Skip to main content

Advertisement

SpringerLink
Log in

Fall mechanisms, bone strength, and hip fractures in elderly men and women in Taiwan

  • Original Article
  • Published:
Osteoporosis International Aims and scope Submit manuscript

Abstract

Summary

Three modifiable factors of fall direction, poor bone strength, and depression were associated with an increased risk of hip fractures for elderly men and women; fall direction was a much stronger predictor than the other two. When a fall occurs, changing fall direction may be most effective to prevent hip fractures.

Introduction

A matched case-control study was conducted to identify risk factors for hip fractures in elderly men and women in Taiwan.

Methods

Cases were defined as persons who visited the emergency room due to a fall and were diagnosed with a first hip fracture. For each case, a control was matched by gender and time of falling, selected from persons who sought care at the same emergency room due to a fall resulting in injury other than a hip fracture. In total, 85 paired men and 221 paired women were included.

Results

For men, backward, straight-down, and sideways falls were associated with 10.8-, 13.6-, and 15.2-fold increased risks of hip fractures, respectively, compared with forward falls. Poor bone strength and depression were associated with 2.27- and 2.85-fold increased risks of hip fractures, respectively, while dependence in ≥3 activities of daily living was associated with a fivefold lower risk. For women, compared with forward falls, backward, straight-down, and sideways falls were associated with 10.2-, 9.86-, and 12.8-fold increased risks of hip fractures, respectively. Living in a rented house, poor bone strength, depression, and use of antidiabetics were associated with 1.65-, 2.78-, 1.89-, and 1.92-fold increased risks of hip fractures, respectively. Hormone replacement therapy was associated with a fivefold lower risk of hip fractures.

Conclusions

While bone strength and depression can be risk factors for hip fractures in elderly people, the direction of the fall was the strongest predictor. Some risk factors differed between elderly men and women.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  1. Cummings SR, Kelsey JL, Nevitt MC, O’Dowd KJ (1985) Epidemiology of osteoporosis and osteoporotic fractures. Epidemiol Rev 7:178–208

    PubMed  CAS  Google Scholar 

  2. Kannus P, Parkkari J, Koskinen S et al (1999) Fall-induced injuries and deaths among older adults. JAMA 281(20):1895–1899

    Article  PubMed  CAS  Google Scholar 

  3. Grisso JA, Kelsey JL, Strom BL et al (1991) Risk factors for falls as a cause of hip fracture in women. The Northeast hip fracture study group. N Engl J Med 324(19):1326–1331

    Article  PubMed  CAS  Google Scholar 

  4. Bentler SE, Liu L, Obrizan M et al (2009) The aftermath of hip fracture: discharge placement, functional status change and mortality. Am J Epidemiol 170:1290–1299

    Article  PubMed  Google Scholar 

  5. Magaziner J, Fredman L, Hawkes W et al (2003) Changes in functional status attributable to hip fracture: a comparison of hip fracture patients to community-dwelling aged. Am J Epidemiol 157(11):1023–1031

    Article  PubMed  Google Scholar 

  6. Resnick NM, Greenspan SL (1989) ‘Senile’ osteoporosis reconsidered. JAMA 17 261(7):1025–1029

    Article  CAS  Google Scholar 

  7. Koot VC, Peeters PH, de Jong JR, Clevers GJ, van der Werken C (2000) Functional results after treatment of hip fracture: a multicentre, prospective study in 215 patients. Eur J Surg 166:480–485

    Article  PubMed  CAS  Google Scholar 

  8. Cummings SR, Nevitt MC, Browner WS et al (1995) Risk factors for hip fracture in white women. Study of osteoporotic fractures research group. N Engl J Med 332(12):767–773

    Article  PubMed  CAS  Google Scholar 

  9. Kanis J, Johnell O, Gullberg B et al (1999) Risk factors for hip fracture in men from southern Europe: the MEDOS study. Mediterranean osteoporosis study. Osteoporos Int 9(1):45–54

    Article  PubMed  CAS  Google Scholar 

  10. Lan TY, Hou SM, Chen CY et al (2010) Risk factors for hip fracture in older adults: a case-control study in Taiwan. Osteoporos Int 21(5):773–784

    Article  PubMed  Google Scholar 

  11. Stone KL, Seeley DG, Lui LY et al (2003) BMD at multiple sites and risk of fracture of multiple types: long-term results from the study of osteoporotic fractures. J Bone Miner Res 18:1947–1954

    Article  PubMed  Google Scholar 

  12. Kannus P, Sievänen H, Palvanen M, Järvinen T, Parkkari J (2005) Prevention of falls and consequent injuries in elderly people. Lancet 366(9500):1885–1893

    Article  PubMed  Google Scholar 

  13. Hayes WC, Myers ER, Robinovitch SN, van den Kroonenberg AJ, Courtney AC, McMahon TA (1996) Etiology and prevention of age-related hip fractures. Bone 18(Suppl 1):77 S–86 S

    Google Scholar 

  14. Greenspan SL, Myers ER, Maitland LA, Resnick NM, Hayes WC (1994) Fall severity and bone mineral density as risk factors for hip fracture in ambulatory elderly. JAMA 271(2):128–133

    Article  PubMed  CAS  Google Scholar 

  15. Järvinen TL, Sievänen H, Khan KM, Heinonen A, Kannus P (2008) Shifting the focus in fracture prevention from osteoporosis to falls. BMJ 336(7636):124–126

    Article  PubMed  Google Scholar 

  16. Cummings SR, Nevitt MC (1989) A hypothesis: the causes of hip fractures. J Gerontol 44(4):M107–M111

    PubMed  CAS  Google Scholar 

  17. Hayes WC, Myers ER, Morris JN, Gerhart TN, Yett HS, Lipsitz LA (1993) Impact near the hip dominates fracture risk in elderly nursing home residents who fall. Calcif Tissue Int 52(3):192–198

    Article  PubMed  CAS  Google Scholar 

  18. Grisso JA, Kelsey JL, Strom BL et al (1994) Risk factors for hip fracture in black women. N Engl J Med 330:1555–1559

    Article  PubMed  CAS  Google Scholar 

  19. Grisso JA, Kelsey JL, O’Brien LA et al (1997) Risk factors for hip fracture in men. Am J Epidemiol 145:786–793

    PubMed  CAS  Google Scholar 

  20. Cumming RG, Klineberg R (1994) Case-control study of risk factors for hip fractures in the elderly. Am J Epidemiol 139:493–503

    PubMed  CAS  Google Scholar 

  21. Lau EM, Lee JK, Suriwongpaisal P et al (2001) The incidence of hip fracture in four Asian countries: the Asian Osteoporosis Study (AOS). Osteoporos Int 12(3):239–243

    Article  PubMed  CAS  Google Scholar 

  22. Chie WC, Yang RS, Liu JP, Tsai KS (2004) High incidence rate of hip fracture in Taiwan: estimated from a nationwide health insurance database. Osteoporos Int 15(12):998–1002

    Article  PubMed  CAS  Google Scholar 

  23. Lamb SW, Jørstad-Stein EC, Hauer K, Becker C (2005) Prevention of falls network Europe and outcomes consensus group. Development of a common outcome data set for fall injury prevention trials: the prevention of falls network Europe consensus. J Am Geriatr Soc 53(9):1618–1622

    Article  PubMed  Google Scholar 

  24. WHO/IASO/IOTF (2000) The Asia-Pacific perspective: redefining obesity and its treatment. Health Communication Australia, Melbourne

    Google Scholar 

  25. Bauer DC, Gluer CC, Cauley JA et al (1997) Broadband ultrasound attenuation predicts fractures strongly and independently of densitometry in older women. A prospective study. Arch Intern Med 157:629–634

    Article  PubMed  CAS  Google Scholar 

  26. Khaw KT, Reeve J, Luben R et al (2004) Prediction of total and hip fracture risk in men and women by quantitative ultrasound of the calcaneus: EPIC-Norfolk prospective population study. Lancet 363:197–202

    Article  PubMed  Google Scholar 

  27. Hans D, Dargent-Molina P, Schott AM et al (1996) Ultrasonographic heel measurements to predict hip fracture in elderly women: the EPIDOS prospective study. Lancet 348:511–514

    Article  PubMed  CAS  Google Scholar 

  28. Fillenbaum GG, Smyer MA (1981) The development, validity, and reliability of the OARS multidimensional functional assessment questionnaire. J Gerontol 36:428–434

    PubMed  CAS  Google Scholar 

  29. Chiu HC, Chen YC, Mau LW, Shiao SH, Liu HW, Huang MS (1997) An evaluation of the reliability and validity of the Chinese-version OARS multidimensional functional assessment questionnaire. Chin J Public Health Taipei 16(2):119–132

    Google Scholar 

  30. Pfeiffer E (1975) A short portable mental status questionnaire for the assessment of organic brain deficit in elderly patients. J Am Geriatr Soc 23:433–441

    PubMed  CAS  Google Scholar 

  31. Liu CK, Tai CT, Lin RT, Chen YF, Lai CL (1996) Validation of Short Portable Mental Status Questionnaire. The 5th Annual Meeting of the Gerontological Society, Taiwan, R.O.C. p. 41

  32. Sheikh JA, Yessavage JA (1986) Geriatric Depression Scale (GDS): recent findings and development of a shorter version. In: Brink TL (ed) Clinical gerontology: a guide to assessment and intervention. Howarth Press, New York

    Google Scholar 

  33. Liao YC, Yeh TL, Ko HC et al (1995) Geriatric Depression Scale—validity and reliability of the Chinese-translated version: a preliminary study. Med J Changhua Christ Hosp ROC 1:11–17

    Google Scholar 

  34. Mickey RM, Greenland S (1989) The impact of confounder selection criteria on effect estimation. Am J Epidemiol 129:125–137

    PubMed  CAS  Google Scholar 

  35. de Bakker PM, Manske SL, Ebacher V, Oxland TR, Cripton PA, Guy P (2009) During sideways falls proximal femur fractures initiate in the superolateral cortex: evidence from high-speed video of simulated fractures. J Biomech 42:1917–1925

    Article  PubMed  Google Scholar 

  36. Parkkari J, Kannus P, Palvanen M et al (1999) Majority of hip fractures occur as a result of a fall and impact on the greater trochanter of the femur: a prospective controlled hip fracture study with 206 consecutive patients. Calcif Tissue Int 65(3):183–187

    Article  PubMed  CAS  Google Scholar 

  37. Sabick MB, Hay JG, Goel VK, Banks SA (1999) Active responses decrease impact forces at the hip and shoulder in falls to the side. J Biomech 32:993–998

    Article  PubMed  CAS  Google Scholar 

  38. Mussolino ME (2005) Depression and hip fracture risk: the NHANES I epidemiologic follow-up study. Public Health Rep 120(1):71–75

    PubMed  Google Scholar 

  39. Whooley MA, Kip KE, Cauley JA, Ensrud KE, Nevitt MC, Browner WS (1999) Depression, falls, and risk of fracture in older women. Study of osteoporotic fractures research group. Arch Intern Med 159(5):484–490

    Article  PubMed  CAS  Google Scholar 

  40. Ray WA, Griffin MR, Schaffner W, Baugh DK, Melton LJ (1987) Psychotropic drug use and the risk of hip fracture. N Engl J Med 316(7):363–369

    Article  PubMed  CAS  Google Scholar 

  41. Walter LC, Lui L-Y, Eng C, Covinsky KE (2003) Risk of in disabled community-living older adults. J Am Geriatr Soc 51:50–55

    Article  PubMed  Google Scholar 

  42. Norton R, Butler M, Robinson E, Lee-Joe T, Campbell AJ (2000) Declines in physical functioning attributable to hip fracture among older people: a follow-up study of case-control participants. Disabil Rehabil 22:345–351

    Article  PubMed  CAS  Google Scholar 

  43. Fransen M, Woodward M, Norton R, Robinson E, Butler M, Campbell AJ (2002) Excess mortality or institutionalization after hip fracture: men are at greater risk than women. J Am Geriatr Soc 50:685–690

    Article  PubMed  Google Scholar 

  44. Forsen L, Sogaard AJ, Meyer HE, Edna T, Kopjar B (1999) Survival after hip fracture: short- and long-term excess mortality according to age and gender. Osteoporos Int 10:73–78

    Article  PubMed  CAS  Google Scholar 

  45. Stenvall M, Elinge E, von Heideken WP, Lundström M, Gustafson Y, Nyberg L (2005) Having had a hip fracture: association with dependency among the oldest old. Age Ageing 34:294–297

    Article  PubMed  Google Scholar 

  46. Nakamura K, Takahashi S, Oyama M et al (2009) Incidence and risk factors associated with hip fracture in institutionalized elderly people in Japan. Age Ageing 38(4):478–482

    Article  PubMed  Google Scholar 

  47. Volpato S, Leveille SG, Blaum C, Fried LP, Guralnik JM (2005) Risk factors for falls in older disabled women with diabetes: the Women's Health and Aging Study. J Gerontol A Biol Sci Med Sci 60A:1539–1545

    Article  Google Scholar 

  48. Wallace C, Reiber GE, LeMaster J et al (2002) Incidence of falls, risk factors for falls, and fall-related fractures in individuals with diabetes and a prior foot ulcer. Diabet Care 11:1983–1986

    Article  Google Scholar 

  49. Ivers RQ, Cumming RG, Mitchell P, Peduto AJ (2001) Diabetes and risk of fracture: the Blue Mountains Eye Study. Diabet Care 24:1198–1203

    Article  CAS  Google Scholar 

  50. UK Prospective Diabetes Study Group (1998) Intensive blood-glucose control with sulphonylureas or insulin compared with conventional treatment and risk of complications in patients with type 2 diabetes (UKPDS 33). Lancet 352:837–853

    Article  Google Scholar 

  51. Cavanagh PR, Derr JA, Ulbrecht JS, Maser RE, Orchard JJ (1992) Problems with gait and posture in neuropathic patients with insulin-dependent diabetes mellitus. Diabet Med 9:469–474

    Article  PubMed  CAS  Google Scholar 

  52. Cauley JA, Robbins J, Chen Z et al (2003) Effects of estrogen plus progestin on risk of fracture and bone mineral density: the Women's Health Initiative randomized trial. JAMA 290:1729–1738

    Article  PubMed  CAS  Google Scholar 

  53. Collaborative Group on Hormonal Factors in Breast Cancer (1997) Breast cancer and hormone replacement therapy: collaborative reanalysis of data from 51 epidemiological studies of 52705 women with breast cancer and 108411 women without breast cancer. Lancet 350:1047–1059

    Article  Google Scholar 

  54. Beresford SAA, Weiss NS, Voigt LF, McKnight B (1997) Risk of endometrial cancer in relation to use of estrogen combined with cyclic progestagen therapy in postmenopausal women. Lancet 349:458–461

    Article  PubMed  CAS  Google Scholar 

  55. Jick H, Derby LE, Myers MW, Vasilakis C, Newton KM (1996) Risk of hospital admission for idiopathic venous thromboembolism among users of post-menopausal estrogens. Lancet 348:981–983

    Article  PubMed  CAS  Google Scholar 

  56. Vestergaard P, Rejnmark L, Mosekilde L (2001) Hip fracture prevention – cost-effective strategies. Pharmcoeconomics 19:449–468

    Article  CAS  Google Scholar 

Download references

Acknowledgements

This work was funded by the National Health Research Institute (NHRI-EX98-9805PI), Taiwan, ROC.

Conflicts of interest

None.

Author information

Authors and Affiliations

  1. Department of Nursing, National Taipei University of Nursing and Health Science, Taipei, Taiwan

    H.-F. Hwang

  2. Department of Family Medicine, Taipei Medical University Hospital, Taipei, Taiwan

    H.-D. Lee

  3. Department of Emergency Medicine, Tali Branch, Jen-Ai Hospital, Taichung, Taiwan

    H.-H. Huang

  4. Institute of Injury Prevention and Control, College of Public Health and Nutrition, Taipei Medical University, 250 Wu-Hsing Street, Taipei, 110, Taiwan

    C.-Y. Chen & M.-R. Lin

Authors
  1. H.-F. Hwang
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. H.-D. Lee
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. H.-H. Huang
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. C.-Y. Chen
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. M.-R. Lin
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to M.-R. Lin.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Hwang, HF., Lee, HD., Huang, HH. et al. Fall mechanisms, bone strength, and hip fractures in elderly men and women in Taiwan. Osteoporos Int 22, 2385–2393 (2011). https://doi.org/10.1007/s00198-010-1446-4

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00198-010-1446-4

Keywords

Search

Navigation