Risk factors predicting subsequent falls and osteoporotic fractures at 4 years after distal radius fracture—a prospective cohort study
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In a prospective cohort of 113 patients followed 4 years after distal radius fracture (DRF), 24% of patients experienced a subsequent fall and 19% experienced a subsequent fracture. People with poor balance, greater fracture-specific pain/disability, low bone density, and prior falls had nearly a three times higher risk of subsequent falls.
To determine the extent to which modifiable risk factors alone or in combination with bone mineral density (BMD) and non-modifiable risk factors predict subsequent falls and osteoporotic (OP) fractures after distal radius fracture (DRF).
We assessed a cohort of patients (n = 191; mean age = 62 ± 8 years; female = 88%) shortly after DRF (baseline) and again at 4 years to identify subsequent falls or OP fractures. Baseline predictors included age, sex, prior falls, and modifiable risk factors such as balance, muscle strength, physical activity, fear of falling, BMD, fracture-specific pain/disability, and general health status. Univariate, multivariate, and stepwise logistic regression analyses were conducted to compute odds ratio (OR) with 95% CI to determine the extent of association between the risk factors and outcomes.
Among the 113 patients, who completed 4-year follow-up, 24% reported ≥ 1 subsequent fall and 19% reported ≥ 1 subsequent fracture. Significant predictors of subsequent falls included poor balance (OR = 3.3), low total hip BMD (OR = 3.3), high patient-rated wrist evaluation (PRWE) score (OR = 3.0), and prior falls (OR = 3.4). When adjusted for BMD, age, and sex; only prior falls (OR = 4.1) remained a significant independent predictor of future falls. None of the modifiable or non-modifiable risk factors were significantly associated with subsequent fractures.
Prior falls (≥ 2) is an independent predictor of subsequent falls in patients with DRF. In clinical practice, screening of patients for prior falls, balance, fracture-specific pain/disability, and BMD may identify those who might be at risk of subsequent falls after their first DRF.
KeywordsDistal radius Wrist fracture Osteoporosis Falls Bone density Risk factors
Neha Dewan was supported in part by the Joint Motion Program (JuMP): “A Canadian Institute of Health Research (CIHR) Training Program in Musculoskeletal Health Research and Leadership” from University of Western Ontario. Dr. Joy C. MacDermid is supported by a CIHR Chair in Gender, Work and Health and Dr. James Roth Chair in Musculoskeletal Measurement and Knowledge Translation. The research study was funded by CIHR grant award no. 93372. We thank all the patients who volunteered to participate in this study. We would like to thank Prof. Lauren Griffith, for her teachings on logistic regression and Prof. Paul Stratford to review our data analysis. Also, we would like to thank the research assistant Katrina Munro working at Hand and Upper Limb Center, for her kind assistance in accommodating patient appointments for BMD testing scheduled at Hand and Upper Limb Center.
Compliance with ethical standards
Conflict of interest
- 1.Cooper C, Melton LJIII (1996) Magnitude and impact of osteoporosis and fractures. In: Marcus R, Feldman O, Kelsey J (eds) Osteoporosis. Academic, San Diego, pp 557–567Google Scholar
- 3.Einsiedel T, Becker C, Stengel D, Schmelz A, Kramer M, Däxle M, Lechner F, Kinzl L, Gebhard F (2006) Do injuries of the upper extremity in geriatric patients end up in helplessness? A prospective study for the outcome of distal radius and proximal humerus fractures in individuals over 65. Z Gerontol Geriatr 39(6):451–461. https://doi.org/10.1007/s00391-006-0378-2. CrossRefPubMedGoogle Scholar
- 4.Mehta SP, MacDermid JC, Richardson J, MacIntyre N, Grewal R (2012) Predicting risk for adverse outcomes following distal radius fracture. Hamilton, Ontario: Dissertation, School of Rehabilitation Science, McMaster UniversityGoogle Scholar
- 9.Nordvall H (2009) Factors in secondary prevention subsequent to distal radius fracture Focus on physical function, co-morbidity, bone mineral density and health-related quality of life. Dissertation, Umea University. Available at : http://www.diva-portal.org/smash/get/diva2:212706/FULLTEXT01.pdf. Accessed on 9/4/2014
- 10.Haentjens P, Johnell O, Kanis JA, Bouillon R, Cooper C, Lamraski G, Vanderschueren D, Kaufman JM, Boonen S, Network on Male Osteoporosis in Europe (NEMO) (2004) Evidence from data searches and life-table analyses for gender-related differences in absolute risk of hip fracture after Colles’ or spine fracture: Colles’ fracture as an early and sensitive marker of skeletal fragility in white men. J Bone Miner Res 19(12):1933–1944CrossRefGoogle Scholar
- 12.Crandall CJ, Hovey KM, Cauley JA, Andrews CA, Curtis JR, Wactawski-Wende J, Wright NC, Li W, LeBoff MS (2015) Wrist fracture and risk of subsequent fracture: findings from the women’s health initiative study. J Bone Miner Res 30(11):2086–2095. https://doi.org/10.1002/jbmr.2559 CrossRefPubMedPubMedCentralGoogle Scholar
- 13.Hodsman AB, Leslie WD, Tsang JF, Gamble GD (2008) 10-year probability of recurrent fractures following wrist and other osteoporotic fractures in a large clinical cohort: an analysis from the Manitoba Bone Density Program. Arch Intern Med 168(20):2261–2267. https://doi.org/10.1001/archinte.168.20.2261 CrossRefPubMedGoogle Scholar
- 19.Lewis CE, Ewing SK, Taylor BC, Shikany JM, Fink HA, Ensrud KE, Barrett-Connor E, Cummings SR, Orwoll E, Osteoporotic Fractures in Men (MrOS) Study Research Group (2007) Predictors of non-spine fracture in elderly men: the MrOS study. J Bone Miner Res 22(2):211–219. https://doi.org/10.1359/jbmr.061017. CrossRefGoogle Scholar
- 23.The prevention of falls in later life (1987) A report of the Kellogg international work group on the prevention of falls by the elderly. Dan Med Bull 34(4):1–24Google Scholar
- 24.Khatib R, Yusuf S, Barzilay JI, Papaioannou A, Thabane L, Gao P, Joseph PG, Teo K, Mente A (2014) Impact of lifestyle factors on fracture risk in older patients with cardiovascular disease: a prospective cohort study of 26,335 individuals from 40 countries. Age Ageing 43(5):629–635. https://doi.org/10.1093/ageing/afu009 CrossRefPubMedGoogle Scholar
- 26.Biodex Balance System SD (#950–300) Clinical Resource Manual 945–308 (2016) Biodex Medical Systems, Inc. http://www.interferenciales.com.mx/pdf/casos/101.pdf. Accessed 21 Sept 2016
- 28.The Biodex System 3 PRO Application/Operation Manual (2016) Biodex Medical Systems, Inc. http://www.biodex.com/sites/default/files/835000man_06159.pdf. Accessed 21 Sept 2016
- 29.MacDermid J, Alyafi T, Richards R, Roth J (2001) Test-retest reliability of isometric strength and endurance grip tests performed on th Jamar and NK devices. Physiother Can 53(1):48–54Google Scholar
- 30.Fess E (1992) Grip strength. In: Casanova JS (ed) Clinical assessment recommendations, 2nd edn. American Society of Hand Therapists, Chicago, pp 41–45Google Scholar
- 38.de Vasconcelos RA, Bevilaqua-Grossi D, Shimano AC, Paccola CJ, Salvini TF, Prado CL, Junior WAM (2009) Reliability and validity of a modified isometric dynamometer in the assessment of muscular performance in individuals with anterior cruciate ligament reconstruction. Rev Bras Ortop 44(3):214–224. https://doi.org/10.1016/S2255-4971(15)30071-9 CrossRefPubMedGoogle Scholar
- 39.Kleinbaum DG, Kupper LL, Nizam A, Rosenberg ES (2014) Applied regression analysis and other multivariable methods, Fifth edn. Cengage Learning, Boston, MassachusettsGoogle Scholar
- 40.Fleiss JL (1981) Statistical methods for rates and proportions, 2nd edn. Wiley, New YorkGoogle Scholar
- 41.Wuensch K (2015) Cohen’s conventions for small, medium, and large effects [internet]. east carolina university. Available from: http://core.ecu.edu/psyc/wuenschk/docs30/EffectSizeConventions.pdf. Accessed 19 Sept 2016
- 45.Siggeirsdottir K, Aspelund T, Sigurdsson G, Mogensen B, Chang M, Jonsdottir B, Eiriksdottir G, Launer LJ, Harris TB, Jonsson BY, Gudnason V (2007) Inaccuracy in self-report of fractures may underestimate association with health outcomes when compared with medical record based fracture registry. Eur J Epidemiol 22(9):631–639. https://doi.org/10.1007/s10654-007-9163-9 CrossRefPubMedGoogle Scholar
- 49.Khan AA, Bachrach L, Brown JP, Hanley DA, Josse RG, Kendler DL, Leib ES, Lentle BC, Leslie WD, Lewiecki EM, Miller PD, Nicholson RL, O'Brien C, Olszynski WP, Theriault MY, Watts NB, Canadian Panel of the International Society of Clinical Densitometry (2004) Standards and guidelines for performing central dual-energy x-ray absorptiometry in premenopausal women, men, and children. J Clin Densitom 7(1):51–64. https://doi.org/10.1385/JCD:7:1:51. CrossRefPubMedGoogle Scholar
- 50.Crandall CJ, Hovey KM, Andrews CA, Cauley JA, Manson JAE, Wactawski-Wende J, Wright NC, Li W, Beavers K, Curtis JR, LeBoff MS (2015) Bone mineral density as a predictor of subsequent wrist fractures: findings from the women’s health initiative study. J Clin Endocrinol Metab 100(11):4315–4324. https://doi.org/10.1210/jc.2015-2568 CrossRefPubMedPubMedCentralGoogle Scholar
- 52.Mehta SP, MacDermid JC, Richardson J, MacIntyre NJ, Grewal R (2015) Reliability and validity of selected measures associated with increased fall risk in females over the age of 45 years with distal radius fracture—a pilot study. J Hand Ther 28(1):2–10. https://doi.org/10.1016/j.jht.2014.09.009 CrossRefPubMedGoogle Scholar
- 53.MacDermid JC, Richards RS, Donner A, Bellamy N, Roth JH (2000) Responsiveness of the short form-36, disability of the arm, shoulder, and hand questionnaire, patient-rated wrist evaluation, and physical impairment measurements in evaluating recovery after a distal radius fracture. J Hand Surg Am 25(2):330–340. https://doi.org/10.1053/jhsu.2000.jhsu25a0330 CrossRefPubMedGoogle Scholar
- 54.Siris ES, Adler R, Bilezikian J, Bolognese M, Dawson-Hughes B, Favus MJ, Harris ST, Jan de Beur SM, Khosla S, Lane NE, Lindsay R, Nana AD, Orwoll ES, Saag K, Silverman S, Watts NB (2014) The clinical diagnosis of osteoporosis: a position statement from the National Bone Health Alliance Working Group. Osteoporos Int 25(5):1439–1443. https://doi.org/10.1007/s00198-014-2655-z CrossRefPubMedPubMedCentralGoogle Scholar