were recruited from rural and urban areas throughout Greece and completed the appropriate questionnaire. Serum 25(OH)D measured by enzyme immunoassay, QUS parameters, broadband ultrasound attenuation (BUA), speed of sound (SOS) and stiffness index (SI), was assessed with an Achilles device. Univariate Analysis of Variance was used for the assessment of serum 25(OH)D determinants. RESULTS Mean serum 25(OH)D of the total population was 20,00 ± 8,00 ng/mL. Females had lower levels than males. The negative determinants of serum 25(OH)D in the total population were the female sex and the winter-spring season of sampling while age proved negative association solely in obese subjects. Positive determinants of vitamin D status were summer sun exposure and organized physical activity as expected. Urban had lower SOS and SI than rural residents. Individuals with 25(OH)D ≥ 20 ng/mL had higher SOS than those with 25(OH)D < 20 ng/mL. BUA, SOS, and SI are positively correlated with organized physical activity and negatively with PTH. CONCLUSIONS This study reports that vitamin D deficiency is highly prevalent among healthy Greek men and women, demonstrates the multifactorial causation of 25(OH)D levels, and points out that further research is required to determine more factors related to vitamin D status and bone health.
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Affiliation(s)
- Effimia V Grigoriou
- Department of Nutrition and Dietetics, School of Health Science and Education, Harokopio University, El. Venizelou 70, 17671, Athens, Greece
| | - George Trovas
- Th. Garofalidis Laboratory for Research of the Musculoskeletal System, Medical School, National and Kapodistrian University of Athens, 10 Athinas Street, 14561, Athens, Greece
| | - Nikolaos Papaioannou
- Th. Garofalidis Laboratory for Research of the Musculoskeletal System, Medical School, National and Kapodistrian University of Athens, 10 Athinas Street, 14561, Athens, Greece
| | - Polyzois Makras
- Department of Endocrinology and Diabetes, 251 Hellenic Air Force General Hospital, 3 Kanellopoulou st, 11525, Athens, Greece
- Department of Medical Research, 251 Hellenic Air Force & VA General Hospital, Athens, Greece
| | - Panagiotis Kokkoris
- Department of Endocrinology and Diabetes, 251 Hellenic Air Force General Hospital, 3 Kanellopoulou st, 11525, Athens, Greece
- Department of Medical Research, 251 Hellenic Air Force & VA General Hospital, Athens, Greece
| | - Ismene Dontas
- Th. Garofalidis Laboratory for Research of the Musculoskeletal System, Medical School, National and Kapodistrian University of Athens, 10 Athinas Street, 14561, Athens, Greece
| | | | - Symeon Tournis
- Th. Garofalidis Laboratory for Research of the Musculoskeletal System, Medical School, National and Kapodistrian University of Athens, 10 Athinas Street, 14561, Athens, Greece
| | - George V Dedoussis
- Department of Nutrition and Dietetics, School of Health Science and Education, Harokopio University, El. Venizelou 70, 17671, Athens, Greece.
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Feng Y, Cheng G, Wang H, Chen B. The associations between serum 25-hydroxyvitamin D level and the risk of total fracture and hip fracture. Osteoporos Int 2017; 28:1641-1652. [PMID: 28220196 DOI: 10.1007/s00198-017-3955-x] [Citation(s) in RCA: 36] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/10/2016] [Accepted: 01/31/2017] [Indexed: 02/07/2023]
Abstract
UNLABELLED In this meta-analysis, we evaluated the association between serum 25-hydroxyvitamin D (25(OH) vitamin D) level and the risk of total fractures and hip fractures. Low serum 25(OH) vitamin D level is associated with an increased risk of total and hip fractures. INTRODUCTION Data on the association between serum 25(OH) vitamin D level and the risk of fractures are conflicting. This study aimed to provide a summary of prospective cohort or nested case-control studies on the association between serum 25(OH) vitamin D level and the risk of total fractures and hip fractures. METHODS We identified relevant studies by searching the PubMed, EMBASE, and OVID databases from their inception to June 1, 2016. We included published prospective cohort or nested case-control studies evaluating the associations of serum 25(OH) vitamin D level with the fracture risk. Two reviewers abstracted the data independently. Relative risks (RRs) with 95% confidence intervals (CIs) were derived throughout the whole analysis. RESULTS Sixteen prospective cohort studies and three nested case-control studies were included. We found that low serum 25(OH) vitamin D level was significantly associated with the risk of total fractures (RR 1.25, 95% CI 1.06-1.43; I 2 = 31.3%, p for heterogeneity = 0.15) and hip fractures (RR 1.48, 95% CI 1.29-1.68; I 2 = 0%, p for heterogeneity = 0.51). The hip fracture risk was increased by 40% for each SD decrease in serum 25(OH) vitamin D level (RR 1.40, 95% CI 1.20-1.61; I 2 = 0%, p for heterogeneity = 0.51). The per SD decrease in serum 25(OH) vitamin D level was not associated with the increased risk of total fractures (RR 1.14, 95% CI 0.93-1.35; I 2 = 63.2%, p for heterogeneity = 0.04). CONCLUSIONS Our study suggests that low serum 25(OH) vitamin D level is associated with increased risks of total and hip fractures. In the analyzed studies, the per SD decrease in serum 25(OH) vitamin D level was associated with the hip fracture risk but not with the total fracture risk.
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Affiliation(s)
- Y Feng
- Department of Orthopedics, Ren Ji Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, People's Republic of China
| | - G Cheng
- Department of Orthopedics, Ren Ji Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, People's Republic of China
| | - H Wang
- Department of Orthopedics, Ren Ji Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, People's Republic of China
| | - B Chen
- Department of Orthopedics, Ren Ji Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, People's Republic of China.
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Manhard MK, Nyman JS, Does MD. Advances in imaging approaches to fracture risk evaluation. Transl Res 2017; 181:1-14. [PMID: 27816505 PMCID: PMC5357194 DOI: 10.1016/j.trsl.2016.09.006] [Citation(s) in RCA: 49] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/15/2016] [Revised: 09/19/2016] [Accepted: 09/27/2016] [Indexed: 01/23/2023]
Abstract
Fragility fractures are a growing problem worldwide, and current methods for diagnosing osteoporosis do not always identify individuals who require treatment to prevent a fracture and may misidentify those not a risk. Traditionally, fracture risk is assessed using dual-energy X-ray absorptiometry, which provides measurements of areal bone mineral density at sites prone to fracture. Recent advances in imaging show promise in adding new information that could improve the prediction of fracture risk in the clinic. As reviewed herein, advances in quantitative computed tomography (QCT) predict hip and vertebral body strength; high-resolution HR-peripheral QCT (HR-pQCT) and micromagnetic resonance imaging assess the microarchitecture of trabecular bone; quantitative ultrasound measures the modulus or tissue stiffness of cortical bone; and quantitative ultrashort echo-time MRI methods quantify the concentrations of bound water and pore water in cortical bone, which reflect a variety of mechanical properties of bone. Each of these technologies provides unique characteristics of bone and may improve fracture risk diagnoses and reduce prevalence of fractures by helping to guide treatment decisions.
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Affiliation(s)
- Mary Kate Manhard
- Biomedical Engineering, Vanderbilt University, Nashville, TN; Vanderbilt University Institute of Imaging Science, Nashville, TN
| | - Jeffry S Nyman
- Biomedical Engineering, Vanderbilt University, Nashville, TN; Vanderbilt University Institute of Imaging Science, Nashville, TN; Orthopaedic Surgery and Rehabilitation, Vanderbilt University, Nashville, TN; Tennessee Valley Healthcare System, Department of Veterans Affairs, Nashville, TN; Center for Bone Biology, Vanderbilt University Medical Center, Nashville, TN
| | - Mark D Does
- Biomedical Engineering, Vanderbilt University, Nashville, TN; Vanderbilt University Institute of Imaging Science, Nashville, TN; Radiology and Radiological Sciences, Vanderbilt University, Nashville, TN; Electrical Engineering, Vanderbilt University, Nashville, TN.
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Zha XY, Hu Y, Pang XN, Chang GL, Li L. Diagnostic value of osteoporosis self-assessment tool for Asians (OSTA) and quantitative bone ultrasound (QUS) in detecting high-risk populations for osteoporosis among elderly Chinese men. J Bone Miner Metab 2015; 33:230-8. [PMID: 24748148 DOI: 10.1007/s00774-014-0587-5] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/09/2013] [Accepted: 03/11/2014] [Indexed: 02/02/2023]
Abstract
This study aims to evaluate an osteoporosis self-assessment tool for Asians (OSTA) and quantitative bone ultrasound (QUS) and their combination in detecting populations at high risk for osteoporosis, and to determine the best cutoff value for the diagnosis of osteoporosis among elderly Chinese men. A group of Chinese men, aged ≥ 60 years, recruited from the health checkup population of Zhongshan Hospital, Fudan University, were included. The OSTA index was calculated from age and weight. Bone mineral density (BMD) at left hip (femoral neck, internal, and total hip) and lumbar spine (L1-L4, L-Total) was measured with dual-energy X-ray absorptiometry (DXA), and calcaneal BMD was measured with QUS. Receiver operating characteristic analysis was used to determine the best cutoff values, sensitivity, and specificity. The area under the curve (AUC) between the different screening tools was compared. Our study included 472 men with mean age of 78.0 years. The prevalence of osteoporosis was 27.7%.The best cutoff for OSTA was -3.5 for predicting men with osteoporosis at any site; this yielded a sensitivity and specificity of 47.3% and 76.8%, respectively. The AUC for OSTA was 0.676. The optimal cutoff for QUS-T score was -1.25, with a sensitivity of 80.4% and specificity of 59.7%. The AUC for QUS-T score was 0.762. Combining QUS with OSTA improved the specificity to 92.9% but reduced sensitivity to 36.1%. A new variable derived from a combination of OSTA and the QUS-T score gave a better performance, with sensitivity of 70.1% and specificity of 72.1%; the AUC for this variable was 0.771, which was greater than OSTA but not different from QUS alone. In conclusion, OSTA and QUS, respectively, and their combination may help find populations at high risk for osteoporosis, which could be an alternative method for diagnosing osteoporosis, especially in areas where DXA measurement is not accessible.
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Affiliation(s)
- Xiao-Yun Zha
- Department of Geriatrics, Zhongshan Hospital, Fudan University, 180 Fenglin Road, Shanghai, 200032, China
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Nuti R, Caffarelli C, Guglielmi G, Gennari L, Gonnelli S. Undiagnosed vertebral fractures influence quality of life in postmenopausal women with reduced ultrasound parameters. Clin Orthop Relat Res 2014; 472:2254-61. [PMID: 24728662 PMCID: PMC4048413 DOI: 10.1007/s11999-014-3588-8] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/04/2013] [Accepted: 03/17/2014] [Indexed: 01/31/2023]
Abstract
BACKGROUND Osteoporosis, a multifactorial systemic skeletal disease characterized by low bone mass and microarchitectural deterioration of bone tissue leading to increased bone fragility, is a worldwide public health problem. Vertebral fractures affect approximately 20% of postmenopausal women and are a hallmark of osteoporosis, but they may pass unnoticed, although they may lead to long-term immobility and disability. QUESTIONS/PURPOSES The aims of the present study were (1) to determine the prevalence and the severity of vertebral fractures in a large cohort of Italian women aged 60 years or older with reduced values of quantitative ultrasound parameters; and (2) to assess whether vertebral fractures and other variables may be associated with health-related quality of life. METHODS A total of 2450 women without back pain aged 60 years or older, after the completion of the Quality of Life Questionnaire of the European Foundation for Osteoporosis QUALEFFO, underwent quantitative ultrasound evaluation of the calcaneus; in those with a stiffness t-score of ≤ -2 (n = 1194), radiographic evaluation of the thoracic and lumbar spine was carried out and then quantitative morphometry was performed by dedicated software (MorphoXpress). The radiographic analysis was carried out on 885 women who presented films of adequate quality. Multivariate regression was used to adjust for confounding variables. RESULTS Of those who underwent radiographic analysis, 681 had no vertebral fractures, and 204 women (23.1%) had one or more previously undiagnosed vertebral fractures. The prevalence of previously undiagnosed vertebral fractures increased with advancing age with more than 30% of women older than 75 years having at least one fracture. Older age, body mass index, and severe vertebral fractures were independently associated with a worse total QUALEFFO score. CONCLUSIONS We found that approximately one in four women showed evidence of undiagnosed vertebral fractures, and there was a strong age effect trend. Moreover, the severity grade of vertebral fractures, more than the number of fractures, was associated with a worsening of health-related quality of life as assessed by QUALEFFO. These findings confirm the clinical relevance of an early diagnosis of vertebral fractures and seem to support the usefulness of quantitative ultrasound measurements in the stratification of postmenopausal women at increased fracture risk. LEVEL OF EVIDENCE Level III, prognostic study. See the Guidelines for Authors for a complete description of levels of evidence.
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Affiliation(s)
- Ranuccio Nuti
- />Department of Internal Medicine, Surgery and Neurosciences, Policlinico Le Scotte, University of Siena, Viale Bracci 2, 53100 Siena, Italy
| | - Carla Caffarelli
- />Department of Internal Medicine, Surgery and Neurosciences, Policlinico Le Scotte, University of Siena, Viale Bracci 2, 53100 Siena, Italy
| | - Giuseppe Guglielmi
- />Department of Radiology, Scientific Institute Hospital, Casa Sollievo della Sofferenza, San Giovanni Rotondo, Italy
| | - Luigi Gennari
- />Department of Internal Medicine, Surgery and Neurosciences, Policlinico Le Scotte, University of Siena, Viale Bracci 2, 53100 Siena, Italy
| | - Stefano Gonnelli
- />Department of Internal Medicine, Surgery and Neurosciences, Policlinico Le Scotte, University of Siena, Viale Bracci 2, 53100 Siena, Italy
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Kauppi M, Stenholm S, Impivaara O, Mäki J, Heliövaara M, Jula A. Fall-related risk factors and heel quantitative ultrasound in the assessment of hip fracture risk: a 10-year follow-up of a nationally representative adult population sample. Osteoporos Int 2014; 25:1685-95. [PMID: 24658297 DOI: 10.1007/s00198-014-2674-9] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/09/2013] [Accepted: 02/22/2014] [Indexed: 12/22/2022]
Abstract
UNLABELLED Maximal walking speed and quantitative ultrasound index (QUI) were significant and independent predictors of hip fracture among subjects aged ≥ 55 years. A model including readily available variables along with simple fall-related factors may be clinically useful in the assessment of hip fracture risk even without a QUI measurement. INTRODUCTION This study assessed fall-related risk factors along with heel bone quantitative ultrasound (QUS) measurements for the prediction of hip fracture during a mean follow-up of 9.8 years in a nationally representative population sample. METHODS The study population consisted of 2,300 subjects (1,331 women and 969 men) aged 55 years or over, who had participated in a comprehensive health survey in 2000-2001. Information on the subjects’ health and fall-related risk factors was obtained with interviews, questionnaires and tests carried out by specially trained professionals. QUS measurements were made by means of the Hologic Sahara device. First emerging cases of hip fracture were identified from the National Hospital Discharge Register. RESULTS During the follow-up, 96 subjects sustained a hip fracture. Slow maximal walking speed, low quantitative ultrasound index (QUI), high age, tallness, short waist circumference, Parkinson's disease and the number of central nervous system active medication were significant and independent predictors of hip fracture. The model including all of these risk factors explained 68 % of the variation in hip fracture risk. Excluding QUI from this model reduced the percentage to 66%. CONCLUSIONS Maximal walking speed and QUI were significant and independent predictors of hip fracture. A model including readily available variables such as age, gender, height and waist circumference along with simple fall-related factors may be of clinical use in the assessment of hip fracture risk even without a QUS measurement.
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