Fracture risk assessment in frail older people using clinical risk factors

Health burden related to osteoporotic fractures in an aging female population far exceeds that imposed by other chronic disorders such as cardiovascular disease and breast cancer. Bone mineral density assessment and clinical risk factors provide independent insights into fracture risk in individuals. A finite list of clinical risk factors are identified as prognostic of fracture risk, namely among aging women, including low body mass, compromised reproductive physiology (e.g., prolonged periods of amenorrhea and early menopause), parental and personal histories of fracture, and alcohol and tobacco use. Pelvic organ prolapse is a common gynecologic entity and a contributor to age-related morbidities. The purpose of this review is to communicate data identifying pelvic organ prolapse as another clinical risk factor for fracture risk in postmenopausal women and to increase the caregiver's vigilance in anticipating and instituting preventive care strategies to a population (i.e., postmenopausal women with clinically appreciable pelvic organ prolapse) that may be at an enhanced lifetime risk for skeletal fractures.

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Combining genetic markers and clinical risk factors improves the risk assessment of impaired glucose metabolism

Annals of Medicine ◽

10.3109/07853890903559716 ◽

2010 ◽

Vol 42 (3) ◽

pp. 196-206 ◽

Cited By ~ 7

Author(s):

Stephanie-May Ruchat ◽

Marie-Claude Vohl ◽

S. John Weisnagel ◽

Tuomo Rankinen ◽

Claude Bouchard ◽

...

Keyword(s):

Risk Factors ◽

Risk Assessment ◽

Glucose Metabolism ◽

Genetic Markers ◽

Clinical Risk Factors ◽

Impaired Glucose Metabolism ◽

Clinical Risk

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One leg standing time predicts fracture risk in older women independent of clinical risk factors and BMD

Osteoporosis International ◽

10.1007/s00198-021-06039-6 ◽

2021 ◽

Author(s):

B.A.M. Larsson ◽

L. Johansson ◽

D. Mellström ◽

H. Johansson ◽

K.F. Axelsson ◽

...

Keyword(s):

Risk Factors ◽

Fracture Risk ◽

Older Women ◽

Clinical Risk Factors ◽

Standing Time ◽

Clinical Risk

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Redefining osteoporosis treatment: who to treat and how long to treat

Arquivos Brasileiros de Endocrinologia & Metabologia ◽

10.1590/s0004-27302006000400015 ◽

2006 ◽

Vol 50 (4) ◽

pp. 694-704 ◽

Cited By ~ 10

Author(s):

E. Michael Lewiecki ◽

Stuart L. Silverman

Keyword(s):

Risk Factors ◽

Fracture Risk ◽

Weight Bearing ◽

Pharmacological Therapy ◽

Clinical Risk Factors ◽

Common Disease ◽

Mineral Density ◽

Clinical Risk ◽

Increased Risk ◽

Bmd Testing

Osteoporosis is a common disease that is associated with increased risk of fractures and serious clinical consequences. Bone mineral density (BMD) testing is used to diagnose osteoporosis, estimate the risk of fracture, and monitor changes in BMD over time. Combining clinical risk factors for fracture with BMD is a better predictor of fracture risk than BMD or clinical risk factors alone. Methodologies are being developed to use BMD and validated risk factors to estimate the 10-year probability of fracture, and then combine fracture probability with country-specific economic assumptions to determine cost-effective intervention thresholds. The decision to treat is based on factors that also include availability of therapy, patient preferences, and co-morbidities. All patients benefit from nonpharmacological lifestyle treatments such a weight-bearing exercise, adequate intake of calcium and vitamin D, fall prevention, avoidance of cigarette smoking and bone-toxic drugs, and moderation of alcohol intake. Patients at high risk for fracture should be considered for pharmacological therapy, which can reduce fracture risk by about 50%.

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7 Stop Falling Before it Starts: Increasing Access to Multifactorial Falls and Fracture Risk Assessment and Intervention for Older People At Risk of Falls or Early in Their Falls Career Via Proactive Case Finding

Age and Ageing ◽

10.1093/ageing/afz183.07 ◽

2020 ◽

Vol 49 (Supplement_1) ◽

pp. i1-i8

Author(s):

J Turner ◽

S W Parry ◽

F E Shaw

Keyword(s):

Risk Assessment ◽

Older People ◽

Fracture Risk ◽

Physical Performance ◽

Frailty Index ◽

Target Population ◽

Case Finding ◽

Fracture Risk Assessment ◽

Community Based ◽

Balance Exercise

Abstract Background Target population: patients from 6 (of 43) Newcastle upon Tyne General Practices, age 65 – 75, mild frailty on electronic frailty index, who had fallen or noticed a balance problem in the previous year. Introduction Usually multifactorial falls and fracture prevention services target frailer older people and intervention begins after a fall or fracture has occurred. There is limited provision of community-based strength and balance exercise. Intervention New service model ‘Stop Falling Before It Starts (SFBIS)’: proactive case finding by postal questionnaire; multifactorial falls and fracture risk assessment by specialist nurse; interventions recommended to General Practitioner (GP); community-based exercise offered to all, predominantly new 15 week ‘Steady On’ strength and balance classes suitable for fitter older people. Methods Data collection: patient characteristics, physical performance (Timed up and Go (TUG), 30 second sit to stand (STS)) before starting and on completion of Steady On classes, service process measures, patient and GP experience. Results 157 patients assessed. 80 (51%) fallen in previous year. 9 (6%) history of syncope / pre-syncope. 18 (11%) orthostatic hypotension. 124 (79%) culprit medications. Recommendations: GP review of history 6 (4%) or medications 13 (8%); referral to secondary care falls service 1 (0.5%); optician assessment 58 (37%); DXA 13 (8%). 131 (83%) referred to Steady On; 119 (91%) attended first class, 61 (51%) completed classes. Mean initial TUG 11 seconds, mean improvement 3 seconds. Mean initial STS 11 repetitions, mean improvement 3 repetitions. Mean patient feedback score 14.6/15 (15 best). GP feedback positive. Conclusions SFBIS was effective in identifying the target population and engaging them in community-based strength and balance exercise classes. Meaningful improvements in physical performance were demonstrated. A smaller number of additional risk factors were identified. There was a high level of satisfaction from patients and GPs. Wider implementation would increase participation in evidence-based community exercise.

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Evaluation of fracture risk in osteoporosis

Orvosi Hetilap ◽

10.1556/oh.2011.29191 ◽

2011 ◽

Vol 152 (33) ◽

pp. 1304-1311 ◽

Cited By ~ 2

Author(s):

Miklós Szathmári

Keyword(s):

Risk Factors ◽

Fracture Risk ◽

Absolute Risk ◽

Treatment Options ◽

Osteoporotic Fractures ◽

Clinical Risk Factors ◽

Mineral Density ◽

High Fracture ◽

Parental History ◽

Clinical Risk

Osteoporotic fractures are associated with excess mortality. Effective treatment options are available, which reduce the risk of vertebral and non-vertebral fractures, but the identification of patients with high fracture risk is problematic. Low bone mineral density (BMD) – the basis for the diagnosis of osteoporosis – is an important, but not the only determinant of fracture risk. Several clinical risk factors are know that operate partially or completely independently of BMD, and affect the fracture risk. These include age, a prior fragility fracture, a parental history of hip fracture, use of corticosteroids, excess alcohol intake, rheumatoid arthritis, and different types of diseases which can cause secondary bone loss. The FRAX® tool integrates the weight of above mentioned clinical risk factors for fracture risk assessment with or without BMD value, and calculates the 10-year absolute risk of hip and major osteoporotic (hip, vertebral, humerus and forearm together) fracture probabilities. Although the use of data is not yet uniform, the FRAX® is a promising opportunity to identify individuals with high fracture risk. The accumulation of experience with FRAX® is going on and it can modify current diagnostic and therapeutic recommendations in Hungary as well. Orv. Hetil., 2011, 152, 1304–1311.

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