title: Hip fracture prevention with a multifactorial educational program in elderly community-dwelling Finnish women.
abstract: Guidelines suggest identification of women at fracture risk by bone density measurement and subsequently pharmacotherapy. However, most women who sustain a hip fracture do not have osteoporosis in terms of bone density. The present non-pharmacological intervention among elderly women unselected for osteoporosis reduced hip fracture risk by 55 % providing an alternative approach to fracture prevention.
  
  
  BACKGROUND
  Hip fractures are expensive for society and cause disability for those who sustain them. We studied whether a multifactorial non-pharmacological prevention program reduces hip fracture risk in elderly women.
  
  
  METHODS
  A controlled trial concerning 60- to 70-year-old community-dwelling Finnish women was undertaken. A random sample was drawn from the Population Information System and assigned into the intervention group (IG) and control group (CG). Of the 2,547 women who were invited to the IG, 1,004 (39 %) and of the 2,120 invited to the CG, 1,174 (55 %) participated. The IG participated in a fracture prevention program for 1 week at a rehabilitation center followed by review days twice. The CG received no intervention. During the 10-year follow-up, both groups participated in survey questionnaire by mail. Outcome of interest was occurrence of hip fractures and changes in bone-health-related lifestyle.
  
  
  RESULTS
  During the follow-up, 12 (1.2 %) women in the IG and 29 (2.5 %) in the CG sustained a hip fracture (P = 0.039). The determinants of hip fractures by stepwise logistic regression were baseline smoking (odds ratio (OR) 4.32 (95 % confidence interval [CI] 2.14-8.71), age OR 1.15/year (95 % CI 1.03-1.28), fall history OR 2.7 (95 % CI 1.24-5.9), stroke history OR 2.99 (95 % CI 1.19-7.54) and participating in this program OR 0.45 (95 % CI 0.22-0.93). Starting vitamin D and calcium supplement use was more common in the IG compared with the CG.
  
  
  CONCLUSIONS
  The results suggest that this non-pharmacological fracture prevention program may reduce the risk of hip fractures in elderly Finnish women.
authors: Division of Endocrinology, Department of Medicine, Helsinki University Central Hospital, Peijas Hospital, Sairaalakatu 1, PL 900, FI-00029, HUS, Vantaa, Finland, tuula.pekkarinen@hus.fi.
authors: T
authors: T
authors: Pekkarinen
authors: E
authors: E
authors: Löyttyniemi
authors: M
authors: M
authors: Välimäki
mesh_terms: D000058:Accidental Falls / Q000517:prevention & control / Q000706:statistics & numerical data; D000368:Aged; D002118:Calcium / Q000627:therapeutic use; D004363:Drug Utilization / Q000706:statistics & numerical data; D005260:Female; D005387:Finland / Q000453:epidemiology; D005500:Follow-Up Studies; D006266:Health Education / Q000379:methods*; D006293:Health Promotion / Q000379:methods*; D006620:Hip Fractures / Q000453:epidemiology / Q000517:prevention & control*; D006801:Humans; D015994:Incidence; D008019:Life Style; D008875:Middle Aged; D058866:Osteoporotic Fractures / Q000453:epidemiology / Q000517:prevention & control*; D000074606:Smoking Prevention; D014807:Vitamin D / Q000627:therapeutic use
chemical_list: D014807:Vitamin D; D002118:Calcium
references: Osteoporos Int. 2008 Dec;19(12):1717-23
references: 18629572
references: Ann Epidemiol. 2004 Sep;14(8):579-84
references: 15350958
references: Appl Health Econ Health Policy. 2008;6(1):1-18
references: 18774866
references: J Bone Miner Res. 1995 May;10(5):675-82
references: 7639101
references: Forensic Sci Int. 2001 Jan 1;115(1-2):15-32
references: 11056267
references: Cochrane Database Syst Rev. 2009 Apr 15;(2):CD007146
references: 19370674
references: Acta Orthop Scand. 1995 Jun;66(3):245-8
references: 7604706
references: JAMA. 1998 Dec 23-30;280(24):2077-82
references: 9875874
references: BMJ. 2011 Apr 19;342:d2175
references: 21505222
references: Am J Epidemiol. 1994 May 15;139(10):990-1000
references: 8178787
references: Arch Intern Med. 2011 Nov 14;171(20):1831-7
references: 21949033
references: J Bone Miner Res. 2011 Jul;26(7):1638-47
references: 21328475
references: Curr Opin Rheumatol. 2009 Jul;21(4):356-62
references: 19412103
references: Am J Med. 1999 Mar;106(3):311-4
references: 10190380
references: J Clin Epidemiol. 2004 Oct;57(10):1096-103
references: 15528061
references: Mayo Clin Proc. 2007 Dec;82(12):1493-501
references: 18053457
references: Ann Epidemiol. 2008 Nov;18(11):827-35
references: 18809340
references: Am J Epidemiol. 1989 Dec;130(6):1088-100
references: 2589302
references: J Bone Miner Res. 2004 Aug;19(8):1241-9
references: 15231010
references: N Engl J Med. 2001 Feb 1;344(5):333-40
references: 11172164
references: Am J Epidemiol. 1996 Aug 1;144(3):255-63
references: 8686694
references: N Engl J Med. 1991 May 9;324(19):1326-31
references: 2017229
references: Osteoporos Int. 2008 Nov;19(11):1613-20
references: 18483689
references: BMJ. 1997 Oct 4;315(7112):841-6
references: 9353503
references: Osteoporos Int. 2013 Jan;24(1):23-57
references: 23079689
references: Int J Epidemiol. 1994 Dec;23(6):1198-205
references: 7536718
references: Qual Saf Health Care. 2007 Jun;16(3):230-4
references: 17545352
references: Osteoporos Int. 2009 Oct;20(10):1633-50
references: 19421703
references: Ann Epidemiol. 1994 Sep;4(5):398-403
references: 7981848
references: Lancet. 2002 May 18;359(9319):1761-7
references: 12049882
references: Osteoporos Int. 2011 May;22(5):1277-88
references: 21461721
references: N Engl J Med. 2012 Jul 5;367(1):40-9
references: 22762317
references: Osteoporos Int. 2011 Oct;22(10):2565-73
references: 21617992
references: J Bone Miner Res. 1991 Nov;6(11):1227-33
references: 1805545
references: Int J Epidemiol. 1991 Jun;20(2):328-38
references: 1917231
references: J Bone Miner Res. 2006 Dec;21(12):1836-8
references: 17002578
references: BMJ. 1997 Jun 7;314(7095):1666-74
references: 9193292
references: Ann Intern Med. 2010 Dec 21;153(12):815-25
references: 21173416
references: Calcif Tissue Int. 1994 Nov;55(5):342-5
references: 7866913
references: Lancet. 2007 Aug 25;370(9588):657-66
references: 17720017
references: Duodecim. 2006;122(9):1085-91
references: 16866339
references: N Engl J Med. 1995 Mar 23;332(12):767-73
references: 7862179
references: J Clin Endocrinol Metab. 2005 May;90(5):2787-93
references: 15728213
references: Age Ageing. 1997 Jul;26(4):253-60
references: 9271287
references: Am J Public Health. 2008 Feb;98(2):351-7
references: 18172132
references: Clin Endocrinol (Oxf). 2010 Sep;73(3):277-85
references: 20796001
references: J Clin Endocrinol Metab. 2008 Jul;93(7):2463-5
references: 18544615