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Persistent hypovitaminosis D and loss of hip bone mineral density over time as additional risk factors for recurrent falls in a population-based prospective cohort of elderly persons living in the community. The São Paulo Ageing & Health (SPAH) Study

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Abstract

Summary

We performed concomitant evaluation of clinical, laboratory, and bone mineral density (BMD) parameters as potential risk factors for falls in a population-based prospective cohort of older adults, since previous studies have focused mostly in clinical risk factors. Loss of hip BMD and persistent hypovitaminosis D were associated with recurrent falls in community-dwelling elderly.

Introduction

Few studies have performed a concomitant evaluation of clinical data, laboratory bone parameters, and bone mineral density (BMD) to determine more accurately the contribution of each of these variables to risk of falls in elderly persons. We investigated the association between bone parameters and recurrent falls in a population-based prospective cohort of community-dwelling older adults.

Methods

A total of 705 elderly individuals (448 women, 257 men) were evaluated with clinical data, BMD, and laboratory bone tests at baseline and after a mean follow-up of 4.3 ± 0.8 years. Individuals with recurrent falls (≥2 falls in the previous year from the date of the second evaluation) were considered chronic fallers. Logistic regression models were used to identify independent risk factors for recurrent falls.

Results

The frequency of chronic fallers was 16.5 %. In multivariate analyses, risk factors for recurrent falls were visual impairment (odds ratio (OR) = 2.49, 95 % confidence interval (CI) 1.30–4.74, p = 0.006), use of psychotropic drugs (OR = 2.47, 95 % CI 1.37–4.49, p = 0.003), clinical fracture (OR = 2.78, 95 % CI 1.48–5.20, p = 0.001), persistently low 25-hydroxyvitamin D (25OHD) (<20 ng/mL) (OR = 1.71, 95 % CI 1.10–2.64, p = 0.016), and loss of total hip BMD during the study (OR = 1.21, 95 % CI 1.17–1.25, p = 0.035 for each 4 % decrease).

Conclusions

In addition to traditional clinical risk factors for falls, loss of hip BMD and hypovitaminosis D were associated with recurrent falls in community-dwelling elderly persons. Thus, recognizing these factors is essential to preventing falls and improving the outcomes of this population.

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Abbreviations

SPAH:

São Paulo Ageing & Health

BMD:

Bone mineral density

OR:

Odds ratio

25OHD:

25-Hydroxyvitamin D

PTH:

Parathyroid hormone

PRO-AIM:

Improvement Program of Information on Mortality in São Paulo

BMI:

Body mass index

DXA:

Dual X-ray absorptiometry

ISCD:

International Society for Clinical Densitometry

ASM:

Appendicular skeletal muscle mass

CTX:

Type I collagen C-telopeptide

eGFR:

Estimated glomerular filtration rate

References

  1. Lima-Costa MF, Veras R (2003) Aging and public health. Cad Saúde Pública 19(3):700–701

    Article  Google Scholar 

  2. United Nations (UN) (2004). World Population Prospects: The 2004 Revision. New York, USA

  3. IBGE - Instituto Brasileiro de Geografia e Estatística. Perfil dos idosos responsáveis pelos domicílios no Brasil 2000. Estudos e Pesquisas: Informação Demográfica e Socioeconômica

  4. Cesari M, Landi F, Torre S, Onder G, Lattanzio F, Bernabei R (2002) Prevalence and risk factors for falls in an older community-dwelling population. J Gerontol A Biol Sci Med Sci 57:M722–M726

    Article  PubMed  Google Scholar 

  5. American Geriatrics Society, British Geriatrics Society, American Academy of Orthopaedic Surgeons Panel on Falls Prevention (2001) Guideline for the prevention of falls in older persons. J Am Geriatr Soc 49:664–672

    Article  Google Scholar 

  6. Espino DV, Palmer RF, Miles TP, Mouton CP, Wood RC, Bayne NS et al (2000) Prevalence, incidence and risk factors associated with hip fractures in community-dwelling older Mexican Americans: results of the Hispanic EPESE study. Establish population for the epidemiologic study for the elderly. J Am Geriatr Soc 48(10):1252–1260

    CAS  PubMed  Google Scholar 

  7. Kannus P, Parkkari J, Koskinen S, Niemi S, Palvanen M, Jarvinen M et al (1999) Fall-induced injuries and deaths among older adults. JAMA 281(20):1895–1899

    Article  CAS  PubMed  Google Scholar 

  8. Young Y, Myers AH, Provenzano G (2001) Factors associated with time to first hip fracture. J Aging Health 13(4):511–526

    Article  CAS  PubMed  Google Scholar 

  9. Tinetti ME, Speechley M, Ginter SF (1988) Risk factors for falls among elderly persons living in the community. N Engl J Med 319(26):1701–1707

    Article  CAS  PubMed  Google Scholar 

  10. Hartholt KA, Oudshoorn C, Zielinski SM, PTBW B- e, Panneman MJM, van Beeck EF et al (2011) The epidemic of hip fractures: are we on the right track? PLoS ONE 6:e22227

    Article  PubMed Central  CAS  PubMed  Google Scholar 

  11. O’Loughlin JL, Robitaille Y, Boivin JF, Suissa S (1993) Incidence of and risk factors for falls and injurious falls among the community-dwelling elderly. Am J Epidemiol 137:342–354

    PubMed  Google Scholar 

  12. Ensrud KE, Blackwell TL, Mangione CM, Bowman PJ, Whooley MA, Bauer DC et al (2002) Central nervous system-active medications and risk for falls in older women. J Am Geriatr Soc 50:1629–1637

    Article  PubMed  Google Scholar 

  13. Parry SW, Steen N, Galloway SR, Kenny RA, Bond J (2001) Falls and confidence related quality of life outcome measures in an older British cohort. Postgrad Med J 77:103–108

    Article  PubMed Central  CAS  PubMed  Google Scholar 

  14. Henry MJ, Pasco JA, Sanders KM, Nicholson GC, Kotowicz MA (2006) Fracture Risk (FRISK) Score: Geelong Osteoporosis Study. Radiology 241:190–196

    Article  PubMed  Google Scholar 

  15. Pluijm SM, Smit JH, Tromp EA, Stel VS, Deeg DJ, Bouter LM, Lips P (2006) A risk profile for identifying community-dwelling elderly with a high risk of recurrent falling: results of a 3-year prospective study. Osteoporos Int 17(3):417–425

    Article  CAS  PubMed  Google Scholar 

  16. Schwartz AV, Villa ML, Prill M, Kelsey JA, Galinus JA, Delay RR et al (1999) Falls in older Mexican-American women. J Am Geriatr Soc 47:1371–1378

    CAS  PubMed  Google Scholar 

  17. Mathias TA, Jorge MH, Andrade OG (2006) Morbidity and mortality due to external causes among the elderly in the South of Brazil. Rev Lat Am Enfermagem 14:17–24

    Article  PubMed  Google Scholar 

  18. Pinheiro MM, Ciconelli RM, Martini LA, Ferraz MB (2010) Risk factors for recurrent falls among Brazilian women and men: the Brazilian osteoporosis study (BRAZOS). Cad Saúde Pública 26:89–96

    Article  Google Scholar 

  19. Perracini MR, Ramos LR (2002) Fall-related factors in a cohort of elderly community residents. Rev Saude Publica 36(6):709–716

    Article  PubMed  Google Scholar 

  20. Rozenfeld S, Camacho LAB, Veras RP (2003) Medication as a risk factor for falls in older women in Brazil. Rev Panam Salud Pública 13:369–375

    Article  PubMed  Google Scholar 

  21. Snijder MB, van Schoor NM, Pluijm SM, van Dam RM, Visser M, Lips P (2006) Vitamin D status in relation to one-year risk of recurrent falling in older men and women. J Clin Endocrinol Metab 91(8):2980–2985

    Article  CAS  PubMed  Google Scholar 

  22. LeBoff MS, Hawkes WG, Glowacki J, Yu-Yahiro J, Hurwitz S, Magaziner J (2008) Vitamin D-deficiency and post-fracture changes in lower extremity function and falls in women with hip fractures. Osteoporos Int 19:1283–1290

    Article  PubMed Central  CAS  PubMed  Google Scholar 

  23. Suzuki T, Kwon J, Kim H, Shimada H, Yoshida Y, Iwasa H et al (2008) Low serum 25-hydroxyvitamin D levels associated with falls among Japanese community-dwelling elderly. J Bone Miner Res 23(8):1309–1317

    Article  CAS  PubMed  Google Scholar 

  24. Menant JC, Close JC, Delbaere K, Sturnieks DL, Trollor J, Sachdev PS et al (2012) Relationships between serum vitamin D levels, neuromuscular and neuropsychological function and falls in older men and women. Osteoporos Int 23(3):981–989

    Article  CAS  PubMed  Google Scholar 

  25. Annweiler C, Beauchet O (2014) Questioning vitamin D status of elderly fallers and nonfallers: a meta-analysis to address a ‘forgotten step’. J Intern Med 4. doi: 10.1111/joim.12250

  26. Lopes JB, Danilevicius CF, Takayama L, Caparbo VF, Menezes PR, Scazufca M, Kuroishi ME, Pereira RM (2011) Prevalence and risk factors of radiographic vertebral fracture in Brazilian community-dwelling elderly. Osteoporos Int 22(2):711–719

    Article  CAS  PubMed  Google Scholar 

  27. Domiciano DS, Machado LG, Lopes JB, Figueiredo CP, Caparbo VF, Takayama L, Oliveira RM, Menezes PR, Pereira RM (2014) Incidence and risk factors for osteoporotic vertebral fracture in low-income community-dwelling elderly: a population-based prospective cohort study in Brazil. The São Paulo Ageing & Health (SPAH) Study. Osteoporos Int 25(12):2805–2815

    Article  CAS  PubMed  Google Scholar 

  28. Schousboe JT, Shepherd JA, Bilezikian JP, Baim S (2013) Executive summary of the 2013 International Society for Clinical Densitometry Position Development Conference on Bone Densitometry. J Clin Densitom 16(4):455–466

    Article  PubMed  Google Scholar 

  29. Domiciano DS, Figueiredo CP, Lopes JB, Caparbo VF, Takayama L, Menezes PR, Bonfa E, Pereira RM (2013) Discriminating sarcopenia in community-dwelling older women with high frequency of overweight/obesity: the São Paulo Ageing & Health Study (SPAH). Osteoporos Int 24(2):595–603

    Article  CAS  PubMed  Google Scholar 

  30. Figueiredo CP, Domiciano DS, Lopes JB, Caparbo VF, Scazufca M, Bonfá E, Pereira RM (2014) Prevalence of sarcopenia and associated risk factors by two diagnostic criteria in community-dwelling older men: the São Paulo Ageing & Health Study (SPAH). Osteoporos Int 25(2):589–596

    Article  CAS  PubMed  Google Scholar 

  31. Genant HK, Wu CY, van Kuijk C, Nevitt MC (1993) Vertebral fracture assessment using a semiquantitative technique. J Bone Miner Res 8:1137–1148

    Article  CAS  PubMed  Google Scholar 

  32. Cockcroft DW, Gault MH (1976) Prediction of creatinine clearance from serum creatinine. Nephron 16:31–41

    Article  CAS  PubMed  Google Scholar 

  33. Kabeshova A, Annweiler C, Fantino B, Philip T, Gromov VA, Launay CP, Beauchet O (2014) A regression tree for identifying combinations of fall risk factors associated to recurrent falling: a cross-sectional elderly population-based study. Aging Clin Exp Res 26(3):331–336

    Article  CAS  PubMed  Google Scholar 

  34. de Deco CP, do Santos JF, da Cunha V d P, Marchini L (2007) General health of elderly institutionalized and community-dwelling Brazilians. Gerodontology 24:136–142

    Article  PubMed  Google Scholar 

  35. Tromp AM, Smit JH, Deeg DJ, Bouter LM, Lips P (1998) Predictors for falls and fractures in the Longitudinal Aging Study Amsterdam. J Bone Miner Res 13:1932–1939

    Article  CAS  PubMed  Google Scholar 

  36. Reyes-Ortiz CA, Al Snih S, Markides KS (2005) Falls among elderly persons in Latin America and the Caribbean and among elderly Mexican-Americans. Rev Panam Salud Publica 17(5–6):362–369

    PubMed  Google Scholar 

  37. Bischoff HA, Borchers M, Gudat F, Duermueller U, Theiler R, Staehelin HB et al (2001) In situ detection of the 1, 25-dihydroxyvitamin D3 receptor in human skeletal muscle tissue. Histochem J 33:19–24

    Article  CAS  PubMed  Google Scholar 

  38. Ceglia L, Niramitmahapanya S, da Silva MM, Rivas DA, Harris SS, Bischoff-Ferrari H et al (2013) A randomized study on the effect of vitamin D3 supplementation on skeletal muscle morphology and vitamin D receptor concentration in older women. J Clin Endocrinol Metab 98(12):E1927–E1935

    Article  PubMed Central  CAS  PubMed  Google Scholar 

  39. Bischoff HA, Stähelin HB, Dick W, Akos R, Knecht M, Salis C et al (2003) Effects of vitamin D and calcium supplementation on falls: a randomized controlled trial. J Bone Miner Res 18(2):343–351

    Article  CAS  PubMed  Google Scholar 

  40. Larsen ER, Mosekilde L, Foldspang A (2005) Vitamin D and calcium supplementation prevents severe falls in elderly community-dwelling women: a pragmatic population-based 3-year intervention study. Aging Clin Exp Res 17(2):125–132

    Article  CAS  PubMed  Google Scholar 

  41. Bischoff-Ferrari HA, Conzelmann M, Stähelin HB, Dick W, Carpenter MG, Adkin AL et al (2006) Is fall prevention by vitamin D mediated by a change in postural or dynamic balance? Osteoporos Int 17(5):656–663

    Article  CAS  PubMed  Google Scholar 

  42. Broe KE, Chen TC, Weinberg J, Bischoff-Ferrari HA, Holick MF, Kiel DP (2007) A higher dose of vitamin d reduces the risk of falls in nursing home residents: a randomized, multiple-dose study. J Am Geriatr Soc 55(2):234–239

    Article  PubMed  Google Scholar 

  43. Jackson C, Gaugris S, Sen SS, Hosking D (2007) The effect of cholecalciferol (vitamin D3) on the risk of fall and fracture: a meta-analysis. QJM 100:185–192

    Article  CAS  PubMed  Google Scholar 

  44. Beaudart C, Buckinx F, Rabenda V, Gillain S, Cavalier E, Slomian J et al (2014) The effects of vitamin d on skeletal muscle strength, muscle mass, and muscle power: a systematic review and meta-analysis of randomized controlled trials. J Clin Endocrinol Metab 99(11):4336–4345

    Article  CAS  PubMed  Google Scholar 

  45. Holick MF, Binkley NC, Bischoff-Ferrari HA, Gordon CM, Hanley DA, Heaney RP et al (2011) Evaluation, treatment, and prevention of vitamin D deficiency: an endocrine society clinical practice guideline. J Clin Endocrinol Metab 96(7):1911–1930

    Article  CAS  PubMed  Google Scholar 

  46. Maeda SS, Saraiva GL, Hayashi LF, Cendoroglo MS, Ramos LR, Corrêa M d P et al (2013) Seasonal variation in the serum 25-hydroxyvitamin D levels of young and elderly active and inactive adults in São Paulo, Brazil: the São Paulo Vitamin D Evaluation Study (SPADES). Dermatoendocrinol 5(1):211–217

    Article  PubMed Central  PubMed  Google Scholar 

  47. Ensrud KE, Ewing SK, Taylor BC, Fink HA, Stone KL, Cauley JA et al (2007) Frailty and risk of falls, fracture, and mortality in older women: the study of osteoporotic fractures. J Gerontol A Biol Sci Med Sci 62:744–751

    Article  PubMed  Google Scholar 

  48. Sarkisian CA, Liu H, Gutierrez PR, Seeley DG, Cummings SR, Mangione M (2000) Modifiable risk factors predict functional decline among older women: a prospectively validated clinical prediction tool. The study of osteoporotic fractures research group. J Am Geriatr Soc 48:170–178

    CAS  PubMed  Google Scholar 

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Acknowledgments

This study was not sponsored by any pharmaceutical company. The SPAH project was supported by grants from the Fundação de Amparo e Pesquisa do Estado de São Paulo (FAPESP) #03/09313-0, #04/12694-8and #09/15346-4; Conselho Nacional de Ciência e Tecnologia (CNPQ) #300559/2009-7 and # 301805/2013-0 (RMRP), Federico Foundation (RMRP), and Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES) (DSD, JBL, CPF).

Conflicts of interest

None.

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Authors and Affiliations

  1. Bone Metabolism Laboratory, Rheumatology Division, Faculdade de Medicina da Universidade de São Paulo, Av. Dr. Arnaldo, 455, 3° andar, sala 3193, São Paulo, SP, 01246-903, Brazil

    K. L. L. L. Machado, D. S. Domiciano, L. G. Machado, J. B. Lopes, C. P. Figueiredo, L. Takayama & R. M. R. Pereira

  2. RDO Diagnósticos Médicos, Sao Paulo, Brazil

    R. M. Oliveira

  3. Department of Preventive Medicine, Faculdade de Medicina da Universidade de São Paulo, Sao Paulo, Brazil

    P. R. Menezes

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  1. K. L. L. L. Machado
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  2. D. S. Domiciano
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  3. L. G. Machado
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  4. J. B. Lopes
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  5. C. P. Figueiredo
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  6. L. Takayama
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  7. R. M. Oliveira
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  8. P. R. Menezes
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  9. R. M. R. Pereira
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Correspondence to R. M. R. Pereira.

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Machado, K.L.L.L., Domiciano, D.S., Machado, L.G. et al. Persistent hypovitaminosis D and loss of hip bone mineral density over time as additional risk factors for recurrent falls in a population-based prospective cohort of elderly persons living in the community. The São Paulo Ageing & Health (SPAH) Study. Osteoporos Int 26, 1535–1542 (2015). https://doi.org/10.1007/s00198-014-3024-7

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