Risk Factors for Falls as a Cause of Hip Fracture in Women

TLDR

Although most falls in the elderly do not cause fractures, over 90 % of hip fractures result from a fall, yet few studies have examined whether fall risk factors also predict hip fracture. The study aimed to assess whether fall risk factors predict hip fracture by conducting a case‑control study of 174 women with first hip fractures across 30 hospitals. The case‑control design matched 174 hip‑fracture women to controls by age and hospital, selecting controls from general and orthopedic surgical services and gathering information through direct interviews. Fall risk factors such as lower‑limb dysfunction, visual impairment, prior stroke, Parkinson’s disease, and long‑acting barbiturate use were significantly associated with hip fracture (odds ratios 1.7–9.4), and hip‑fracture patients were more likely to have fallen from standing height or higher and, among younger patients, on hard surfaces; thus, fall‑prevention measures should accompany bone‑loss interventions.

Abstract

Although even in the elderly most falls are not associated with fractures, over 90 percent of hip fractures are the result of a fall. Few studies have assessed whether the risk factors for falls are also important risk factors for hip fracture.To examine the importance of risk factors for falls in the epidemiology of hip fracture, we performed a case-control study of 174 women (median age, 80 years) admitted with a first hip fracture to 1 of 30 hospitals in New York and Philadelphia. Controls, matched to the case patients according to age and hospital, were selected from general surgical and orthopedic surgical hospital services. Information was obtained by direct interview.As measured by the odds ratio, increased risks for hip fracture were associated with lower-limb dysfunction (odds ratio = 1.7; 95 percent confidence interval, 1.1 to 2.8), visual impairment (odds ratio = 5.1; 95 percent confidence interval, 1.9 to 13.9), previous stroke (odds ratio = 2.0; 95 percent confidence interval, 1.0 to 4.0), Parkinson's disease (odds ratio = 9.4; 95 percent confidence interval, 1.2 to 76.1), and use of long-acting barbiturates (odds ratio = 5.2; 95 percent confidence interval, 0.6 to 45.0). Of the controls, 44 (25 percent) had had a recent fall. The case patients were more likely than these controls to have fallen from a standing height or higher (odds ratio = 2.4; 95 percent confidence interval, 1.0 to 5.7). Of those with hip fracture the younger patients (less than 75 years old) were more likely than the older ones (greater than or equal to 75 years old) to have fallen on a hard surface (odds ratio = 1.9; 95 percent confidence interval, 1.04 to 3.7).A number of factors that have been identified as risk factors for falls are also associated with hip fracture, including lower-limb dysfunction, neurologic conditions, barbiturate use, and visual impairment. Given the prevalence of these problems among the elderly, who are at highest risk, programs to prevent hip fracture should include measures to prevent falls in addition to measures to slow bone loss.