Predictors of falls among postmenopausal women: results from the National Osteoporosis Risk Assessment (NORA).
Using data from 66,134 postmenopausal women enrolled in the National Osteoporosis Risk Assessment (NORA) study, more than half of whom were less than age 65, we identified 18 risk factors that independently predicted a significantly increased risk of falling and observed a graded increase in risk with an increasing number of risk factors.


BACKGROUND
This study was designed to identify predictors of falls in a large prospective study of community-dwelling, postmenopausal women, 58% of whom were less than 65 years old at baseline.


METHODS
We exclusively used survey data from 66,134 NORA participants who completed the baseline survey and three follow-up surveys over 6 years. Stepwise logistic regression was used to select potential fall predictors. A simple fall risk index was created by giving one point to each significant independent risk factor.


RESULTS
More than one third (38.2%) of participants reported at least one fall since baseline. The largest predictor of fall risk was history of falls (odds ratio [OR] = 2.7). In the multivariate analysis, 17 additional risk factors were significantly associated with incident falls (but with smaller OR), including age, college education, poor hearing, diabetes, personal or family history of fracture, hypothyroidism, and height loss. Of the 3,346 women with zero fall risk factors, 22.6% reported falling compared to 84.3% of the 51 women with >or=11 risk factors.


CONCLUSIONS
This large cohort had sufficient power to identify 18 risk factors that independently predicted a significantly increased risk of falling with a graded increase in risk with increasing number of risk factors.
Barrett-Connor
E
E
Department of Family and Preventive Medicine, University of California, San Diego, La Jolla, CA, USA.
Weiss
T W
TW
McHorney
C A
CA
Miller
P D
PD
Siris
E S
ES
D015502:Absorptiometry, Photon; D000058:Accidental Falls / Q000706:statistics & numerical data*; D000368:Aged; D000369:Aged, 80 and over; D015519:Bone Density; D002111:Calcaneus / Q000000981:diagnostic imaging; D005260:Female; D005542:Forearm / Q000000981:diagnostic imaging; D006801:Humans; D008875:Middle Aged; D017698:Postmenopause; D011446:Prospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D014481:United States / Q000453:epidemiology
J Gerontol A Biol Sci Med Sci. 2001 Apr;56(4):M253-9
11283200
Osteoporos Int. 2006;17(3):417-25
16416256
J Am Board Fam Pract. 1993 May-Jun;6(3):239-42
8503294
J Bone Miner Res. 2004 Aug;19(8):1215-20
15231007
Scand J Prim Health Care. 1995 Dec;13(4):294-9
8693215
Age Ageing. 1996 Jan;25(1):29-38
8670526
J Am Geriatr Soc. 1999 Jul;47(7):792-8
10404921
J Bone Miner Res. 1998 Dec;13(12):1932-9
9844112
Clin Rehabil. 2006 Jan;20(1):83-90
16502754
Age Ageing. 2007 Mar;36(2):130-9
17293604
Med Care. 1996 Mar;34(3):220-33
8628042
Clin Geriatr Med. 2002 May;18(2):141-58
12180240
JAMA. 2001 Dec 12;286(22):2815-22
11735756
N Engl J Med. 1988 Dec 29;319(26):1701-7
3205267
J Am Geriatr Soc. 2006 Aug;54(8):1177-83
16913982
J Br Menopause Soc. 2003 Sep;9(3):101-6
14670194
JAMA. 1989 May 12;261(18):2663-8
2709546
Ann Epidemiol. 2004 May;14(5):311-8
15177269
Am J Epidemiol. 1996 Jun 1;143(11):1129-36
8633602
Arch Phys Med Rehabil. 2002 Jul;83(7):903-6
12098147
Osteoporos Int. 2002 Dec;13(12):955-61
12459938
Arch Intern Med. 2004 May 24;164(10):1108-12
15159268
JAMA. 1995 May 3;273(17):1348-53
7715059
Inj Prev. 2002 Jun;8(2):155-60
12120837
J Clin Epidemiol. 2001 Aug;54(8):837-44
11470394
Ophthalmology. 2004 May;111(5):857-62
15121359
J Am Geriatr Soc. 1999 Jan;47(1):30-9
9920227
Osteoporos Int. 2006;17(4):565-74
16392027
Am J Med. 1986 Mar;80(3):429-34
3953620
Am J Epidemiol. 1993 Feb 1;137(3):342-54
8452142
J Allergy Clin Immunol. 2001 Jan;107(1):3-8
11149982
J Clin Epidemiol. 2002 Nov;55(11):1088-94
12507672
Med Clin North Am. 2006 Sep;90(5):807-24
16962843
MMWR Morb Mortal Wkly Rep. 2006 Nov 17;55(45):1221-4
17108890
Inj Prev. 2006 Oct;12(5):290-5
17018668
J Am Geriatr Soc. 2002 Aug;50(8):1329-35
12164987
J Am Geriatr Soc. 1995 Nov;43(11):1207-13
7594153
J Gerontol. 1989 Jul;44(4):M112-7
2738307
Gerontology. 1998;44(4):232-8
9657085
Osteoporos Int. 1994;4 Suppl 1:67-70
8081063
J Am Geriatr Soc. 1995 Nov;43(11):1214-21
7594154
J Epidemiol Community Health. 2002 Aug;56(8):631-6
12118057
Osteoporos Int. 1996;6(3):249-55
8783300
Fam Pract. 2000 Dec;17(6):490-6
11120721
Inj Prev. 2004 Oct;10(5):308-13
15470013