title: Simply ask them about their balance--future fracture risk in a nationwide cohort study of twins.
abstract: The principal causal components of an osteoporotic fracture are a fall and weakened bone strength. While bone quality measures have been frequently studied, the ability of simple measures of impaired balance to predict fracture risk has received less attention. Computer-assisted telephone interviews were conducted between 1998 and 2000 among 24,598 Swedish twins aged 55 years or older. Impaired balance at the time of interview was reported by 2,890 (12%) of the twins. Twin pairs who were discordant with regard to impaired balance were selected for analysis and followed for fractures through 2005. In a pairwise analysis, the odds ratio for hip fracture was 3.13 (95% confidence interval (CI): 1.62, 6.05) among twins with impaired balance as compared with their co-twins with normal balance. When previously recognized clinical risk factors for osteoporotic fracture were considered in the model, the odds ratio for hip fracture with impaired balance was 3.88 (95% CI: 1.40, 10.72). Approximately 40% of all hip fractures were attributable to impaired balance. The odds ratios for any fracture and any osteoporotic fracture for twins with impaired balance were 2.00 (95% CI: 1.29, 3.11) and 2.39 (95% CI: 1.49, 3.82), respectively. These results imply that self-reported impaired balance is a novel and readily assessed risk factor for future fractures in the elderly.
authors.affiliation: Department of Surgical Sciences, Section of Orthopaedics, University Hospital, Uppsala, Sweden.
authors.forename: Helene
authors.initials: H
authors.lastname: Wagner
authors.forename: Håkan
authors.initials: H
authors.lastname: Melhus
authors.forename: Rolf
authors.initials: R
authors.lastname: Gedeborg
authors.forename: Nancy L
authors.initials: NL
authors.lastname: Pedersen
authors.forename: Karl
authors.initials: K
authors.lastname: Michaëlsson
mesh_terms: D000058:Accidental Falls / Q000517:prevention & control / Q000706:statistics & numerical data*; D000368:Aged; D000369:Aged, 80 and over; D016001:Confidence Intervals; D005260:Female; D016330:Frail Elderly / Q000706:statistics & numerical data*; D006620:Hip Fractures / Q000453:epidemiology* / Q000208:ethnology / Q000209:etiology; D006801:Humans; D008297:Male; D008875:Middle Aged; D016017:Odds Ratio; D010024:Osteoporosis / Q000150:complications* / Q000503:physiopathology; D004856:Postural Balance; D011446:Prospective Studies; D012042:Registries; D018570:Risk Assessment; D012307:Risk Factors; D013548:Sweden / Q000453:epidemiology; D014427:Twins