Treatment for menopausal symptoms and having health insurance were associated with a lower prevalence of falls among Brazilian women

Screening for high hip fracture risk does not impact on falls risk: a post hoc analysis from the SCOOP study

A reduction in hip fracture incidence following population screening might reflect the effectiveness of anti-osteoporosis therapy, behaviour change to reduce falls, or both. This post hoc analysis demonstrates that identifying high hip fracture risk by FRAX was not associated with any alteration in falls risk.

INTRODUCTION

To investigate whether effectiveness of an osteoporosis screening programme to reduce hip fractures was mediated by modification of falls risk in the screening arm.

METHODS

The SCOOP study recruited 12,483 women aged 70-85 years, individually randomised to a control (n = 6250) or screening (n = 6233) arm; in the latter, osteoporosis treatment was recommended to women at high risk of hip fracture, while the control arm received usual care. Falls were captured by self-reported questionnaire. We determined the influence of baseline risk factors on future falls, and then examined for differences in falls risk between the randomisation groups, particularly in those at high fracture risk.

RESULTS

Women sustaining one or more falls were slightly older at baseline than those remaining falls free during follow-up (mean difference 0.70 years, 95%CI 0.55-0.85, p < 0.001). A higher FRAX 10-year probability of hip fracture was associated with increased likelihood of falling, with fall risk increasing by 1-2% for every 1% increase in hip fracture probability. However, falls risk factors were well balanced between the study arms and, importantly, there was no evidence of a difference in falls occurrence. In particular, there was no evidence of interaction (p = 0.18) between baseline FRAX hip fracture probabilities and falls risk in the two arms, consistent with no impact of screening on falls in women informed to be at high risk of hip fracture.

CONCLUSION

Effectiveness of screening for high FRAX hip fracture probability to reduce hip fracture risk was not mediated by a reduction in falls.

Disability and multimorbidity in women older than 50 years: a population-based household survey

OBJECTIVE

This study aims to evaluate the prevalence of disability and associated factors in Brazilian women older than 50 years.

METHODS

We conducted a cross-sectional study (in the form of a population survey) of 622 women older than 50 years and residing in Campinas, Brazil. Disability was assessed through a questionnaire with seven items and defined as "being completely unable to perform any of them." Independent variables included self-perception of health, sociodemographic data, health-related habits, and morbidities. Statistical analysis was carried out by χ(2) test and Poisson regression.

RESULTS

The mean age of women was 64.1 years, and the prevalence of disability was 43.4%. Age (prevalence ratio [PR], 1.02; 95% CI, 1.01-1.03), fear of falling (PR, 1.59; 95% CI, 1.17-2.16), higher body mass index (PR, 1.03; 95% CI, 1.01-1.05), personal history of myocardial infarction (PR, 1.36; 95% CI, 1.06-1.76), smoking more than 15 cigarettes per day (PR, 1.34; 95% CI, 1.04-1.72), hospitalization in the past year (PR, 1.29; 95% CI, 1.03-1.62), multimorbidity (PR, 1.43; 95% CI, 1.02-2.02), and use of any medication prescribed by a doctor (PR, 1.57; 95% CI, 1.02-2.41) were associated with a higher prevalence of disability. Self-perception of health as good/very good (PR, 0.67; 95% CI, 0.52-0.86), use of alternative medications (PR, 0.54; 95% CI, 0.33-0.90), and more years of schooling (PR, 0.65; 95% CI, 0.45-0.93) were associated with a lower prevalence of disability.

CONCLUSIONS

The results improve our understanding of the factors associated with disability in Brazilian women and may help identify those who need multidisciplinary support to reduce effects on quality of life.