Persistent hypovitaminosis D and loss of hip bone mineral density over time as additional risk factors for recurrent falls in a population-based prospective cohort of elderly persons living in the community. The São Paulo Ageing & Health (SPAH) Study.
Osteoporos Int. 2015 Jan 20. [Epub ahead of print]
705 community-dwellers in Brazil
Of the 16% who had fallen more than twice in previous year
2.5X more likely if visual impairment
2.5X more likely if psychotropic drugs
1.7X more likely if vitamin D < 20 ng
Machado KL1, Domiciano DS, Machado LG, Lopes JB, Figueiredo CP, Takayama L, Oliveira RM, Menezes PR, Pereira RM.
1Bone Metabolism Laboratory, Rheumatology Division, Faculdade de Medicina da Universidade de São Paulo, Av. Dr. Arnaldo, 455, 3° andar, sala 3193, São Paulo, SP, 01246-903, Brazil.
We performed concomitant evaluation of clinical, laboratory, and bone mineral density (BMD) parameters as potential risk factors for falls in a population-based prospective cohort of older adults, since previous studies have focused mostly in clinical risk factors. Loss of hip BMD and persistent hypovitaminosis D were associated with recurrent falls in community-dwelling elderly.
Few studies have performed a concomitant evaluation of clinical data, laboratory bone parameters, and bone mineral density (BMD) to determine more accurately the contribution of each of these variables to risk of falls in elderly persons. We investigated the association between bone parameters and recurrent falls in a population-based prospective cohort of community-dwelling older adults.
A total of 705 elderly individuals (448 women, 257 men) were evaluated with clinical data, BMD, and laboratory bone tests at baseline and after a mean follow-up of 4.3 ± 0.8 years. Individuals with recurrent falls (≥2 falls in the previous year from the date of the second evaluation) were considered chronic fallers. Logistic regression models were used to identify independent risk factors for recurrent falls.
The frequency of chronic fallers was 16.5 %. In multivariate analyses, risk factors for recurrent falls were visual impairment (odds ratio (OR) = 2.49, 95 % confidence interval (CI) 1.30-4.74, p = 0.006), use of psychotropic drugs (OR = 2.47, 95 % CI 1.37-4.49, p = 0.003), clinical fracture (OR = 2.78, 95 % CI 1.48-5.20, p = 0.001), persistently low 25-hydroxyvitamin D (25OHD) (<20 ng/mL) (OR = 1.71, 95 % CI 1.10-2.64, p = 0.016), and loss of total hip BMD during the study (OR = 1.21, 95 % CI 1.17-1.25, p = 0.035 for each 4 % decrease).
In addition to traditional clinical risk factors for falls, loss of hip BMD and hypovitaminosis D were associated with recurrent falls in community-dwelling elderly persons. Thus, recognizing these factors is essential to preventing falls and improving the outcomes of this population.
This study ignores other causes of fuzzy brain, such as Chemotherapy, Surgery, Stroke, etc.
- Overview Fractures and Falls and Vitamin D
- Seniors need at least 4,000 IU vitamin D, no test needed – Consensus Jan 2014
- Following a stroke, a hip fracture is 6X more likely if low vitamin D – July 2001
Psychotropic Medications Associated With Falls in Elderly Patients – 2009
Table. Risk of Falls Associated With Various Drug Classes
|Drug Class||Adjusted Odds Ratio (95% CI)|
|Sedatives and hypnotics||1.47 (1.35 – 1.62)|
|Benzodiazepines||1.41 (1.20 – 1.71)|
|Antidepressants||1.36 (1.13 – 1.76)|
CI = confidence interval