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Situational risk factors for fall-related vertebral fractures in older men and women

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Abstract

Summary

Situational factors might help explain why most vertebral fractures occur in older people without a previous osteoporosis diagnosis. After adjusting for predisposing risk factors, the activity before the fall, type of fall, and falling direction remained as strong determinants of fall-related vertebral fractures in older men and women.

Introduction

A matched case-control study was conducted to investigate the effects of situational factors, in addition to predisposing factors, on clinical vertebral fractures in older men and women in Taiwan.

Methods

Cases were community-dwelling individuals aged ≥ 65 years who visited emergency departments (EDs) of two university-affiliated hospitals due to a fall and had a primary diagnosis of a vertebral fracture during a 1-year period in 2017. Five control patients per case, matched by the time of falling, gender, and age, who sought care in the same ED due to a fall resulting in a soft tissue injury were selected. A total of 64 men (age range: 65 ~ 99 years) and 194 women (age range: 65 ~ 100 years), diagnosed with a vertebral fracture, participated in the study.

Results

Multivariable logistic models were conducted separately for men and women. Results suggested that the following factors were significantly associated with an increased risk of vertebral fractures in men: a low educational level (adjusted odds ratio [OR] = 1.95; 95% confidence interval (CI), 1.02 ~ 3.71), asthma (OR = 2.96; 95% CI, 1.35 ~ 6.92), depression (OR = 4.31; 95% CI, 1.03 ~ 17.5), toileting (OR = 2.30; 95% CI, 1.04 ~ 4.94), slipping (OR = 5.27; 95% CI, 1.80 ~ 15.4), stepping down (OR = 3.99; 95% CI, 1.40 ~ 11.4), sudden leg weakness (OR = 3.73; 95% CI, 1.13 ~ 12.4), and falling backwards (OR = 3.78; 95% CI, 1.83 ~ 7.80); and in women: a fracture history (OR = 2.00; 95% CI, 1.07 ~ 3.76), osteoporosis (OR = 1.94; 95% CI, 1.15 ~ 3.49), getting in/out of the bed/chair (OR = 1.90; 95% CI, 1.07 ~ 3.39), stepping down (OR = 2.10; 95% CI, 1.17 ~ 3.77), and falling backwards (OR = 4.00; 95% CI, 2.39 ~ 6.68) and sideways (OR = 2.61; 95% CI, 1.38 ~ 4.96).

Conclusions

The combination of predisposing and situational risk factors may display a more comprehensive risk profile for the occurrence of VFs, and thus, interventions that add both types of risk factors may result in greater risk reduction of VFs, although those specifically targeted at situational risk factors during falls are limited and their effectiveness and efficiency remained to be explored.

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Abbreviations

BMD:

Bone mineral density

CI:

Confidence interval

COM:

Center of mass

ED:

Emergency department

GDS:

Geriatric Depression Scale

OR:

Odds ratio

VF:

Vertebral fracture

SPMSQ:

Short Portable Mental Status Questionnaire

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Funding

This work was funded by the National Health Research Institutes (NHRI-EX109-10804PI) and the Ministry of Science and Technology (MOST109-2314-B-038-065-MY3 and MOST106-2314-B-038-046), Taiwan, R.O.C.

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Authors and Affiliations

  1. Department of Emergency Medicine, Taipei Medical University Hospital, Taipei, Taiwan, Republic of China

    W.-Y. Yu

  2. Institute of Injury Prevention and Control, College of Public Health, Taipei Medical University, Taipei, Taiwan, Republic of China

    W.-Y. Yu, C.-Y. Chen & M.-R. Lin

  3. Department of Nursing, National Taipei University of Nursing and Health Sciences, Taipei, Taiwan, Republic of China

    H.-F. Hwang

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  1. W.-Y. Yu
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  2. H.-F. Hwang
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Correspondence to M.-R. Lin.

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Wen-Yu Yu, Hei-Fen Hwang, Chih-Yi Chen, and Mau-Roung Lin declare that they have no direct or indirect conflicts of interest discussed in the manuscript.

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Yu, WY., Hwang, HF., Chen, CY. et al. Situational risk factors for fall-related vertebral fractures in older men and women. Osteoporos Int 32, 1061–1070 (2021). https://doi.org/10.1007/s00198-020-05799-x

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  • DOI: https://doi.org/10.1007/s00198-020-05799-x

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