title: Persistent hypovitaminosis D and loss of hip bone mineral density over time as additional risk factors for recurrent falls in a population-based prospective cohort of elderly persons living in the community. The São Paulo Ageing & Health (SPAH) Study.
abstract: We performed concomitant evaluation of clinical, laboratory, and bone mineral density (BMD) parameters as potential risk factors for falls in a population-based prospective cohort of older adults, since previous studies have focused mostly in clinical risk factors. Loss of hip BMD and persistent hypovitaminosis D were associated with recurrent falls in community-dwelling elderly.
  
  
  BACKGROUND
  Few studies have performed a concomitant evaluation of clinical data, laboratory bone parameters, and bone mineral density (BMD) to determine more accurately the contribution of each of these variables to risk of falls in elderly persons. We investigated the association between bone parameters and recurrent falls in a population-based prospective cohort of community-dwelling older adults.
  
  
  METHODS
  A total of 705 elderly individuals (448 women, 257 men) were evaluated with clinical data, BMD, and laboratory bone tests at baseline and after a mean follow-up of 4.3 ± 0.8 years. Individuals with recurrent falls (≥2 falls in the previous year from the date of the second evaluation) were considered chronic fallers. Logistic regression models were used to identify independent risk factors for recurrent falls.
  
  
  RESULTS
  The frequency of chronic fallers was 16.5%. In multivariate analyses, risk factors for recurrent falls were visual impairment (odds ratio (OR) = 2.49, 95% confidence interval (CI) 1.30-4.74, p = 0.006), use of psychotropic drugs (OR = 2.47, 95% CI 1.37-4.49, p = 0.003), clinical fracture (OR = 2.78, 95% CI 1.48-5.20, p = 0.001), persistently low 25-hydroxyvitamin D (25OHD) (<20 ng/mL) (OR = 1.71, 95% CI 1.10-2.64, p = 0.016), and loss of total hip BMD during the study (OR = 1.21, 95% CI 1.17-1.25, p = 0.035 for each 4% decrease).
  
  
  CONCLUSIONS
  In addition to traditional clinical risk factors for falls, loss of hip BMD and hypovitaminosis D were associated with recurrent falls in community-dwelling elderly persons. Thus, recognizing these factors is essential to preventing falls and improving the outcomes of this population.
authors.affiliation: Bone Metabolism Laboratory, Rheumatology Division, Faculdade de Medicina da Universidade de São Paulo, Av. Dr. Arnaldo, 455, 3° andar, sala 3193, São Paulo, SP, 01246-903, Brazil.
authors.forename: K L L L
authors.initials: KL
authors.lastname: Machado
authors.forename: D S
authors.initials: DS
authors.lastname: Domiciano
authors.forename: L G
authors.initials: LG
authors.lastname: Machado
authors.forename: J B
authors.initials: JB
authors.lastname: Lopes
authors.forename: C P
authors.initials: CP
authors.lastname: Figueiredo
authors.forename: L
authors.initials: L
authors.lastname: Takayama
authors.forename: R M
authors.initials: RM
authors.lastname: Oliveira
authors.forename: P R
authors.initials: PR
authors.lastname: Menezes
authors.forename: R M R
authors.initials: RM
authors.lastname: Pereira
mesh_terms: D015502:Absorptiometry, Photon / Q000379:methods; D000058:Accidental Falls / Q000706:statistics & numerical data; D000368:Aged; D000369:Aged, 80 and over; D015519:Bone Density / Q000502:physiology; D001938:Brazil / Q000453:epidemiology; D005260:Female; D006621:Hip Joint / Q000503:physiopathology; D006801:Humans; D008297:Male; D010024:Osteoporosis / Q000453:epidemiology / Q000209:etiology* / Q000503:physiopathology; D058866:Osteoporotic Fractures / Q000150:complications / Q000453:epidemiology / Q000503:physiopathology; D011446:Prospective Studies; D012008:Recurrence; D012307:Risk Factors; D014808:Vitamin D Deficiency / Q000150:complications* / Q000453:epidemiology / Q000503:physiopathology