A prospective cohort study of the risk factors for new falls and fragility fractures in self-caring elderly patients aged 80 years and over

Confounding association between plasma HDL-C levels and increased fracture risk: A correspondence

Background

This article explores the association between fractures, particularly in the elderly, and elevated plasma high-density lipoprotein cholesterol (HDL-C) levels. The study challenges the conventional idea of HDL-C as "good cholesterol" by revealing its potential role as a risk factor for fractures. Factors contributing to fractures in the elderly, such as diminishing bone strength due to aging-related tissue breakdown, are discussed. Sedentary lifestyles, low bone mineral density (BMD), and habits like smoking and alcohol consumption compound fracture susceptibility.

Materials and Methods

The study delves into mechanisms linking elevated HDL-C to fractures, using data from the ASPREE-Fracturesub-study of the ASPREE trial involving Australian and American participants aged 65 and above.

Results

The study showed that over a 4-year period, elevated HDL-C levels in healthy older people were linked to a 14% higher fracture risk. This revelation expands the understanding of fracture risk factors beyond the established norms.

Conclusion

The article emphasizes the need to reconsider HDL-C's traditional role as an indicator of cardiovascular health, particularly in light of medications like Statins and Anacetrapib that raise HDL-C levels. It calls for further exploration into the relationship between HDL-C, fractures at varying sites, and different age groups. Practical implications involve incorporating fracture risk associated with high HDL-C into clinical considerations, alongside advocating lifestyle changes for optimal HDL-C levels. In summary, this study prompts a reevaluation of HDL-C's implications in clinical practice, demanding further investigation into the intricacies of this relationship.

Lifestyle and ADL Are Prioritized Factors Influencing All-Cause Mortality Risk Among Oldest Old: A Population-Based Cohort Study

To identify key factors affecting all-cause mortality in the elderly aged 80 years and above. Data from Chinese Longitudinal Healthy Longevity Survey (2011-2018) were utilized (N = 3993). A healthy lifestyle score was obtained by assigning 8 factors: smoking, drinking, exercise, sleep duration, social activity, waist circumference, BMI, and healthful plant-based diet index. Cox regression and decision tree model were used to identify factors influencing the mortality risk. Lifestyle and activities of daily living (ADL) were 2 of the most important modifiable factors influencing the mortality risk of the oldest seniors. A higher healthy lifestyle score was associated with lower mortality risk. The HR (95% CI) of death risk in Q2, Q3, and Q4 groups were 0.91 (0.81-1.01), 0.78 (0.71-0.86), and 0.64 (0.58-0.71), respectively, when compared with the Q1 group of healthy lifestyle score. Elderly with ADL disability had a higher mortality rate than those without ADL disability. When the elderly already have ADL disability, the healthier the lifestyle, the lower the mortality rate. Among individuals aged 80 to 89 years with ADL disability, the mortality rate was higher in the healthy lifestyle score Q1-Q2 groups (92.1%) than that in the Q3-Q4 groups (71.6%). Similar results were observed among subjects aged 90 to 99 years with ADL disability (Q1-Q2: 97.9%, Q3-Q4: 92.1%). For centenarians without ADL disability, maintaining a healthy lifestyle significantly reduced mortality (Q1-Q3: 90.5%, Q4: 75.5%). Caregivers should prioritize the consideration of lifestyle and ADL in their healthcare practices of the oldest old.

Targeted optimum care approach for osteoporotic fragility fractures: tailored strategy based on risk stratification to reduce incidents of falls-an initiative by the Egyptian Academy of bone health based on the FLS national register

Since falling is the third cause of chronic disability, a better understanding of the frequency, severity, and risk factors of falls across diagnostic groups is needed to design and implement customized, effective fall prevention, and management programs for these individuals, particularly those at risk of sustaining a fragility fracture.

OBJECTIVE

(1) To assess the incidence of falls among osteoporotic patients with fragility fractures. (2) To evaluate the potential for stratifying the people at risk of falling in bone health setting aiming to provide targeted optimum care for them.

METHODS

This was a multi-center, cross-sectional, observational study. Both men and postmenopausal women, admitted with an osteoporotic fracture (whether major osteoporosis or hip fracture), were consecutively recruited for this work and managed under Fracture Liaison Service. All the patients were assessed for their Fracture risk (FRAX), falls risk (FRAS), and sarcopenia risk (SARC-F) as well as functional disability (HAQ). Blood tests for bone profile as well as DXA scan were offered to all the patients.

RESULTS

Four hundred five patients (121 males, 284 females) were included in this work. Mean age was 70.1 (SD = 9.2) years. The incidence of falls was 64.9%. The prevalence of falls was high (64.8%) in the patients presenting with major osteoporosis fractures and in those with hip fractures (61.8%). The prevalence of fragility fractures was positively correlated with HAQ score and the SARC-F score (p = 0.01 and 0.021 respectively). Falls risk score was positively correlated with FRAX score of major osteoporotic fractures, HAQ score, and SARC-F score (p = 0.01, 0.013, and 0.003 respectively). Seventy percent of the osteopenia patients who sustained fragility fracture had high falls risk and/or SARC-F score.

CONCLUSION

This study highlighted the importance of falls risk stratification in osteoporotic patients presenting with fragility fractures. Identification of the patients at increased risk of falls should be a component of the standard practice.

[Exercise therapy and basic treatment for osteoporosis]

Physical training is an important component in the prophylaxis of osteoporosis and the prevention of fractures. Physical training not only has a direct effect on muscle strength and muscular performance, but also on the risk of falling and the fear of falling. Therefore, physical training is also an integral part of the basic treatment for osteoporosis. The recommendations for basic treatment are an adequate intake of nutrients, including protein in particular. The intake of calcium and vitamin D in sufficient quantities is also important and, in the case of specific drug therapy, also to avoid side effects and to ensure the therapeutic effect. This article summarizes the recommendations of the updated S3 guideline on the diagnosis and treatment of osteoporosis and explains the background for the recommendations included.

A prospective cohort study on the association between new falls and balancing ability among older adults over 80 years who are independent

OBJECTIVE

The purpose of this study was to prospectively investigate the relationship between new falls and the balancing ability of older adults aged ≥80 years who are independent and evaluate the validity of the assessment tools as a predictor of falls.

METHODS

We enrolled a total of 160 participants (104 males and 56 females) aged 80 years or older. During the 12 months of observation, we investigated underlying diseases and drug use and performed a comprehensive geriatric assessment (including self-care ability, muscle strength, action ability, cognition, emotional state, and other aspects), as well as computerized dynamic posturography to assess balance and gait functions. We further analyzed the relationship between new falls and multiple internal risk factors.

RESULTS

A total of 159 participants were included for statistical analysis, and there were 108 new falls among the 59 participants. Fall history and visual preference (PREF) scores on the sensory integration test showed a positive correlation with new falls. The composite equilibrium score (SOTcom), left total hip bone mineral density, left directional control, and end point deviation were all found to be negatively correlated with new falls (P < 0.05). The cut-off point of the timed "up and go" test (TUG) in predicting new falls in this cohort was >12.03 s, with a sensitivity of 78.0 %, a specificity of 51.5 %, and an AUC of 0.667 (P < 0.001, 95 % CI: 0.567-0.721). The cut-off point of SOTcom in predicting new falls was ≤52, with a sensitivity of 40.7 %, a specificity of 84.0 %, and an AUC of 0.606 (P = 0.028, 95 % CI: 0.525-0.682).

CONCLUSIONS

The decline of balance sensory input function (mainly vestibular and visual sense), skeletal muscle motor function, and related postural control ability constituted the main risk factors for new falls in older adults who were independent. The combined use of TUG and SOT was useful in further improving the accuracy of predicting new falls in this population and providing a direction for effective intervention and rehabilitation measures.

Bone, cognitive, and anthropometric profiles and their relation to fracture sites in fallers: a cross-sectional study

Risk factors involved in the different osteoporotic fracture locations are not well-known. The results of this study suggest that there is not one typical profile characterising a particular fracture site but that the occurrence of a fracture may result from the combination of different bone, cognitive, and anthropometrics characteristics.

PURPOSE

Risk factors involved in the different osteoporotic fracture locations are not well-known. The aim of this study was to identify the differences in bone, cognitive, and anthropometric characteristics between different fracture sites, and to determine whether the site of a fall-related fracture is related to a specific profile.

METHODS

One hundred six women aged 55 years and older with a recent fall-related fracture of the hip (n = 30), humerus (n = 28), wrist (n = 32), or ankle (n = 16) were included. Bone, cognitive, and anthropometric characteristics were first compared among the four fracture site groups. Then, a principal component analysis (PCA) was performed and a comparison was made between the four profiles identified by the first two PCA components.

RESULTS

The four fracture site groups differed significantly in their education level, bone mineral density (BMD), body mass index (BMI), fear of falling, and number of errors in the Trail Making Test B, an executive function test. Each of the four fracture sites was found in each four PCA profiles, albeit with a different distribution. The profiles differed mainly by bone, cognitive, and anthropometric characteristics, but also by fear of falling.

CONCLUSIONS

The fall-related fracture sites differ significantly in anthropometric and bone parameters, in fear of falling and in cognitive abilities. There is not one typical bone, cognitive, and anthropometric profile characterising a particular fall-related site, but rather several possible profiles for a given site. This suggests that the fracture site depends on a combination of several characteristics of the patient.

Executive summary: Italian guidelines for diagnosis, risk stratification, and care continuity of fragility fractures 2021

Background

Fragility fractures are a major public health concern owing to their worrying and growing burden and their onerous burden upon health systems. There is now a substantial body of evidence that individuals who have already suffered a fragility fracture are at a greater risk for further fractures, thus suggesting the potential for secondary prevention in this field.

Purpose

This guideline aims to provide evidence-based recommendations for recognizing, stratifying the risk, treating, and managing patients with fragility fracture. This is a summary version of the full Italian guideline.

Methods

The Italian Fragility Fracture Team appointed by the Italian National Health Institute was employed from January 2020 to February 2021 to (i) identify previously published systematic reviews and guidelines on the field, (ii) formulate relevant clinical questions, (iii) systematically review literature and summarize evidence, (iv) draft the Evidence to Decision Framework, and (v) formulate recommendations.

Results

Overall, 351 original papers were included in our systematic review to answer six clinical questions. Recommendations were categorized into issues concerning (i) frailty recognition as the cause of bone fracture, (ii) (re)fracture risk assessment, for prioritizing interventions, and (iii) treatment and management of patients experiencing fragility fractures. Six recommendations were overall developed, of which one, four, and one were of high, moderate, and low quality, respectively.

Conclusions

The current guidelines provide guidance to support individualized management of patients experiencing non-traumatic bone fracture to benefit from secondary prevention of (re)fracture. Although our recommendations are based on the best available evidence, questionable quality evidence is still available for some relevant clinical questions, so future research has the potential to reduce uncertainty about the effects of intervention and the reasons for doing so at a reasonable cost.

Risk Factors Associated With Fragility Fracture Among Older Adults With Fragility Fracture: A Systematic Review

Aim: To investigate risk factors of fragility fractures among older people. Data Sources: The electronic databases employed were PubMed, Science Direct, and Google Scholar from 2016 to December 2021. Review Method: The methodological quality of the studies was assessed using the National Institutes of Health (NIH) Quality Assessment Tool for Observational Cohort and Cross-sectional study. Two independent reviewers screened total 147 articles. Results: Twelve studies were finally included in this review that consisted of 7 cross sectional, 2 longitudinal and 3 cohort studies. Six studies were of good quality and six were fair. Studies that were of good quality showed that physical performance, muscle strength, and falls due to balance impairment were associated with an increased of fragility fractures. While the results for sarcopenia status were uncertain. Conclusion: This review suggests that physical functional related factors were main contributors to the risk of fragility fracture among older people. Lack of research in this area warrants more studies to be carried out in the future.

Clinical-Functional Vulnerability, Functional Capacity, and Falls in Octogenarians with Different Physical Activity Levels-A Cross-Sectional Study

AIM

To compare differences between frailty, functional capacity, and fall prevalence among community-dwelling oldest-old adults regarding their physical activity levels.

METHODS

Two hundred and thirty-nine octogenarians (80+ years) were allocated according to their physical activity as insufficiently active (<150 min week^-1; n = 98; 84.4 ± 3.7 years), active (150 to 300 min week^-1, n = 81, 83.9 ± 3.1 years), and very active (>300 min week^-1, n = 60; 83.8 ± 3.4 years). Frailty (CFVI-20 questionnaire), functional capacity (Five Times Sit-to-Stand Test, Timed Up and Go, Balance, and handgrip strength), fall history, and physical activity were assessed.

RESULTS

The insufficiently active group was the frailest and presented the worst functional performance compared to the other groups. The fall prevalence was higher in the insufficiently active (60.9%) compared to the active (26.4%) and very active (12.7%) groups.

CONCLUSIONS

The group of insufficiently active octogenarians showed the greatest frailty, worst functional capacity, and higher fall prevalence than the active and very active groups. The engagement in physical activity of at least 300 min week^-1 is essential to reverse or minimize the deleterious effects of aging on frailty, functional capacity, and falls in octogenarians.

An insight into the implications of estrogen deficiency and transforming growth factor β in antiepileptic drugs-induced bone loss

There have been a number of reports that chronic antiepileptic drug (AEDs) therapy is associated with abnormal bone and calcium metabolism, osteoporosis/osteomalacia, and increased risk of fractures. Bony adverse effects of long term antiepileptic drug therapy have been reported for more than four decades but the exact molecular mechanism is still lacking. Several mechanisms have been proposed regarding AEDs induced bone loss; Hypovitaminosis D, hyperparathyroidism, estrogen deficiency, calcitonin deficiency. Transforming growth factor-β (TGF- β) is abundant in bone matrix and has been shown to regulate the activity of osteoblasts and osteoclasts in vitro. All isoforms of TGF- β are expressed in bone and intricately play role in bone homeostasis by modulating estrogen level. Ovariectomised animal have shown down regulation of TGF- β in bone that could also be a probable target of AEDs therapy associated bone loss. One of the widely accepted hypotheses regarding the conventional drugs induced bone loss is hypovitaminosis D which is by virtue of their microsomal enzyme inducing effect. However, despite of the lack of enzyme inducing effect of certain newer antiepileptic drugs, reduced bone mineral density with these drugs have also been reported. Thus an understanding of bone biology, pathophysiology of AEDs induced bone loss at molecular level can aid in the better management of bone loss in patients on chronic AEDs therapy. This review focuses mainly on certain new molecular targets of AEDs induced bone loss.