title: A selection strategy was developed for fracture reduction programs in frail older people.
abstract: 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.
authors.affiliation: Institute of Bone and Joint Research, Royal North Shore Hospital, New South Wales, Australia. jschen@med.usyd.edu.au
authors.forename: Jian Sheng
authors.initials: JS
authors.lastname: Chen
authors.forename: Philip N
authors.initials: PN
authors.lastname: Sambrook
authors.forename: Judy M
authors.initials: JM
authors.lastname: Simpson
authors.forename: Lyn M
authors.initials: LM
authors.lastname: March
authors.forename: Robert G
authors.initials: RG
authors.lastname: Cumming
authors.forename: Markus J
authors.initials: MJ
authors.lastname: Seibel
authors.forename: Stephen R
authors.initials: SR
authors.lastname: Lord
authors.forename: Ian D
authors.initials: ID
authors.lastname: Cameron
mesh_terms: 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