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Predictors and Sequelae of Fractures in the Elderly: The Canadian Study of Health and Aging (CSHA)*

Published online by Cambridge University Press:  31 March 2010

Truls Østbye ,
Ruth E. Walton ,
Runa Steenhuis  and
Anthony B. Hodsman
Truls Østbye*
Affiliation:
Department of Community and Family Medicine, Duke University Medical Center
Ruth E. Walton
Affiliation:
Canadian Task Force on Preventive Health Care
Runa Steenhuis
Affiliation:
Short Stay Assessment and Treatment Centre, Mount St. Joseph Hospital, Vancouver
Anthony B. Hodsman
Affiliation:
Lawson Research Institute Faculty of Medicine, University of Western Ontario
*
Requests for offprints should be sent to: / Les demandes de tirés-à-part doivent être adressées à : Truls Østbye, Department of Community and Family Medicine, Box 2914, Duke University Medical Center, Durham, NC 27710. (truls.ostbye@duke.edu)
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Abstract

The objective of this study was to describe the incidence, type, risk factors, and sequelae of fractures experienced by community-dwelling elderly Canadians. Data are from the Canadian Study of Health and Aging (CSHA), a longitudinal cohort study, collected in three waves: baseline (1991), wave 2 (1996), and wave 3 (2001). In CSHA-2 (1996), fractures were reported by 3.7 per cent of men and 7.5 per cent of women; in CSHA-3 (2001), by 2.9 per cent of men and 7.3 per cent of women. The distribution of fracture types was similar for men and women. Risk factors for women were increased age, history of fracture, and regular alcohol use; for men, stroke, arthritis, and lack of independent bathing. Walkers or wheelchairs were needed by over 30 per cent of those with any lower body fracture. One third of subjects with any fracture and over 50 per cent with femur fractures reported moderate or severe pain. It is concluded that elderly Canadians are at high risk for fractures, and older women are at most risk. Pain and mobility problems were common sequelae. The need for primary and secondary prevention of these age-related events is paramount.

Résumé

Cette étude avait pour objet de décrire l'incidence, le type, les facteurs de risque et les séquelles laissées par les fractures chez les aînés canadiens vivant en milieu communautaire. Les données sont tirées de l'Étude sur la santé et le vieillissement au Canada (ÉSVC), une étude longitudinale des cohortes effectuée en trois phases : étude préliminaire (1991), phase 2 (1996) et phase 3 (2001). Dans l'ÉSVC-2 (1996), 3,7 % des hommes et 7,5 % des femmes sondés avaient subi une fracture, dans l'ÉSVC-3 (2001) ces chiffres étaient de 2,9 % pour les hommes et de 7,3 % pour les femmes. Les types de fractures étaient les mêmes chez les deux sexes. Chez les femmes, les facteurs de risque étaient l'âge, les antécédents de fracture et la consommation régulière d'alcool, et chez les hommes, les accidents vasculaires cérébraux, l'arthrite et la difficulté de faire sa toilette seul. Plus de 30 % des personnes ayant eu une fracture du tronc inférieur avaient besoin d'une marchette ou d'un fauteuil roulant pour se déplacer. Un tiers des sujets ayant eu une fracture et plus de la moitié de ceux qui s'étaient fracturé le fémur disaient souffrir de douleur modérée à forte. En conclusion, le risque de fracture chez les aînés canadiens est élevé, et les femmes sont plus à risque que les hommes. Les séquelles le plus souvent rapportées sont la douleur et des problèmes de mobilité. Il est essentiel de mettre en place des stratégies de prévention primaire et secondaire contre ces accidents liés à l'âge.

Keywords

agingfractureselderlypainsequelaerisk factorsCanadavieillissementfracturespersonnes âgées/aînésdouleurséquellesfacteurs de risqueCanada
Type
Articles
Information
Canadian Journal on Aging / La Revue canadienne du vieillissement , Volume 23 , Issue 3 , Fall/Automne 2004 , pp. 245 - 251
Copyright
Copyright © Canadian Association on Gerontology 2004

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Footnotes

*

The data reported in this article were collected as part of the Canadian Study of Health and Aging. The core study was funded by the Seniors' Independence Research Program, through the National Health Research and Development Program (NHRDP) of Health Canada (project no. 6606–3954-MC(S)). Additional funding was provided by Pfizer Canada Incorporated through the Medical Research Council / Pharmaceutical Manufacturers Association of Canada Health Activity Program, NHRDP (project no. 6603–1417–302(R)), Bayer Incorporated, and the British Columbia Health Research Foundation (projects no. 38 (93–2) and no. 34 (96–1)). The study was coordinated through the University of Ottawa and the Division of Aging and Seniors, Health Canada. Thanks to Katrina Krause, M.A., for editing of the manuscript.

References

1Ross, PD. Osteoporosis: frequency, consequences, and risk factors. Arch Intern Med 1996;156:1399–411.CrossRefGoogle ScholarPubMed
2Jacobsen, SJ, Goldberg, J, Miles, TP, Brody, JA, Stiers, W, Rimm, AA. Hip fracture incidence among the old and very old: a population-based study of 745,435 cases. Am J Public Health 1990;80:871–3.Google Scholar
3Cooper, C, Melton, JL. Magnitude and impact of osteoposis and fractures. In: Marcus, R, Feldman, D, Kelsey, J, eds. Osteoporosis. San Diego, CA: Academic Press; 1996. p. 419–31.Google Scholar
4Cumming, RG, Nevitt, MC, Cummings, SR. Epidemiology of hip fractures. Epidemiol Rev 1997;19:244–56.Google Scholar
5Marotolli, RA, Berkman, LF, Leo-Summers, L, Cooney, LM. Predictors of mortality and institutionalisation after hip fracture: the New Haven EPESE Cohort. Am J Public Health 1994;84:1807–12.CrossRefGoogle Scholar
6Poor, G, Atkinson, EJ, Lewallen, DG, O'Fallon, WM, Melton, LJ 3rd. Age-related hip fractures in men: clinical spectrum and short-term outcomes. Osteoporosis Int 1995;5:419–26.Google Scholar
7Diamond, TH, Thornley, SW, Sekel, R, Smerdely, P. Hip fracture in elderly men: prognostic factors and outcomes. Med J Aust 1997;167:412–15.Google Scholar
8Greendale, GA, Barret-Conner, E, Ingles, S, Haile, R. Late physical activity and functional effects of osteoporotic fracture in women: the Rancho Bernardo Study. J Am Geriatr Soc 1995;43:955–61.Google Scholar
9Grisso, JA, Kelsey, JL, O'Brien, LA, Miles, CG, Sidney, S, Maislin, G, et al. Risk factors for hip fracture in men. Am J Epidemiol 1997;145:786–93.Google Scholar
10Nguyen, TV, Eisman, JA, Kelly, PJ, Sambrook, PN. Risk factors for osteoporotic fractures in elderly men. Am J Epidemiol 1996;144:254–63.Google Scholar
11Papadimitropoulos, EA, Coyte, PC, Josse, RG, Greenwood, CE. Current and projected rates of hip fracture in Canada. Can Med Assoc J 1997;157:1357–1363.Google Scholar
12Cummings, SR, Kelsey, JL, Nevitt, MC, O'Dowd, KJ. Epidemiology of osteoporosis and osteoporotic fractures. Epidemiol Rev 1985;7:178–207.CrossRefGoogle ScholarPubMed
13Lauderdale, DS, Jacobsen, SJ, Furner, SE, Levy, PS, Brody, JA, Goldberg, J. Hip fracture incidence among elderly Asian-American populations. Am J Epidemiol 1997;146:503–11.Google Scholar
14Melton, LJ, Beard, CM, Kokmen, E, Atkinson, J, O'Fallon, WM. Fracture risk in patients with Alzheimer's disease. J Am Geriatr Soc 1994;42:614–9.CrossRefGoogle ScholarPubMed
15Hoffman, S, Grisso, JA, Kelsey, JL, et al. Parity, lactation and hip fracture. Osteoporosis Int 1993;3:171–6.CrossRefGoogle ScholarPubMed
16Fries, JF. Prevention of osteoporotic fractures: possibilities, the role of exercise, and limitations. Scand J Rheumatol 1996;25(Suppl. 103):6–10.Google Scholar
17Coupland, C, Wood, D, Cooper, C. Physical inactivity is an independent risk factor for hip fracture in the elderly. J Epidemiol Community Health 1993;47:441–3.CrossRefGoogle ScholarPubMed
18Wolinsky, FD, Fitzgerald, JF, Stump, TE. The effect of hip fracture on mortality, hospitalization, and functional status: a prospective study. Am J Public Health 1997;87:398–403.Google Scholar
19Huang, Z, Himes, JH, McGovern, PG. Nutrition and subsequent hip fracture risk among a national cohort of white women. Am J Epidemiol 1996;144:124–234.Google Scholar
20Law, MR, Hackshaw, AR. A meta-analysis of cigarette smoking, bone mineral density and risk of hip fracture: recognition of a major effect. BMJ 1997;315:841–6.CrossRefGoogle ScholarPubMed
21Province, MA, Hadley, EC, Hornbrook, MC, Lipsitz, LA, Miller, JP, Mulrow, CD, et al. The effect of exercise on falls in elderly patients: a pre-planned meta-analysis of the FICSIT trials. JAMA 1995;273:1341–7.Google Scholar
22Gregg, EW, Cauley, JA, Seeley, DG, Ensrud, KE, Bauer, DC. Physical activity and osteoporotic fracture risk in older women. Ann Intern Med 1998;129:81–8.Google Scholar
23Stevens, JA, Powell, KE, Smith, SM, Wingo, PA, Sattin, RW. Physical activity, functional limitations, and risk of fall-related fractures in community-dwelling elderly. Ann Epidemiol 1997;7:54–61.CrossRefGoogle ScholarPubMed
24Canadian Study of Health and Aging Working Group. Canadian Study of Health and Aging: study methods and prevalence of dementia. Can Med Assoc J 1994;150:899–913.Google Scholar
25Canadian Study of Health and Aging Working Group. Canadian Study of Health and Aging: risk factors for Alzheimer's disease in Canada. Neurology 1994;44:2073–80.Google Scholar
26Canadian Study of Health and Aging Working Group. Canadian Study of Health and Aging: patterns of caring for people with dementia in Canada. Can J Aging 1994;13:470–87.Google Scholar
27Teng, EL, Chui, HC. The Modified Mini-Mental State (3MS) examination. J Clin Psychiatry 1987;48:314–8.Google Scholar
28Lee, KI, Koval, JJ. Determinants of the best significance level in forward stepwise logistic regression. CoSCC 1997;26:559–75.Google Scholar
29Mickey, RM, Greenland, S. The impact of confounder selection strategies. Am J Epidemiol 1989;129:125–37.Google Scholar
30Podsiadlo, D, Richardson, S. The timed “Up & Go”: a test of basic functional mobility for frail elderly persons. J Am Geriatr Soc 1991;39:142–8.Google Scholar
31Ontario Trauma Registry, Canadian Institute for Health Management. Injury admissions due to falls in Ontario, 1996/97. Don Mills, ON: Canadian Institute for Health Management; 1998.Google Scholar
32Centers for Disease Control and Prevention. Incidence and costs to Medicare of fractures among Medicare beneficiaries aged greater than or equal to 65 years—United States, July 1991-June 1992. MMWR Morb Mortal Wkly Rep 1996;45(41):877–83.Google Scholar
33Nevitt, MC, Cummings, SR, Browner, WS, Seeley, DG, Cauley, JA, Vogt, TM, et al. The accuracy of self-report of fractures in elderly women: evidence from a prospective study. Am J Epidemiol 1992;135:490–9.CrossRefGoogle ScholarPubMed
34Woolf, AD, Akesson, K. Preventing fractures in elderly people. BMJ 2003;327:89–95.Google Scholar