A selection strategy was developed for fracture reduction programs in frail older people.
OBJECTIVE
The aims of this study were to develop and evaluate a simple index for assessing the risk of fractures after a fall and to propose a selection strategy for identifying elderly individuals at high risk of both falls and fall-related fractures.


METHODS
Two thousand five institutionalized older men and women were assessed for clinical risk factors and then followed up for falls and fall-related fractures for up to 2 years.


RESULTS
Our fracture risk index is derived from seven previously identified significant independent risk factors: weight, lower leg length, balance, cognitive function, type of institution, fracture history, and falls in the past year. The fracture rate was 6.5 times greater in the one-sixth of the falls with the highest index (9.7/100 falls) than in the lowest sixth (1.5/100 falls). Our proposed approach (based on balance, risk of falls, and the fracture risk index) selected a group of older people with high risk of both falls and fall-related fracture. The fracture incidence rate was 144% higher, and the falls incidence rate was 31% higher in the selected residents than in the remainder.


CONCLUSIONS
The index could help rationalize fracture prevention programs for frail older people.
Chen
Jian Sheng
JS
Institute of Bone and Joint Research, Royal North Shore Hospital, New South Wales, Australia. jschen@med.usyd.edu.au
Sambrook
Philip N
PN
Simpson
Judy M
JM
March
Lyn M
LM
Cumming
Robert G
RG
Seibel
Markus J
MJ
Lord
Stephen R
SR
Cameron
Ian D
ID
D000058:Accidental Falls / Q000517:prevention & control* / Q000706:statistics & numerical data; D000369:Aged, 80 and over; D001315:Australia / Q000453:epidemiology; D005260:Female; D050723:Fractures, Bone / Q000453:epidemiology / Q000517:prevention & control*; D016330:Frail Elderly; D006801:Humans; D008297:Male; D011322:Primary Prevention / Q000379:methods*; D018570:Risk Assessment / Q000706:statistics & numerical data; D012307:Risk Factors