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Risk Factors for Osteoporotic Fracture in Nursing Home Residents

Low bone mineral density (BMD) is a known risk factor for fracture among elderly white females, but what other factors are important? In this prospective cohort study, researchers analyzed data on a high-risk population -- 1427 white female nursing home residents aged 65 and older. Baseline clinical, cognitive, and functional status data were collected between 1995 and 1997, and clinically detected osteoporotic fractures were recorded during the following 18 months.

A total of 223 fractures occurred in 180 women; the 2 major independent predictors were low BMD and transfer independence (i.e., ability to move to or from a bed, chair, or wheelchair without supervision). There was evidence of an interaction between these 2 variables: Women who were independent in transfer had a hazard ratio of 3.1 for fracture if their BMDs were below the median, and a substantial increase in risk for every decrease of 1 standard deviation in BMD. In contrast, women who were dependent in transfer with a BMD below the median had a hazard ratio of 1.6. For hip fracture specifically, the risk was 2.5 times higher in women with BMD below the median among those who were independent in transfer, but not among those who were dependent in transfer.

Comment: These data confirm the importance of BMD as a predictor of fracture risk, and also show that women who are mobile have a higher risk for falling and suffering fractures. Interventions to increase BMD and to reduce the risk for falling among these women may be helpful.

— TH Lee

Published in Journal Watch General Medicine September 12, 2000

Citation(s):

Chandler JM et al. Low bone mineral density and risk of fracture in white female nursing home residents. JAMA 2000 Aug 23 284 972-977.

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