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Reduced gait and postural stability under challenging conditions in fallers with upper limb fracture

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Abstract

Background

While most fractures are caused by falls, not all falls result in fractures. Risk factors for falls are well established, but only weak associations have been demonstrated for risk factors for fractures. Conflicting results on the implication of bone mineral density (BMD) suggest that other risk factors should be studied, such as gait and balance disorders.

Aims

Gait and postural stability in challenging conditions were, therefore, compared between fallers with and without fracture.

Methods

We enrolled 80 adults aged 55 and older who fell in the previous year. We compared gait and posture after obstacle crossing between fallers with an upper-limb fracture (n = 38), and fallers without fracture (n = 42). Data on BMD, body mass index, handgrip strength, fear of falling, number of comorbidities, number of falls, global cognition, executive functioning and education level were collected.

Results

Compared to fallers without fracture, fallers with fracture had significant lower gait velocity (Likelihood-Ratio = 4.93; P = 0.03) and lower postural stability during stabilization after obstacle crossing (Likelihood-Ratio = 10.99; P < 0.001). In addition, fallers with fracture had lower handgrip strength (Likelihood-Ratio = 9.92; P = 0.002), lower education level (Likelihood-Ratio = 8.32; P = 0.004), poorer executive functions (Likelihood-Ratio = 5.81; P = 0.02, higher fear of falling (Likelihood-Ratio = 5.55; P = 0.02) and were more likely women (Likelihood-Ratio = 17.55; P < 0.001), compared to fallers without fracture.

Discussion

This study demonstrated that the main difference between fallers with upper-limb fracture and fallers without fracture is mobility in dynamic condition. Poor executive function and low muscular strength could also be involved.

Conclusions

These factors should be taken into account when assessing risk factors for fracture and implementing preventive programs.

Clinical trial registration

clinicaltrials.gov. NCT02292316

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Acknowledgements

This work was supported by the French Ministry of Health (Programme Hospitalier de Recherche Clinique 2011 no. 2011-A00534-37). The authors would like to thank all the participants for their time and cooperation, Dr. Valérie Caridroit, Dr. Thiphaine Ciappuccini, Dr. Pascale Lescure and Dr. Pablo Descatoire for their participation in the medical examinations, Marion Hommet and Marion Delarue for the neuropsychological assessment, Anita Jamet for her contribution to the participants’ recruitment, and Dr. Catherine-Alexandra Grégoire for English proofreading.

Funding

This work was supported by the French Ministry of Health (Programme Hospitalier de Recherche Clinique 2011 no.2011-A00534-37).

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Authors and Affiliations

  1. Normandie Univ, UNICAEN, INSERM, COMETE, 14000, Caen, France

    Antoine Langeard, Kristell Pothier, Chantal Chavoix & Nicolas Bessot

  2. Normandie Univ, UNIROUEN, INSERM, CHU Rouen, Department of Neurophysiology, COMETE, 76000, Rouen, France

    Nathalie Chastan

  3. Normandie Univ, UNICAEN, INSERM, CHU Caen, Department of Rheumatology, COMETE, 14000, Caen, France

    Christian Marcelli

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  1. Antoine Langeard
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Correspondence to Antoine Langeard.

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Disclaimer

This manuscript reports work that has not been reported in large part in a published article or is contained in or closely related to another paper that has been submitted or accepted for publication elsewhere.

Informed consent

Informed consent was obtained from all individual participants included in the study.

Conflict of interest

The authors declare that they have no conflict of interest.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards [Lower-Normandy ethics committee (No. 2011A00556-35)].

Data availability

The datasets generated during and/or analyzed during the current study are available from the corresponding author on reasonable request.

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Langeard, A., Pothier, K., Chastan, N. et al. Reduced gait and postural stability under challenging conditions in fallers with upper limb fracture. Aging Clin Exp Res 31, 483–489 (2019). https://doi.org/10.1007/s40520-018-0992-z

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  • DOI: https://doi.org/10.1007/s40520-018-0992-z

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