Usefulness of bone density measurement in fallers.
The objective of this systematic literature review is to discuss the latest French recommendation issued in 2012 that a fall within the past year should lead to bone mineral density (BMD) measurement using dual-energy X-ray absorptiometry (DXA). This recommendation rests on four facts. First, osteoporosis and fall risk are the two leading risk factors for nonvertebral fractures in postmenopausal women. Second, BMD measurement using DXA supplies significant information on the fracture risk independently from the fall risk. Thus, when a fall occurs, the fracture risk increases as BMD decreases. Third, osteoporosis drugs have been proven effective in preventing fractures only in populations with osteoporosis defined based on BMD criteria. Finally, the prevalence of osteoporosis is high in patients who fall and increases in the presence of markers for frailty (e.g., recurrent falls, sarcopenia [low muscle mass and strength], limited mobility, and weight loss), which are risk factors for both osteoporosis and falls. Nevertheless, life expectancy should be taken into account when assessing the appropriateness of DXA in fallers, as osteoporosis treatments require at least 12months to decrease the fracture risk. Another relevant factor is the availability of DXA, which may be limited due to geographic factors, patient dependency, or severe cognitive impairments, for instance. Studies are needed to better determine how the fall risk and frailty should be incorporated into the fracture risk evaluation based on BMD and the FRAX® tool.
Pôle de Gériatrie, Centre Antonin-Balmes, CHU de Montpellier, 39, avenue Charles-Flahault, 34395 Montpellier Cedex 5, France; Laboratoire Movement to Health, Euromov, Université Montpellier 1, Site de Référence MACVIA-LR, Contre les Maladies Chroniques pour un vieillissement actif en Languedoc-Roussillon, 700, avenue du Pic-Saint-Loup, 34090 Montpellier, France. Electronic address: h-blain@chu-montpellier.fr.
Hubert
H
Blain
Gérontopôle de Toulouse, Hôpital La Grave-Casselardit, CHU de Toulouse, Toulouse, France.
Yves
Y
Rolland
UPRES EA 4638, Service de gériatrie, CHU d'Angers, Angers, France.
Olivier
O
Beauchet
UPRES EA 4638, Service de gériatrie, CHU d'Angers, Angers, France.
Cedric
C
Annweiler
EA4708 I3MTO, University of Orleans, Orleans, France.
Claude-Laurent
CL
Benhamou
Service de Gériatrie, CHU de Nancy, Inserm U1116, Université de Lorraine, Nancy, France.
Athanase
A
Benetos
Service de gériatrie, CHU de Nantes, Nantes, France.
Gilles
G
Berrut
Service de rhumatologie et GEROM, CHU d'Angers, Angers, France.
Maurice
M
Audran
Médecine Générale, Paris, France.
Sauveur
S
Bendavid
Service de Radiologie Ostéoarticulaire, Hôpital Lariboisière, Paris, France.
Valérie
V
Bousson
Service de rhumatologie, hôpital Cochin, université Paris-Descartes, Paris, France.
Karine
K
Briot
Service de rhumatologie, Hôpital Nord, Amiens, France.
Michel
M
Brazier
Service de rhumatologie, CHU de Nice-1, université Nice Sophia-Antipolis, Nice, France.
Véronique
V
Breuil
Service de rhumatologie, 35500 Vitré, France.
Laure
L
Chapuis
Service de rhumatologie, CHU de Lyon, Lyon, France.
Roland
R
Chapurlat
Inserm U606, Université Paris-Diderot Paris 7, hôpital Lariboisière, Paris, France.
Martine
M
Cohen-Solal
Service de gérontologie, hôpital Broca, université Paris Descartes, Paris, France.
Bernard
B
Cortet
Université Paris-Sud, UMRS 1018, Villejuif, France.
Patricia
P
Dargent
Inserm ERI 12, service de rhumatologie, CHU d'Amiens, Amiens, France.
Patrice
P
Fardellone
Service de chirurgie orthopédique, hôpital Saint-Antoine, Paris, France.
Jean-Marc
JM
Feron
Centre de médecine gériatrique, CHR d'Orléans, Orléans, France.
Jean-Bernard
JB
Gauvain
Inserm UMR U 991, Service de rhumatologie, CHU de Rennes, Rennes, France.
Pascal
P
Guggenbuhl
Service de gérontologie, hôpital Broca, Paris, France.
Olivier
O
Hanon
Centre de Rhumatologie, CHU Purpan, Toulouse, France.
Michel
M
Laroche
Service de rhumatologie, hôpital Cochin, université Paris-Descartes, Paris, France.
Sami
S
Kolta
Inserm ERI 12, service de rhumatologie, CHU d'Amiens, Amiens, France.
Eric
E
Lespessailles
Service de gynécologie médicale et médecine du couple, hôpital Jeanne-de-Flandre, CHRU de Lille, Lille, France.
Brigitte
B
Letombe
Centre de référence des maladies rares du calcium et du phosphore, CIC Inserm 204, CHU de Rouen, Rouen, France.
Eric
E
Mallet
Service de rhumatologie, hôpital Côte-de-Nacre, Caen, France.
Christian
C
Marcelli
Service de rhumatologie, hôpital Lariboisière, Paris, France.
Philippe
P
Orcel
Service de Gériatrie, CHU de Lille, Lille, France.
François
F
Puisieux
Service de rhumatologie, Angers, France.
Patrick
P
Seret
Laboratoire d'Explorations Fonctionnelles, Inserm U845, Hôpital Necker-Enfants-Malades, Paris, France.
Jean-Claude
JC
Souberbielle
Service de chirurgie orthopédique des adultes de l'Institut Calot-de-Berck, Berck-sur-Mer, France.
Bruno
B
Sutter
Centre de ménopause, hôpital Paule-de-Viguier, Toulouse, France.
Florence
F
Trémollières
Service d'endocrinologie, CHU de Nancy, Vandoeuvre-lès-Nancy, France.
Georges
G
Weryha
Inserm U1059, Service de Rhumatologie, CHU de Saint-Étienne, 42055 Saint-Étienne Cedex 2, France.
Christian
C
Roux
Service d'endocrinologie, CHU de Nancy, Vandoeuvre-lès-Nancy, France.
Thierry
T
Thomas
D015502:Absorptiometry, Photon; D000058:Accidental Falls; D015519:Bone Density; D005260:Female; D006801:Humans; D015663:Osteoporosis, Postmenopausal / Q000175:diagnosis*; D012307:Risk Factors
Bone mineral density; Dual-energy X-ray absorptiometry; Falls; Frailty; Management; Osteoporosis; Recommendations