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One-leg standing time and hip-fracture prediction

Osteoporosis International volume 25, pages 1305–1311 (2014)Cite this article

Abstract

Summary

A hip fracture results in a lower quality of life and a cost of £30,000. In this study, one-leg standing time (OLST) had a negative linear relationship to the risk of a hip fracture. OLST could be a useful tool to assess the need for fracture-preventive interventions.

Introduction

A hip fracture immobilizes, restricts autonomy, shortens life expectancy, and results in a cost of £30,000 in the UK health care system. However, effective preventive treatments can be offered to high-risk individuals. Impaired postural balance is an important risk factor for hip fractures, and the aim of this study was to evaluate whether OLST can predict hip fractures in elderly women. FRAX is the most established fracture risk assessment tool worldwide and a secondary aim was to relate the predictive ability of OLST to that of FRAX in this population.

Methods

Three hundred fifty-one women aged between 69 and 79 years were timed standing on one leg up to 30 s with eyes open and assessed with FRAX. Fracture data was obtained from registers.

Results

The main outcome, a hip fracture, occurred in 40 of the 351 participants (11.4 %). The age-adjusted risk of a hip fracture was 5 % lower with 1 s longer OLST (Hazard ratio 0.95, 95 % CI 0.927–0.978). The relation between OLST and hip fracture risk was linear. Harrell’s c was 0.60 for FRAX and 0.68 for OLST adjusted for age.

Conclusion

With 1 s longer OLST, the risk of a hip fracture decreased significantly by 5 %. This risk reduction was not explained by differences in the classic fracture risk factors included in FRAX. OLST had a predictive ability similar to FRAX. OLST is an easily performed balance test which may prove to be valuable in the assessment of hip fracture risk.

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Abbreviations

AUC:

Area under curve

BMD:

Bone mineral density

BMI:

Body mass index

HR:

Hazard ratio

NICE:

National Institute for Health and Clinical Excellence

OLST:

One-leg standing time

PRIMOS:

Primary care and osteoporosis

ROC curve:

Receiving operating characteristic curve

WHO:

World Health Organization

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Financial disclosure

This study was funded by research grants from Stockholm County Council and Centre for Family Medicine.

Conflicts of interest

None.

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Authors and Affiliations

  1. Centre for Family Medicine (CeFAM), Karolinska Institutet, Alfred Nobels allé 12, 141 83 Huddinge, Stockholm, Sweden

    H. Lundin, L.-E. Strender, S.-E. Johansson & H. Salminen

  2. Department of Molecular Medicine and Surgery (MMK), Karolinska Institutet, 171 76, Stockholm, Sweden

    M. Sääf & S. Nyren

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  1. H. Lundin
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  2. M. Sääf
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  3. L.-E. Strender
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Correspondence to H. Lundin.

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Lundin, H., Sääf, M., Strender, LE. et al. One-leg standing time and hip-fracture prediction. Osteoporos Int 25, 1305–1311 (2014). https://doi.org/10.1007/s00198-013-2593-1

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