BACKGROUND. Although even in the elderly most falls are not associated with fractures, over 90 percent of hip fractures are the result of a fall. Few studies have assessed whether the risk factors for falls are also important risk factors for hip fracture. METHODS. To examine the importance of risk factors for falls in the epidemiology of hip fracture, we performed a case-control study of 174 women (median age, 80 years) admitted with a first hip fracture to 1 of 30 hospitals in New York and Philadelphia. Controls, matched to the case patients according to age and hospital, were selected from general surgical and orthopedic surgical hospital services. Information was obtained by direct interview. RESULTS. As measured by the odds ratio, increased risks for hip fracture were associated with lower-limb dysfunction (odds ratio = 1.7; 95 percent confidence interval, 1.1 to 2.8), visual impairment (odds ratio = 5.1; 95 percent confidence interval, 1.9 to 13.9), previous stroke (odds ratio = 2.0; 95 percent confidence interval, 1.0 to 4.0), Parkinson's disease (odds ratio = 9.4; 95 percent confidence interval, 1.2 to 76.1), and use of long-acting barbiturates (odds ratio = 5.2; 95 percent confidence interval, 0.6 to 45.0). Of the controls, 44 (25 percent) had had a recent fall. The case patients were more likely than these controls to have fallen from a standing height or higher (odds ratio = 2.4; 95 percent confidence interval, 1.0 to 5.7). Of those with hip fracture the younger patients (less than 75 years old) were more likely than the older ones (greater than or equal to 75 years old) to have fallen on a hard surface (odds ratio = 1.9; 95 percent confidence interval, 1.04 to 3.7). CONCLUSIONS. A number of factors that have been identified as risk factors for falls are also associated with hip fracture, including lower-limb dysfunction, neurologic conditions, barbiturate use, and visual impairment. Given the prevalence of these problems among the elderly, who are at highest risk, programs to prevent hip fracture should include measures to prevent falls in addition to measures to slow bone loss.
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Clinical Epidemiology Unit, School of Medicine, University of Pennsylvania, Philadelphia 19104-6095.
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[Abstract][Full Text]
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(2004). Risk of hip fracture in protected and unprotected falls in nursing homes in Norway. Inj. Prev.
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[Abstract][Full Text]
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[Abstract][Full Text]
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(2004). Gender differences in the occurrence of farm related injuries. Occup. Environ. Med.
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[Abstract][Full Text]
Chutka, D. S., Takahashi, P. Y., Hoel, R. W.
(2004). Inappropriate Medications for Elderly Patients. Mayo Clin Proc.
79: 122-139
[Abstract]
Anand, V., Buckley, J. G., Scally, A., Elliott, D. B.
(2003). Postural Stability Changes in the Elderly with Cataract Simulation and Refractive Blur. IOVS
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[Abstract][Full Text]
Liu-Ambrose, T., Eng, J. J., Khan, K. M., Carter, N. D., McKay, H. A.
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Sato, Y., Metoki, N., Iwamoto, J., Satoh, K.
(2003). Amelioration of osteoporosis and hypovitaminosis D by sunlight exposure in stroke patients. Neurology
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[Abstract][Full Text]
Koval, K. J., Meek, R., Schemitsch, E., Liporace, F., Strauss, E., Zuckerman, J. D.
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[Full Text]
Brannan, S, Dewar, C, Sen, J, Clarke, D, Marshall, T, Murray, P I
(2003). A prospective study of the rate of falls before and after cataract surgery. Br J Ophthalmol
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(2003). Central Nervous System Active Medications and Risk for Fractures in Older Women. Arch Intern Med
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Owen, C G, Fletcher, A E, Donoghue, M, Rudnicka, A R
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[Abstract][Full Text]
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(2003). Calcium, vitamin D, milk consumption, and hip fractures: a prospective study among postmenopausal women. Am. J. Clin. Nutr.
77: 504-511
[Abstract][Full Text]
Thiagalingam, S, Cumming, R G, Mitchell, P
(2002). Factors associated with undercorrected refractive errors in an older population: the Blue Mountains Eye Study. Br J Ophthalmol
86: 1041-1045
[Abstract][Full Text]
Tuck, S P, Francis, R M
(2002). Osteoporosis. Postgrad. Med. J.
78: 526-532
[Abstract][Full Text]
Gardner, M. J., Flik, K. R., Mooar, P., Lane, J. M.
(2002). Improvement in the Undertreatment of Osteoporosis Following Hip Fracture. JBJS
84: 1342-1348
[Abstract][Full Text]
Peacock, M., Turner, C. H., Econs, M. J., Foroud, T.
(2002). Genetics of Osteoporosis. Endocr. Rev.
23: 303-326
[Abstract][Full Text]
Wood, B H, Bilclough, J A, Bowron, A, Walker, R W
(2002). Incidence and prediction of falls in Parkinson's disease: a prospective multidisciplinary study. J. Neurol. Neurosurg. Psychiatry
72: 721-725
[Abstract][Full Text]
Legood, R, Scuffham, P, Cryer, C
(2002). Are we blind to injuries in the visually impaired? A review of the literature. Inj. Prev.
8: 155-160
[Abstract][Full Text]
Poole, K. E.S., Reeve, J., Warburton, E. A.
(2002). Falls, Fractures, and Osteoporosis After Stroke: Time to Think About Protection?. Stroke
33: 1432-1436
[Abstract][Full Text]
Dennis, M. S., Lo, K. M., McDowall, M., West, T.
(2002). Fractures After Stroke: Frequency, Types, and Associations. Stroke
33: 728-734
[Abstract][Full Text]
Young, Y., Myers, A. H., Provenzano, G.
(2001). Factors Associated with Time to First Hip Fracture. J Aging Health
13: 511-526
[Abstract]
Eastell, R., Reid, D.M., Compston, J., Cooper, C., Fogelman, I., Francis, R.M., Hay, S.M., Hosking, D.J., Purdie, D.W., Ralston, S.H., Reeve, J., Russell, R.G.G., Stevenson, J.C.
(2001). Secondary prevention of osteoporosis: when should a non-vertebral fracture be a trigger for action?. QJM
94: 575-597
[Abstract][Full Text]
Knight, E. L., Avorn, J.
(2001). Quality Indicators for Appropriate Medication Use in Vulnerable Elders. ANN INTERN MED
135: 703-710
[Full Text]
Hoidrup, S., Sorensen, T. I. A., Stroger, U., Lauritzen, J. B., Schroll, M., Gronbak, M.
(2001). Leisure-time Physical Activity Levels and Changes in Relation to Risk of Hip Fracture in Men and Women. Am J Epidemiol
154: 60-68
[Abstract][Full Text]
Olanow, C. W., Watts, R. L., Koller, W. C.
(2001). An algorithm (decision tree) for the management of Parkinson's disease (2001):: Treatment. Neurology
56: S1-S88
[Full Text]
Newcomb, P. A., Trentham-Dietz, A., Egan, K. M., Titus-Ernstoff, L., Baron, J. A., Storer, B. E., Willett, W. C., Stampfer, M. J.
(2001). Fracture History and Risk of Breast and Endometrial Cancer. Am J Epidemiol
153: 1071-1078
[Abstract][Full Text]
Stalenhoef, P. A, Diederiks, J. P., Knottnerus, J A., de Witte, L. P, Crebolder, H. F.
(2000). The construction of a patient record-based risk model for recurrent falls among elderly people living in the community. Fam Pract
17: 490-496
[Abstract][Full Text]
Ivers, R. Q., Norton, R., Cumming, R. G., Butler, M., Campbell, A. J.
(2000). Visual Impairment and Hip Fracture. Am J Epidemiol
152: 633-639
[Abstract][Full Text]
Peacock, M., Liu, G., Carey, M., McClintock, R., Ambrosius, W., Hui, S., Johnston, C. C.
(2000). Effect of Calcium or 25OH Vitamin D3 Dietary Supplementation on Bone Loss at the Hip in Men and Women over the Age of 60. J. Clin. Endocrinol. Metab.
85: 3011-3019
[Abstract][Full Text]
Francis, R.M., Baillie, S.P., Chuck, A.J., Crook, P.R., Daymond, T., Dunn, N., Fordham, J.N., Kelly, C., Rodgers, A.
(2000). Management of osteoporosis in patients with hip fractures. QJM
93: 501-506
[Full Text]
Ramnemark, A., Nilsson, M., Borssen, B., Gustafson, Y.
(2000). Stroke, a Major and Increasing Risk Factor for Femoral Neck Fracture. Stroke
31: 1572-1577
[Abstract][Full Text]
Greenspan, S. L.
(1999). A 73-Year-Old Woman With Osteoporosis. JAMA
281: 1531-1540
[Full Text]
Sato, Y., Manabe, S., Kuno, H., Oizumi, K.
(1999). Amelioration of osteopenia and hypovitaminosis D by 1alpha -hydroxyvitamin D3 in elderly patients with Parkinson's disease. J. Neurol. Neurosurg. Psychiatry
66: 64-68
[Abstract][Full Text]
Smeeth, L., Iliffe, S.
(1998). Effectiveness of screening older people for impaired vision in community setting: systematic review of evidence from randomised controlled trials. BMJ
316: 660-663
[Abstract][Full Text]
Sato, Y., Honda, Y., Kunoh, H., Oizumi, K.
(1997). Long-term Oral Anticoagulation Reduces Bone Mass in Patients with Previous Hemispheric Infarction and Nonrheumatic Atrial Fibrillation. Stroke
28: 2390-2394
[Abstract][Full Text]
Zimmer, Z., Myers, A.
(1997). Receptivity to Protective Garments among the Elderly. J Aging Health
9: 355-372
[Abstract]
Ensrud, K. E., Cauley, J., Lipschutz, R., Cummings, S. R.
(1997). Weight Change and Fractures in Older Women. Arch Intern Med
157: 857-863
[Abstract]
Nyberg, L., Gustafson, Y.
(1997). Fall Prediction Index for Patients in Stroke Rehabilitation. Stroke
28: 716-721
[Abstract][Full Text]
Marshall, D., Johnell, O., Wedel, H.
(1996). Meta-analysis of how well measures of bone mineral density predict occurrence of osteoporotic fractures. BMJ
312: 1254-1259
[Abstract][Full Text]
LANE, J. M., RILEY, E. H., WIRGANOWICZ, P. Z.
(1996). Instructional Course Lectures, The American Academy of Orthopaedic Surgeons - Osteoporosis: Diagnosis and Treatment*{{dagger}}. JBJS
78: 618-32
[Full Text]
Province, M. A., Hadley, E. C., Hornbrook, M. C., Lipsitz, L. A., Miller, J. P., Mulrow, C. D., Ory, M. G., Sattin, R. W., Tinetti, M. E., Wolf, S. L., the FICSIT Group, , Miller, J. P., Province, M. A., Schechtman, K. B., Arfken, C. L., Rossiter-Fornoff, J., Hornbrook, M. C., Stevens, V. J., Wingfield, D. J., Greenlick, M. R., Tinetti, M. E., Baker, D. I., Claus, E. B., Horwitz, R. I., Buchner, D. M., Wagner, E. H., de Lateur, B. J., Cress, M. E., Price, R., Abrass, I. B., Esselman, P., Marguerita, T., ., C. D, Mulrow, , Gerety, M. B., Cornell, J. E., DeNino, L. A., Kanten, D., Wolf, S. L., Kutner, N. G., Green, R. C., McNeely, E., Coogler, C., Fiatarone, M. A., O'Neill, E. F., Ryan, N. D., T, D., Clements, K. M., Lipsitz, L. A., Kehayias, J. J., Roberts, S. B., Evans, W. J., Wallace, R., Ross, J. E., Huston, J. C., Kundel, C. J., Sellberg, M. S., Wolfson, L. I., Whipple, R. H., Amerman, P. M., Judge, J. O., Derby, C. A., King, M. B., Hadley, E. C., Tamboli, A., Ory, M. G., Weiss, S., Sattin, R. W.
(1995). The Effects of Exercise on Falls in Elderly Patients: A Preplanned Meta-analysis of the FICSIT Trials. JAMA
273: 1341-1347
[Abstract]
Cummings, S. R., Nevitt, M. C., Browner, W. S., Stone, K., Fox, K. M., Ensrud, K. E., Cauley, J., Black, D., Vogt, T. M., The Study of Osteoporotic Fractures Research Group,
(1995). Risk Factors for Hip Fracture in White Women. NEJM
332: 767-774
[Abstract][Full Text]
Grisso, J. A., Kelsey, J. L., Strom, B. L., O'Brien, L. A., Maislin, G., LaPann, K., Samelson, L., Hoffman, S., Northeast Hip Fracture Study Group,
(1994). Risk Factors for Hip Fracture in Black Women. NEJM
330: 1555-1559
[Abstract][Full Text]
Arfken, C. L., Lach, H. W., McGee, S., Birge, S. J., Miller, J. P.
(1994). Visual Acuity, Visual Disabilities and Falling in the Elderly. J Aging Health
6: 38-50
[Abstract]
Greenspan, S. L., Myers, E. R., Maitland, L. A., Resnick, N. M., Hayes, W. C.
(1994). Fall Severity and Bone Mineral Density as Risk Factors for Hip Fracture in Ambulatory Elderly. JAMA
271: 128-133
[Abstract]
Marks, W.
(1992). Physical Restraints in the Practice of Medicine: Current Concepts. Arch Intern Med
152: 2203-2206
[Abstract]
Glynn, R. J., Seddon, J. M., Krug, J. H. Jr, Sahagian, C. R., Chiavelli, M. E., Campion, E. W.
(1992). Falls in Elderly Patients With Glaucoma-Reply. Arch Ophthalmol
110: 169-170
[Abstract]
(1991). POTENTIALLY PREVENTABLE RISK FACTORS FOR HIP FRACTURE IN THE ELDERLY. JWatch General
1991: 4-4
[Full Text]
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