FRAX (R): Prediction of Major Osteoporotic Fractures in Women from the General Population: The OPUS Study

Purposes: The aim of this study was to analyse how well FRAXH predicts the risk of major osteoporotic and vertebral fractures over 6 years in postmenopausal women from general population. Patients and methods: The OPUS study was conducted in European women aged above 55 years, recruited in 5 centers from random population samples and followed over 6 years. The population for this study consisted of 1748 women (mean age 74.2 years) with information on incident fractures. 742 (43.1%) had a prevalent fracture; 769 (44%) and 155 (8.9%) of them received an antiosteoporotic treatment before and during the study respectively. We compared FRAXH performance with and without bone mineral density (BMD) using receiver operator characteristic (ROC) c-statistical analysis with ORs and areas under receiver operating characteristics curves (AUCs) and net reclassification improvement (NRI). Results: 85 (4.9%) patients had incident major fractures over 6 years. FRAXH with and without BMD predicted these fractures with an AUC of 0.66 and 0.62 respectively. The AUC were 0.60, 0.66, 0.69 for history of low trauma fracture alone, age and femoral neck (FN) BMD and combination of the 3 clinical risk factors, respectively. FRAXH with and without BMD predicted incident radiographic vertebral fracture (n = 65) with an AUC of 0.67 and 0.65 respectively. NRI analysis showed a significant improvement in risk assignment when BMD is added to FRAXH. Conclusions: This study shows that FRAXH with BMD and to a lesser extent also without FN BMD predict major osteoporotic and vertebral fractures in the general population

Sunlight exposure or vitamin D supplementation for vitamin D-deficient non-western immigrants: a randomized clinical trial

Summary: Vitamin D deficiency is very common in non-western immigrants. In this randomized clinical trial, vitamin D 800 IU/day or 100,000 IU/3 months were compared with advised sunlight exposure. Vitamin D supplementation was more effective than advised sunlight exposure in improving vitamin D status and lowering parathyroid hormone levels. Introduction: Vitamin D deficiency (25-hydroxyvitamin D [25(OH)D]<25 nmol/l) is common among non-western immigrants. It can be treated with vitamin D supplementation or sunlight exposure. Methods: To determine whether the effect of vitamin

Identification of elderly fallers by muscle strength measures

For efficient prevention of falls among older adults, individuals at a high risk of falling need to be identified. In this study, we searched for muscle strength measures that best identified those individuals who would fall after a gait perturbation and those who recovered their balance. Seventeen healthy older adults performed a range of muscle strength tests. We measured maximum and rate of development of ankle plantar flexion moment, knee extension moment and whole leg push-off force, as well as maximum jump height and hand grip strength. Subsequently, their capacity to regain balance after tripping over an obstacle was determined experimentally. Seven of the participants were classified as fallers based on the tripping outcome. Maximum isometric push-off force in a leg press apparatus was the best measure to identify the fallers, as cross-validation of a discriminant model with this variable resulted in the best classification (86% sensitivity and 90% specificity). Jump height and hand grip strength were strongly correlated to leg press force (r = 0.82 and 0.59, respectively) and can also be used to identify fallers, although with slightly lower specificity. These results indicate that whole leg extension strength is associated with the ability to prevent a fall after a gait perturbation and might be used to identify the elderly at risk of falling

Risk factors for falls in older adults in a South African Urban Community

Background: Studies on falls in older adults have mainly been conducted in high income countries. Scant, if any, information exists on risk factors for falls in the older population of sub-Saharan African countries. Methods: A cross-sectional survey and a 12-month follow-up study were conducted to determine risk factors for falls in a representative multi-ethnic sample of 837 randomly selected ambulant community-dwelling subjects aged ≥65 years in three suburbs of Cape Town, South Africa. Logistic regression models were fitted to determine the association between (1) falls and (2) recurrent falls occurring during follow-up and their potential socio-demographic, self-reported medical conditions and physical assessment predictors. Results: Prevalence rates of 26.4 % for falls and 11 % for recurrent falls at baseline and 21.9 % for falls and 6.3 % for recurrent falls during follow-up. In both prospective analyses of falls and recurrent falls, history of previous falls, dizziness/vertigo, ethnicity (white or mixed ancestry vs black African) were significant predictors. However, poor cognitive score was a significant predictor in the falls analysis, and marital status (unmarried vs married) and increased time to perform the timed Up and Go test in the recurrent fall analysis but not in both. Other than the timed Up and Go test in recurrent falls analysis, physical assessment test outcomes were not significant predictors of falls. Conclusion: Our study provides simple criteria based on demographic characteristics, medical and physical assessments to identify older persons at increased risk of falls. History taking remains an important part of medical practice in the determination of a risk of falls in older patients. Physical assessment using tools validated in developed country populations may not produce results needed to predict a risk of falls in a different setting

Ongezonde leefstijl in de loop van het leven: samenhang met lichamelijke achteruitgang op oudere leeftijd

Ongezonde leefstijl en lichamelijke achteruitgang : samenvatting Het doel van deze studie was de samenhang te onderzoeken tussen ongezonde leefstijl op jonge, middelbare, en/of oudere leeftijd en lichamelijke achteruitgang op oudere leeftijd en tussen chronische blootsteling aan een ongezonde leefstijl in de loop van het leven, en lichamelijke achteruitgang op oudere leeftijd. De steekproef bestond uit 1297 respondenten van de Longitudinal Aging Study Amsterdam (LASA). Leefstijl op oudere leeftijd (55-85 jaar) werd gemeten op baseline en op jonge (circa 25 jaar) en middelbare (circa 40 jaar) leeftijd retrospectief nagevraagd en bestond uit lichamelijke activiteit, body mass index (BMI), het aantal alcoholische consumpties per week en roken. Lichamelijke achteruitgang werd berekend als het verschil in de score op lichamelijke prestatietesten tussen baseline en 6-jaar followup. Op oudere leeftijd was een BMI tussen 25-29 versus BMI<25 kg/m2 (Odds ratio (OR) 1,6; 95% betrouwbaarheidsinterval (BI) 1,1 – 2,2) en een BMI =30 versus BMI <25 kg/m2 (OR 1,8; 95% BI 1,2 - 2,7) geassocieerd met lichamelijke achteruitgang op oudere leeftijd. Lichamelijke inactiviteit op oudere leeftijd was niet significant gerelateerd aan lichamelijke achteruitgang, terwijl lichamelijke inactiviteit op zowel middelbare als oudere leeftijd wel het risico op lichamelijke achteruitgang op oudere leeftijd verhoogde (OR 1,6; 95% BI 1,1 – 2,4) vergeleken met respondenten die lichamelijk inactief waren op middelbare leeftijd maar wel actief op oudere leeftijd. Het hebben van overgewicht in beide leeftijdsperioden verhoogde het risico (OR 1,5; 95% BI 1,1 – 2,2). Deze gegevens suggereren dat overgewicht op oudere leeftijd en chronische blootstelling aan lichamelijke inactiviteit of overgewicht in de loop van het leven het risico op lichamelijke achteruitgang op oudere leeftijd verhoogt. Het lijkt daarom van belang om lichaamsbeweging en de preventie van overgewicht op alle leeftijden te stimuleren ter voorkoming van lichamelijke achteruitgang op oudere leeftijd