Poor nutritional status is associated with a higher risk of falling and fracture in elderly people living at home in France: the Three-City cohort study



Falling and fractures are a public health problem in elderly people. The aim of our study was to investigate whether nutritional status is associated with the risk of falling or fracture in community-dwelling elderly. Poor nutritional status was significantly associated with a higher risk of both falling and fractures.


Nutrition could play a role to prevent falls and fractures. The purpose of this study is to investigate whether a poor nutritional status is associated with the risk of falling and of fracture in community dwelling elderly.


Baseline nutritional status of participants was assessed using the Mini Nutritional Assessment (MNA). After a follow-up of 12 years, 6040 individuals with available data for falls and 6839 for fracture were included. People who presented the outcomes at baseline were excluded. Cox models were used to evaluate the associations between nutritional status and the risks of fall or fracture.


The frequency of poor nutritional status (MNA ≤ 23.5), at baseline, was respectively 12.0 % in the “fall study sample” and 12.8 % in the “fracture study sample.” Incident fall and fracture over 12 years were reported in 55.8 and 18.5 % of the respective samples, respectively. In multivariate models controlled for sociodemographic data and several baseline health indicators, poor nutritional status was significantly associated with a higher risk of falling (hazard ratio (HR) = 1.66, 95 % confidence interval (95 % CI) 1.35–2.04 in men and HR = 1.20, 95 % CI 1.07–1.34 in women) and with a higher risk of fracture (HR = 1.28, 95 % CI 1.09–1.49).


Poor nutritional status was associated with a higher risk of both falling and fractures in French elderly community-dwellers. Early screening and management of the nutritional status may be useful to reduce the frequency of these events in older people.

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  1. 1.

    Tinetti ME, Williams CS (1997) Falls, injuries due to falls, and the risk of admission to a nursing home. N Engl J Med 337(18):1279–1284. doi:10.1056/NEJM199710303371806

    CAS  PubMed  Article  Google Scholar 

  2. 2.

    Kannus P, Sievanen H, Palvanen M, Jarvinen T, Parkkari J (2005) Prevention of falls and consequent injuries in elderly people. Lancet 366(9500):1885–1893. doi:10.1016/S0140-6736(05)67604-0

    PubMed  Article  Google Scholar 

  3. 3.

    Cummings SR, Melton LJ (2002) Epidemiology and outcomes of osteoporotic fractures. Lancet 359(9319):1761–1767. doi:10.1016/S0140-6736(02)08657-9

    PubMed  Article  Google Scholar 

  4. 4.

    Ganz DA, Bao Y, Shekelle PG, Rubenstein LZ (2007) Will my patient fall? JAMA J Am Med Assoc 297(1):77–86. doi:10.1001/jama.297.1.77

    Article  Google Scholar 

  5. 5.

    Gill T, Taylor AW, Pengelly A (2005) A population-based survey of factors relating to the prevalence of falls in older people. Gerontology 51(5):340–345. doi:10.1159/000086372

    PubMed  Article  Google Scholar 

  6. 6.

    Bischoff-Ferrari HA (2011) The role of falls in fracture prediction. Curr Osteoporos Rep 9(3):116–121. doi:10.1007/s11914-011-0059-y

    PubMed  Article  Google Scholar 

  7. 7.

    Rachner TD, Khosla S, Hofbauer LC (2011) Osteoporosis: now and the future. Lancet 377(9773):1276–1287. doi:10.1016/S0140-6736(10)62349-5

    CAS  PubMed Central  PubMed  Article  Google Scholar 

  8. 8.

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

    Article  Google Scholar 

  9. 9.

    Deutz NE, Bauer JM, Barazzoni R, Biolo G, Boirie Y, Bosy-Westphal A, Cederholm T, Cruz-Jentoft A, Krznaric Z, Nair KS, Singer P, Teta D, Tipton K, Calder PC (2014) Protein intake and exercise for optimal muscle function with aging: recommendations from the ESPEN Expert Group. Clin Nutr. doi:10.1016/j.clnu.2014.04.007

    PubMed Central  Google Scholar 

  10. 10.

    IOM (Institute of Medicine) (2011) Dietary reference intakes for calcium and Vitamin D. The National Academies Press, Washington, DC

  11. 11.

    Geinoz G, Rapin CH, Rizzoli R, Kraemer R, Buchs B, Slosman D, Michel JP, Bonjour JP (1993) Relationship between bone mineral density and dietary intakes in the elderly. Osteoporos Int J Established Result Cooperation Between Eur Found Osteoporos Natl Osteoporos Found USA 3(5):242–248

    CAS  Article  Google Scholar 

  12. 12.

    Feskanich D, Willett WC, Stampfer MJ, Colditz GA (1996) Protein consumption and bone fractures in women. Am J Epidemiol 143(5):472–479

    CAS  PubMed  Article  Google Scholar 

  13. 13.

    Tang BM, Eslick GD, Nowson C, Smith C, Bensoussan A (2007) Use of calcium or calcium in combination with vitamin D supplementation to prevent fractures and bone loss in people aged 50 years and older: a meta-analysis. Lancet 370(9588):657–666. doi:10.1016/S0140-6736(07)61342-7

    CAS  PubMed  Article  Google Scholar 

  14. 14.

    Bischoff-Ferrari HA, Dawson-Hughes B, Willett WC, Staehelin HB, Bazemore MG, Zee RY, Wong JB (2004) Effect of vitamin D on falls: a meta-analysis. JAMA J Am Med Assoc 291(16):1999–2006. doi:10.1001/jama.291.16.1999

    CAS  Article  Google Scholar 

  15. 15.

    Samieri C, Ginder Coupez V, Lorrain S, Letenneur L, Alles B, Feart C, Paineau D, Barberger-Gateau P (2013) Nutrient patterns and risk of fracture in older subjects: results from the Three-City Study. Osteoporos Int J Established Result Cooperation Between Eur Found Osteoporos Natl Osteoporos Found USA 24(4):1295–1305. doi:10.1007/s00198-012-2132-5

    CAS  Article  Google Scholar 

  16. 16.

    Ulger Z, Halil M, Kalan I, Yavuz BB, Cankurtaran M, Gungor E, Ariogul S (2010) Comprehensive assessment of malnutrition risk and related factors in a large group of community-dwelling older adults. Clin Nutr 29(4):507–511. doi:10.1016/j.clnu.2010.01.006

    PubMed  Article  Google Scholar 

  17. 17.

    Kaiser MJ, Bauer JM, Ramsch C, Uter W, Guigoz Y, Cederholm T, Thomas DR, Anthony PS, Charlton KE, Maggio M, Tsai AC, Vellas B, Sieber CC, Mini Nutritional Assessment International G (2010) Frequency of malnutrition in older adults: a multinational perspective using the mini nutritional assessment. J Am Geriatr Soc 58(9):1734–1738. doi:10.1111/j.1532-5415.2010.03016.x

    PubMed  Article  Google Scholar 

  18. 18.

    Guigoz Y, Vellas B, Garry PJ (1996) Assessing the nutritional status of the elderly: the Mini Nutritional Assessment as part of the geriatric evaluation. Nutr Rev 54(1 Pt 2):S59–S65

    CAS  PubMed  Google Scholar 

  19. 19.

    Ahmed T, Haboubi N (2010) Assessment and management of nutrition in older people and its importance to health. Clin Interv Aging 5:207–216

    PubMed Central  PubMed  Google Scholar 

  20. 20.

    Avila-Funes JA, Gray-Donald K, Payette H (2008) Association of nutritional risk and depressive symptoms with physical performance in the elderly: the Quebec longitudinal study of nutrition as a determinant of successful aging (NuAge). J Am Coll Nutr 27(4):492–498

    PubMed  Article  Google Scholar 

  21. 21.

    Saka B, Kaya O, Ozturk GB, Erten N, Karan MA (2010) Malnutrition in the elderly and its relationship with other geriatric syndromes. Clin Nutr 29(6):745–748. doi:10.1016/j.clnu.2010.04.006

    PubMed  Article  Google Scholar 

  22. 22.

    Chien MH, Guo HR (2014) Nutritional status and falls in community-dwelling older people: a longitudinal study of a population-based random sample. PLoS One 9(3):e91044. doi:10.1371/journal.pone.0091044

    PubMed Central  PubMed  Article  Google Scholar 

  23. 23.

    Johnson CS (2003) The association between nutritional risk and falls among frail elderly. J Nutr Health Aging 7(4):247–250

    PubMed  Google Scholar 

  24. 24.

    Meijers JM, Halfens RJ, Neyens JC, Luiking YC, Verlaan G, Schols JM (2012) Predicting falls in elderly receiving home care: the role of malnutrition and impaired mobility. J Nutr Health Aging 16(7):654–658

    CAS  PubMed  Article  Google Scholar 

  25. 25.

    Neyens J, Halfens R, Spreeuwenberg M, Meijers J, Luiking Y, Verlaan G, Schols J (2013) Malnutrition is associated with an increased risk of falls and impaired activity in elderly patients in Dutch residential long-term care (LTC): a cross-sectional study. Arch Gerontol Geriatr 56(1):265–269. doi:10.1016/j.archger.2012.08.005

    PubMed  Article  Google Scholar 

  26. 26.

    Vivanti A, Ward N, Haines T (2011) Nutritional status and associations with falls, balance, mobility and functionality during hospital admission. J Nutr Health Aging 15(5):388–391

    CAS  PubMed  Article  Google Scholar 

  27. 27.

    3C Study Group (2003) Vascular factors and risk of dementia: design of the Three-City Study and baseline characteristics of the study population. Neuroepidemiology 22(6):316–325

    Article  Google Scholar 

  28. 28.

    Torres MJ, Dorigny B, Kuhn M, Berr C, Barberger-Gateau P, Letenneur L (2014) Nutritional status in community-dwelling elderly in France in urban and rural areas. PLoS ONE 9(8):e105137

  29. 29.

    Cockrell JR, Folstein MF (1988) Mini-Mental State Examination (MMSE). Psychopharmacol Bull 24(4):689–692

    CAS  PubMed  Google Scholar 

  30. 30.

    Visvanathan R, Macintosh C, Callary M, Penhall R, Horowitz M, Chapman I (2003) The nutritional status of 250 older Australian recipients of domiciliary care services and its association with outcomes at 12 months. J Am Geriatr Soc 51(7):1007–1011

    PubMed  Article  Google Scholar 

  31. 31.

    Isenring E, Baker J, Kerr G (2013) Malnutrition and falls risk in community-dwelling older adults. J Nutr Health Aging 17(3):277–279. doi:10.1007/s12603-012-0408-2

    CAS  PubMed  Article  Google Scholar 

  32. 32.

    Boirie Y (2009) Physiopathological mechanism of sarcopenia. J Nutr Health Aging 13(8):717–723

    CAS  PubMed  Article  Google Scholar 

  33. 33.

    Jeejeebhoy KN (1994) How should we monitor nutritional support: structure or function? New Horiz 2(2):131–138

    CAS  PubMed  Google Scholar 

  34. 34.

    Kinney JM (2004) Nutritional frailty, sarcopenia and falls in the elderly. Curr Opin Clin Nutr Metab Care 7(1):15–20

    PubMed  Article  Google Scholar 

  35. 35.

    Rizzoli R, Ammann P, Chevalley T, Bonjour JP (2001) Protein intake and bone disorders in the elderly. Joint Bone Spine Rev Rhum 68(5):383–392

    CAS  Article  Google Scholar 

  36. 36.

    Cummings SR, Nevitt MC, Browner WS, Stone K, Fox KM, Ensrud KE, Cauley J, Black D, Vogt TM (1995) Risk factors for hip fracture in white women. Study of Osteoporotic Fractures Research Group. N Engl J Med 332(12):767–773. doi:10.1056/NEJM199503233321202

    CAS  PubMed  Article  Google Scholar 

  37. 37.

    Langlois JA, Mussolino ME, Visser M, Looker AC, Harris T, Madans J (2001) Weight loss from maximum body weight among middle-aged and older white women and the risk of hip fracture: the NHANES I epidemiologic follow-up study. Osteoporos Int J Established Result Cooperation Between Eur Found Osteoporos Natl Osteoporos Found USA 12(9):763–768. doi:10.1007/s001980170053

    CAS  Article  Google Scholar 

  38. 38.

    Meyer HE, Tverdal A, Selmer R (1998) Weight variability, weight change and the incidence of hip fracture: a prospective study of 39,000 middle-aged Norwegians. Osteoporos Int J Established Result Cooperation Between Eur Found Osteoporos Natl Osteoporos Found USA 8(4):373–378. doi:10.1007/s001980050077

    CAS  Article  Google Scholar 

  39. 39.

    Wilsgaard T, Jacobsen BK, Ahmed LA, Joakimsen RM, Stormer J, Jorgensen L (2011) BMI change is associated with fracture incidence, but only in non-smokers. The Tromso Study. Osteoporos Int J Established Result Cooperation Between Eur Found Osteoporos Natl Osteoporos Found USA 22(4):1237–1245. doi:10.1007/s00198-010-1318-y

    CAS  Article  Google Scholar 

  40. 40.

    Ensrud KE, Cauley J, Lipschutz R, Cummings SR (1997) Weight change and fractures in older women. Study of Osteoporotic Fractures Research Group. Arch Intern Med 157(8):857–863

    CAS  PubMed  Article  Google Scholar 

  41. 41.

    Feart C, Lorrain S, Ginder Coupez V, Samieri C, Letenneur L, Paineau D, Barberger-Gateau P (2013) Adherence to a Mediterranean diet and risk of fractures in French older persons. Osteoporos Int J Established Result Cooperation Between Eur Found Osteoporos Natl Osteoporos Found USA 24(12):3031–3041. doi:10.1007/s00198-013-2421-7

    CAS  Article  Google Scholar 

  42. 42.

    Mithal A, Bonjour JP, Boonen S, Burckhardt P, Degens H, El Hajj Fuleihan G, Josse R, Lips P, Morales Torres J, Rizzoli R, Yoshimura N, Wahl DA, Cooper C, Dawson-Hughes B, Group ICNW (2013) Impact of nutrition on muscle mass, strength, and performance in older adults. Osteoporos Int J Established Result Cooperation Between Eur Found Osteoporos Natl Osteoporos Found USA 24(5):1555–1566. doi:10.1007/s00198-012-2236-y

    CAS  Article  Google Scholar 

  43. 43.

    Bischoff-Ferrari HA, Willett WC, Orav EJ, Lips P, Meunier PJ, Lyons RA, Flicker L, Wark J, Jackson RD, Cauley JA, Meyer HE, Pfeifer M, Sanders KM, Stahelin HB, Theiler R, Dawson-Hughes B (2012) A pooled analysis of vitamin D dose requirements for fracture prevention. N Engl J Med 367(1):40–49. doi:10.1056/NEJMoa1109617

    CAS  PubMed  Article  Google Scholar 

  44. 44.

    Munger RG, Cerhan JR, Chiu BC (1999) Prospective study of dietary protein intake and risk of hip fracture in postmenopausal women. Am J Clin Nutr 69(1):147–152

    CAS  PubMed  Google Scholar 

  45. 45.

    Cederholm T, Cruz-Jentoft AJ, Maggi S (2013) Sarcopenia and fragility fractures. Eur J Phys Rehabil Med 49(1):111–117

    CAS  PubMed  Google Scholar 

  46. 46.

    Yu R, Leung J, Woo J (2014) Incremental predictive value of sarcopenia for incident fracture in an elderly Chinese cohort: results from the Osteoporotic Fractures in Men (MrOs) Study. J Am Med Dir Assoc. doi:10.1016/j.jamda.2014.02.005

    Google Scholar 

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Study funding

The Three-City Study is conducted under a partnership agreement between the Institut National de la Santé et de la Recherche Médicale (INSERM), the Victor Segalen–Bordeaux II University, and Sanofi-Aventis. The Fondation pour la Recherche Médicale funded the preparation and initiation of the study. The 3C Study is also supported by the Caisse Nationale Maladie des Travailleurs Salariés, Direction Générale de la Santé, MGEN, Institut de la Longévité, Conseils Régionaux of Aquitaine and Bourgogne, Fondation de France, and Ministry of Research–INSERM Programme « Cohortes et collections de données biologiques. » This work was supported by the « Fondation Plan Alzheimer » and by grants from the « ANR—Agence Nationale de la Recherche, » The French National Research Agency « Programme National de Recherche en Alimentation et nutrition humaine, » project « COGINUT ANR-06-PNRA-005, » and the « Programme Longévité et vieillissement, » COGICARE 07-LVIE 003 01. The funding organizations played no role in the design and conduct of the study; in the collection, management, analysis, and interpretation of the data; or in preparation, review, or approval of the manuscript.

Conflicts of interest

Marion J Torres was supported by Nutricia France and participated at different meetings with Danone Research. Beatrice Dorigny and Yvette Luiking are employed by Nutricia. Pascale Barberger-Gateau reports grants and non-financial support from Danone Research and Vifor Pharma, personal fees and non-financial support from Nutricia, grants and non-financial support from Groupe Lipides et Nutrition, and non-financial support from ILSI Europe. C. Féart received fees for conferences from Danone Research and Nutricia. L. Letenneur received fees for conferences from Danone Research. Cécilia Samieri and Claudine Berr declare that they have no conflict of interest.

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Correspondence to M. J. Torres.

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Torres, M.J., Féart, C., Samieri, C. et al. Poor nutritional status is associated with a higher risk of falling and fracture in elderly people living at home in France: the Three-City cohort study. Osteoporos Int 26, 2157–2164 (2015). https://doi.org/10.1007/s00198-015-3121-2

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  • Aged
  • Community-dwellers
  • Epidemiology
  • Fall
  • Fracture
  • Nutritional status