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A combination of clinical balance measures and FRAX® to improve identification of high-risk fallers

Najafi, David A.; Dahlberg, Leif E. LU and Hansson, Eva Ekvall LU (2016) In BMC Geriatrics 16(1).
Abstract

Background: The FRAX® algorithm quantifies a patient's 10-year probability of a hip or major osteoporotic fracture without taking an individual's balance into account. Balance measures assess the functional ability of an individual and the FRAX® algorithm is a model that integrates the individual patients clinical risk factors [not balance] and bone mineral density. Thus, clinical balance measures capture aspects that the FRAX® algorithm does not, and vice versa. It is therefore possible that combining FRAX® and clinical balance measures can improve the identification of patients at high fall risk and thereby high fracture risk. Our study aim was to explore whether there is an association between clinical balance measures and fracture... (More)

Background: The FRAX® algorithm quantifies a patient's 10-year probability of a hip or major osteoporotic fracture without taking an individual's balance into account. Balance measures assess the functional ability of an individual and the FRAX® algorithm is a model that integrates the individual patients clinical risk factors [not balance] and bone mineral density. Thus, clinical balance measures capture aspects that the FRAX® algorithm does not, and vice versa. It is therefore possible that combining FRAX® and clinical balance measures can improve the identification of patients at high fall risk and thereby high fracture risk. Our study aim was to explore whether there is an association between clinical balance measures and fracture prediction obtained from FRAX®. Method: A cross-sectional study design was used where post hoc was performed on a dataset of 82 participants (54 to 89 years of age, mean age 71.4, 77 female), with a fall-related wrist-fracture between 2008 and 2012. Balance was measured by tandem stance, standing one leg, walking in the figure of eight, walking heel to toe on a line, walking as fast as possible for 30 m and five times sit to stand balance measures [tandem stance and standing one leg measured first with open and then with closed eyes] and each one analyzed for bivariate relations with the 10-year probability values for hip and major osteoporotic fractures as calculated by FRAX® using Spearman's rank correlation test. Results: Individuals with high FRAX® values had poor outcome in balance measures; however the significance level of the correlation differed between tests. Standing one leg eyes closed had strongest correlation to FRAX® (0.610 p = <0.01) and Five times sit to stand was the only test that did not correlate with FRAX® (0.013). Conclusion: This study showed that there is an association between clinical balance measures and FRAX®. Hence, the use of clinical balance measures and FRAX® in combination, might improve the identification of individuals with high risk of falls and thereby following fractures. Results enable healthcare providers to optimize treatment and prevention of fall-related fractures. Trial registration: The study has been registered in Clinical Trials.gov, registration number NCT00988572.

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author
organization
publishing date
type
Contribution to journal
publication status
published
subject
keywords
Balance, Falls, Fracture, FRAX®
in
BMC Geriatrics
volume
16
issue
1
publisher
BioMed Central
external identifiers
  • Scopus:84978993739
ISSN
1471-2318
DOI
10.1186/s12877-016-0266-6
language
English
LU publication?
yes
id
22371fe6-21dc-4ba6-b207-afcc3f3a5810
date added to LUP
2016-09-08 15:18:26
date last changed
2016-10-13 05:13:23
@misc{22371fe6-21dc-4ba6-b207-afcc3f3a5810,
  abstract     = {<p>Background: The FRAX® algorithm quantifies a patient's 10-year probability of a hip or major osteoporotic fracture without taking an individual's balance into account. Balance measures assess the functional ability of an individual and the FRAX® algorithm is a model that integrates the individual patients clinical risk factors [not balance] and bone mineral density. Thus, clinical balance measures capture aspects that the FRAX® algorithm does not, and vice versa. It is therefore possible that combining FRAX® and clinical balance measures can improve the identification of patients at high fall risk and thereby high fracture risk. Our study aim was to explore whether there is an association between clinical balance measures and fracture prediction obtained from FRAX®. Method: A cross-sectional study design was used where post hoc was performed on a dataset of 82 participants (54 to 89 years of age, mean age 71.4, 77 female), with a fall-related wrist-fracture between 2008 and 2012. Balance was measured by tandem stance, standing one leg, walking in the figure of eight, walking heel to toe on a line, walking as fast as possible for 30 m and five times sit to stand balance measures [tandem stance and standing one leg measured first with open and then with closed eyes] and each one analyzed for bivariate relations with the 10-year probability values for hip and major osteoporotic fractures as calculated by FRAX® using Spearman's rank correlation test. Results: Individuals with high FRAX® values had poor outcome in balance measures; however the significance level of the correlation differed between tests. Standing one leg eyes closed had strongest correlation to FRAX® (0.610 p = &lt;0.01) and Five times sit to stand was the only test that did not correlate with FRAX® (0.013). Conclusion: This study showed that there is an association between clinical balance measures and FRAX®. Hence, the use of clinical balance measures and FRAX® in combination, might improve the identification of individuals with high risk of falls and thereby following fractures. Results enable healthcare providers to optimize treatment and prevention of fall-related fractures. Trial registration: The study has been registered in Clinical Trials.gov, registration number NCT00988572.</p>},
  author       = {Najafi, David A. and Dahlberg, Leif E. and Hansson, Eva Ekvall},
  issn         = {1471-2318},
  keyword      = {Balance,Falls,Fracture,FRAX®},
  language     = {eng},
  month        = {05},
  number       = {1},
  publisher    = {ARRAY(0x9278ae0)},
  series       = {BMC Geriatrics},
  title        = {A combination of clinical balance measures and FRAX® to improve identification of high-risk fallers},
  url          = {http://dx.doi.org/10.1186/s12877-016-0266-6},
  volume       = {16},
  year         = {2016},
}