title: Fracture predictive ability of physical performance tests and history of falls in elderly women: a 10-year prospective study.
abstract: In a large cohort of elderly women followed for 10 years, we found that balance, gait speed, and self-reported history of fall independently predicted fracture. These clinical risk factors are easily evaluated and therefore advantageous in a clinical setting. They would improve fracture risk assessment and thereby also fracture prevention.
  
  
  BACKGROUND
  The aim of this study was to identify additional risk factors for osteoporosis-related fracture by investigating the fracture predictive ability of physical performance tests and self-reported history of falls.
  
  
  METHODS
  In the population-based Osteoporosis Prospective Risk Assessment study (OPRA), 1044 women were recruited at the age of 75 and followed for 10 years. At inclusion, knee extension force, standing balance, gait speed, and bone mineral density (BMD) were examined. Falls the year before investigation was assessed by questionnaire. Cox proportional hazards regression analysis was used to determine fracture hazard ratios (HR) with BMD, history of fracture, BMI, smoking habits, bisphosphonate, vitamin D, glucocorticoid, and alcohol use as covariates. Continuous variables were standardized and HR shown for each standard deviation change.
  
  
  RESULTS
  Of all women, 427 (41%) sustained at least one fracture during the 10-year follow-up. Failing the balance test had an HR of 1.98 (1.18-3.32) for hip fracture. Each standard deviation decrease in gait speed was associated with an HR of 1.37 (1.14-1.64) for hip fracture. Previous fall had an HR of 1.30 (1.03-1.65) for any fracture; 1.39 (1.08-1.79) for any osteoporosis-related fracture; and 1.60 (1.03-2.48) for distal forearm fracture. Knee extension force did not show fracture predictability.
  
  
  CONCLUSIONS
  The balance test, gait speed test, and self-reported history of fall all hold independent fracture predictability. Consideration of these clinical risk factors for fracture would improve the fracture risk assessment and subsequently also fracture prevention.
authors.affiliation: Department of Clinical Science, Intervention and Technology, Karolinska Institutet, Department of Orthopedics, K54, Karolinska University Hospital, Huddinge, SE-141 86, Stockholm, Sweden, axel.wihlborg@karolinska.se.
authors.forename: A
authors.initials: A
authors.lastname: Wihlborg
authors.forename: M
authors.initials: M
authors.lastname: Englund
authors.forename: K
authors.initials: K
authors.lastname: Åkesson
authors.forename: P
authors.initials: P
authors.lastname: Gerdhem
mesh_terms: D000058:Accidental Falls / Q000706:statistics & numerical data*; D000368:Aged; D015519:Bone Density / Q000502:physiology; D005260:Female; D005500:Follow-Up Studies; D005684:Gait / Q000502:physiology; D015577:Geriatric Assessment / Q000379:methods; D006801:Humans; D015663:Osteoporosis, Postmenopausal / Q000150:complications / Q000453:epidemiology / Q000503:physiopathology; D058866:Osteoporotic Fractures / Q000453:epidemiology / Q000209:etiology* / Q000503:physiopathology; D010808:Physical Examination / Q000379:methods; D004856:Postural Balance / Q000502:physiology; D011237:Predictive Value of Tests; D011446:Prospective Studies; D018570:Risk Assessment / Q000379:methods; D012307:Risk Factors; D013548:Sweden / Q000453:epidemiology
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