Calcaneal bone mineral density in older patients who have fallen

• Published in: QJM : An International Journal of Medicine 2006-04, Vol.99 (4), p.231-236
• Main Authors: NEWTON, J. L, JONES, D. E. J, WILTON, K, PAIRMAN, J, PARRY, S. W, FRANCIS, R. M
• Format: Article
• Language: English
• Subjects: Absorptiometry, Photon - standards; Accidental Falls; Aged; Biological and medical sciences; Bone Density - physiology; Calcaneus - diagnostic imaging; Calcaneus - physiology; Cross-Sectional Studies; England - epidemiology; Female; Fractures, Bone - epidemiology; General aspects; Humans; Investigative techniques, diagnostic techniques (general aspects); Male; Medical sciences; Osteoarticular system. Muscles; Osteoporosis - epidemiology; Osteoporosis - physiopathology; Prevalence; Radiodiagnosis. Nmr imagery. Nmr spectrometry; Risk Factors; Sensitivity and Specificity
• ISSN: 1460-2725; 1460-2393
• DOI: 10.1093/qjmed/hcl026

Annually, 35-40% of those aged >65 years fall; up to 5% of such falls result in fracture. Fracture is determined both by propensity to fall and by bone fragility. To determine osteoporosis prevalence and predictors in patients who have fallen. Observational cross-sectional study. We measured calcaneal BMD in 408 consecutive patients aged >50 years attending after falling. Fall number, fracture history, weight, height, and risk factors for falls and osteoporosis were recorded. T scores (SD above or below the mean for young adults) were derived in both sexes, and Z scores (SD above or below age-related normal score) in females. In females (n = 300, 74%), mean (SD) T score was -1.1(1.6), and mean Z score was 0(1.4); 127 (42%) had osteoporosis (T score < - 1.6). ROC curves confirmed significant relationships between osteoporosis and age, weight and height (all p < 0.0001). Incorporating fracture history, our model (fracture aged >50 years, age >83 years, weight or =80 years, weight < or =68 kg, height < or =167 cm as dichotomous variables) predicted osteoporosis with 92% sensitivity, 30% specificity. Osteoporosis prevalence is not increased in female fallers compared to age-related norms; empirical use of osteoporosis treatment solely on the basis of falls thus appears inappropriate. In both sexes, the factors predicting osteoporosis were age, height and weight. Where BMD is not practical, possible or economical, our model may be a sensitive means of predicting fallers with osteoporosis.