Factors that cause women with osteoporosis to fall

A cross-sectional study of women ≥50 years receiving treatment for osteoporosis. Participants filled out questionnaires (demographic characteristics), and researchers took anthropometric measurements of bone mineral density, handgrip strength (HGS), ankle range of motion (ROM), and gait speed (GS). We also evaluated the Timed Up and Go Test (TUGT), Five Times Sit-to-Stand Test (SST), and Falls Efficacy Scale–International (FES-I) and investigated the extrinsic factors for falls.

Results:

We included 144 participants (71.6 [8.3 years]), who reported 133 falls. We classified participants into a non-faller group (NFG; 0 falls, n = 71, 49.5%), a faller group (FG; 1 fall, n = 42, 28.9%), and a recurrent-faller group (RFG; more than 1 fall, n = 31, 21.5%). Most patients had an increased risk of falling according to the TUGT, SST, reduced ankle ROM, and GS (P < .005 for all). FES-I was associated with sporadic and recurrent falls. For the multivariate analysis, the number of falls was influenced by the presence of ramps (RR 0.48, 95% CI, 0.26-0.87, P = .015), uneven surfaces (RR 1.6, 95% CI. 1.05-2.43, P = .028), and antislippery adhesive on stairs (RR 2.75, 95% CI, 1.77-4.28, P < .001).

Conclusion:

Patients receiving treatment for osteoporosis are influenced by intrinsic and extrinsic factors that cause falls. Lower-limb strength and power-discriminated participants at a higher risk of falls, but extrinsic factors varied. Only uneven floors and antislippery adhesives on stairs were associated with increased frequency of falls.

Keywords
Elderly; osteoporosis; falls; intrinsic factors; extrinsic factors

		Mean ± SD	N (%)
Anthropometric and clinical characteristics
Age (years)		71.6 ± 8.2
	<65 years	60.10 ± 7.10	41 (28.1%)
	≥65 years	73.6 ± 7.10	105 (71.9%)
Race
	White		41 (88.3%)
	Black		4 (11.7%)
Comorbidities
	Hypertension		17 (11.7%)
	Dyslipidemia		14 (9.7%)
	Smoking		11 (7.6%)
	Diabetes		9 (6.2%)
	Osteoarthritis		6 (4.1%)
BMI (kg/m²)		26.8 ± 5.3	1 (0.7%)
	Malnutrition	21.9 ± 0.7	24 (16.7%)
	Normal (23 < BMI < 28 kg/m²)	24.9 ± 1.5	29 (20.0%)
	Pre-obesity (28 < BMI < 30 kg/m²)	29.2 ± 0.7	10 (6.9%)
	Obesity (BMI > 30 kg/m²)	34.21 ± 4.1	21 (14.5%)
MMSE (score)		25.6 ± 4.1
WC (cm)		93.7 ± 12.4
WC > 88 cm		100.67 ± 8.4	59 (40.7%)
History of falls
Total falls		133
Number of falls per year (mean)		1.7 ± 1.6
Non-fallers		0.0	60 (49.5%)
Fallers		1.0 ± 0.0	35 (28.9%)
Recurrent fallers		3.1 ± 1.6	26 (21.5%)

Intrinsic Factors		Mean ± SD (n%)
BMD
	Normal	1 (1%)
	Osteopenia	33 (34.4%)
	Osteoporosis	61 (64.6%)
TUGT (s)		11.7 ± 5.0
	Reduced mobility and risk of falling n (%)	88 (60.7%)
SST (s)		1.0 ± 5.7
	Reduced strength and power n (%)	69 (47.6%)
	Risk of falling (RV:15 s)	40 (27.%)
GS (m/s)		0.82 ± 0.7
	Low (≤0.8 m/s)	18 (1.4%)
	Partially low (>0.6 and ≤1 m/s)	64 (44.1%)
HGS (kgf), RV ≥ 16 kgf		20.0 ± 49
	Low	23 (15.9%)
ROM dorsiflexors (°)		14.7 ± 4.3
	Low (<26 ± 6.3°)	32 (22.1%)
ROM plantar flexors (°)		49.0 ± 1.5
	Low (<57 ± 7.2°)	20 (13.8%)
Calf circumference (cm)		35.6 ± 4.1
	Decreased (<31 cm)	12 (8.3%)
FES-I		28.8 ± 9.8
	Sporadic fall (>23)	38 (26.2%)
	Recurrent fall (>31)	35 (24.1%)
	Extrinsic factors
	Risk factors
	Stairs	54 (37.2%)
	Loose mats	49 (33.8%)
	Slippery bathroom floor	47 (32.4%)
	Loose pets	38 (26.2%)
	Uneven surface	36 (24.8%)
	Slippery surface	25 (1.2%)
	Ramps	24 (16.6%)
	Dim lighting	19 (13.1%)
	Obstacles and tripping hazards	14 (9.7%)
	Missing tiles	7 (4.8%)
	Loose cables or wires	3 (2.1%)
	Safety factors	n (%)
	Appropriate bed height	33 (22.8%)
	Grab bars in the bathroom	27 (18.6%)
	Stair handrails	22 (15.2%)
	Non-slip carpets	20 (13.8%)
	Anti-slip adhesive on stairs	16 (11.0%)
	Highest chair	17 (11.7%)
	Ramps handrails	8 (5.5%)
	Anti-slippery adhesive on ramps	6 (4.1%)
	Tall toilet seat	6 (4.1%)

Variable			NFG	FG	RFG	P
Variable			Mean ± SD	Mean ± SD	Mean ± SD	P
Age (years)			71.0 ± 8.3	71.2 ± 8.4	74.3 ± 7.8	0.202 ⁺ + one-way ANOVA;
BMI (kg/m²)			26.5 ± 5.1	25.7 ± 4.1	29.6 ± 7.0	0.210
WC (cm)			94.1 ± 11.6	93.2 ± 13.2	92.9 ± 14.0	0.908 ^# # Kruskal-Wallis test; Bonferroni post hoc test between groups FG and RFG;
MMSE			25.6 ± 4.0	26.0 ± 4.2	26.2 ± 3.3	0.845 ^# # Kruskal-Wallis test; Bonferroni post hoc test between groups FG and RFG;
BMD (T-score SD)
	Spine		-2.3 ± 1.3	-2.3 ± 1.1	-2.1 ± 1.1	0.656
	Femoral neck		-2.0 ± 1.1	-1.9 ± 0.76	-1.7 ± 0.6	0.079
	Total hip		-1.4 ± 1.2	-1.0 ± 1.0	-1.2 ± 1.0	0.166
CC (cm)			35.4 ± 4.4	36.1 ± 4.2	35.3 ± 3.5	0.626 ^# # Kruskal-Wallis test; Bonferroni post hoc test between groups FG and RFG;
	Reduced, n (%)		7 (11.1%)	3 (7.7%)	2 (9.1%)	0.847
Performance
	TUGT (s)		11.5 ± 4.8	11.6 ± 5.0	12.4 ± 5.6	0.983 ^# # Kruskal-Wallis test; Bonferroni post hoc test between groups FG and RFG;
		Low, n (%)	41 (77.4%)	30 (73.2%)	17 (70.8%)	0.804
	GS (m/s)		0.81 ± 0.21	0.85 ± 0.27	0.82 ± 0.40	0.588 ^# # Kruskal-Wallis test; Bonferroni post hoc test between groups FG and RFG;
		Low, n (%)	7 (13.2%)	4 (12.9%)	7 (35.0%)	0.017 ^* * p < 0.05, chi-square test.
		Partially low, n (%)	37 (69.8%)	18 (58.1%)	9 (45.0%)	0.029 ⁺ + one-way ANOVA; ^* * p < 0.05, chi-square test.
		Normal, n (%)	9 (17.0%)	7 (22.6%)	1 (5.0%)	0.156
		Fast, n (%)	0 (0%)	2 (6.5%)	3 (15.0%)
Strength
	HGS (kgf)		20.0 ± 4.7	19.6 ± 5.3	21.0 ± 5.01	0.326 ^# # Kruskal-Wallis test; Bonferroni post hoc test between groups FG and RFG;
		Low, n (%)	10 (16.1%)	9 (22.5%)	4 (17.4%)	0.713
	SST (s)		14.9 ± 5.2	13.5 ± 3.6	17.7 ± 8.7	0.029 ⁺ + one-way ANOVA; ^* * p < 0.05, chi-square test.
		High fall risk, n (%)	24 (38.7%)	7 (21.2%)	9 (42.9%)	0.156
		Reduced strength, n (%)	38 (70.4%)	17 (53.1%)	14 (73.7%)	0.191
Ankle mobility (ROM)
	Dorsiflexors (°)		14.9 ± 4.1	14.1 ± 4.7	15.1 ± 4.5	0.822 ^# # Kruskal-Wallis test; Bonferroni post hoc test between groups FG and RFG;
		Low, n (%)	16 (80.0%)	9 (75.0%)	7 (70.0%)	0.827
	Plantar flexors (°)		50.8 ± 13.3	50.7 ± 11.0	42.4 ± 11.4	0.211 ^# # Kruskal-Wallis test; Bonferroni post hoc test between groups FG and RFG;
		Low, n (%)	9 (45.0%)	5 (41.7%)	6 (60.0%)	0.657
	FES-I		29.9 ± 11.7	27.9 ± 6.8	27.4 ± 8.5	0.762 ^# # Kruskal-Wallis test; Bonferroni post hoc test between groups FG and RFG;
		Sporadic falls, n (%)	18 (32.7%)	13 (38.2%)	7 (31.8%)	0.985
		Recurrent falls, n (%)	18 (32.7%)	10 (29.4%)	7 (31.8%)	0.985

Risk factors	NFG (n = 39)	FG (n = 36)	RFG (n = 21)	χ²
Risk factors				p value
Stairs	20 (51.3%)	22 (61.1%)	12 (57.1%)	0.689
Ramps	13 (33.3%)	9 (25.0%)	2 (9.5%)	0.127
Uneven surface	11 (28.2%)	13 (36.1%)	12 (57.1%)	0.085
Loose mats	19 (48.7%)	18 (50.0%)	12 (57.1%)	0.814
Missing tiles	2 (5.1%)	4 (11.1%)	1 (4.8%)	0.536
Loose cables or wires	2 (5.1%)	1 (5.8%)	0 (0%)	0.546
Slippery surface	12 (30.8%)	7 (19.4%)	6 (28.6%)	0.513
Dim lighting	10 (25.6%)	5 (13.9%)	4 (19.0%)	0.441
Slippery bathroom floor	21 (53.8%)	16 (44.4%)	10 (47.6%)	0.711
Loose pets	17 (43.6%)	13 (36.1%)	8 (38.1%)	0.793
Obstacles and tripping hazards	6 (15.4%)	6 (16.7%)	2 (9.5%)	0.749
Total (mean ± SD)	3.1 ± 2.1	3.3 ± 1.6	3.7 ± 1.5	0.280
Safety factors
Anti-slip adhesive on stairs	3 (7.7%)	5 (13.9%)	8 (38.1%)	0.009
Non-slip carpets	5 (12.8%)	11 (30.6%)	4 (19.0%)	0.163
Anti-slip adhesive on ramps	3 (7.7%)	2 (5.6%)	1 (4.8%)	0.884
Grab bars in the bathroom	7 (17.9%)	12 (33.3%)	8 (38.1%)	0.173
Stair handrails	5 (12.8%)	10 (27.8%)	7 (33.3%)	0.134
Ramp handrails	3 (7.7%)	4 (11.1%)	1 (4.8%)	0.692
Appropriate bed height	10 (25.6%)	16 (44.4%)	7 (33.3%)	0.229
Tallest chair at home	8 (20.5%)	8 (22.2%)	1 (4.8%)	0.209
Tallest toilet seat at home	2 (5.1%)	3 (8.3%)	1 (4.8%)	0.807
Total (mean ± SD)	1.4 ±1.5	1.3 ± 1.0	2.5 ± 1.9	0.052

Sociedade Brasileira de Endocrinologia e Metabologia Rua Botucatu, 572 - Conjuntos 81/83, 04023-061 São Paulo SP Brasil, Tel: (55 11) 5575-0311 - São Paulo - SP - Brazil
E-mail: aem.editorial.office@endocrino.org.br

Acompanhe os números deste periódico no seu leitor de RSS

[1] Correspondence to: Victoria Zeghbi Cochenski Borba, Departamento de Clínica Médica, Programa de Pós-graduação em Medicina Interna, Universidade Federal do Paraná Avenida Agostinho Leão Junior, 285 80030-110 – Curitiba, PR, Brazil. vzcborba@gmail.com