White matter lesions and the risk of incident hip fracture in older persons: results from the progetto veneto anziani study.
BACKGROUND
White matter lesions (WMLs) are associated with hypertension, an increased risk of falling, and impaired physical and cognitive performance that may affect the mechanical effect of falls.


METHODS
We hypothesized that WMLs are a risk factor for hip fracture (HF). We studied a sample of 820 community-dwelling Italian persons 65 years and older from the cohort of the Progetto Veneto Anziani Study who underwent brain magnetic resonance imaging at baseline. Subjects were classified as having no lesions, focal lesions, or diffuse WMLs.


RESULTS
Compared with those with no lesions, participants with diffuse WMLs were older, reported more falls, and had worse physical and cognitive performance, all factors implicated in the causal pathway to HF. During 9 years of follow-up, 51 HFs occurred. Hip fracture risk associated with diffuse WMLs markedly differed between participants younger than 80 years vs those 80 years and older. After adjustment among participants younger than 80 years, diffuse WMLs compared with no lesions were associated with a 2.7-fold (95% confidence interval, 1.1-7.1) increase in the risk of HF. Focal lesions were not statistically significantly associated with an increased risk of HF in the same age group (hazard ratio, 2.0; 95% confidence interval, 0.6-7.6). No associations between diffuse WMLs, focal lesions, and HF were evident among participants 80 years and older, possibly because of the limited sample size.


CONCLUSIONS
White matter lesions represent an independent risk factor for HF in persons younger than 80 years. Older persons with diffuse WMLs should be considered candidates for multifactorial interventions aimed at reducing the risk of falling and fractures.
Corti
Maria-Chiara
MC
Azienda Unità Locale Socio Sanitaria 16, Via Scrovegni 14, 35131 Padova, Italy. chiara.corti@sanita.padova.it
Baggio
Giovannella
G
Sartori
Leonardo
L
Barbato
Gianmaria
G
Manzato
Enzo
E
Musacchio
Estella
E
Ferrucci
Luigi
L
Cardinali
Giulia
G
Donato
Daniele
D
Launer
Lenore J
LJ
Zambon
Sabina
S
Crepaldi
Gaetano
G
Guralnik
Jack M
JM
D000058:Accidental Falls; D000368:Aged; D001921:Brain / Q000473:pathology*; D001927:Brain Diseases / Q000150:complications* / Q000175:diagnosis / Q000453:epidemiology; D016001:Confidence Intervals; D005260:Female; D005500:Follow-Up Studies; D006620:Hip Fractures / Q000453:epidemiology / Q000209:etiology*; D006801:Humans; D015994:Incidence; D007558:Italy / Q000453:epidemiology*; D008279:Magnetic Resonance Imaging; D008297:Male; D011379:Prognosis; D016016:Proportional Hazards Models; D012189:Retrospective Studies; D012424:Rural Population; D012720:Severity of Illness Index; D013997:Time Factors