Up-rise ability predicted hip fractures and mortality in 295 women 70 years and older – a 20 year follow up controlled intervention

Daniel Albertsson, Lisa Alvunger, Anna Lindgren, Ulrica Mölstad, Ferdinando Petrazzuoli, Anna Segernäs, Moses Sjölander, Hans Thulesius, Pär Wanby, Robert Eggertsen

Keywords: hip fracture, uprise, women, follow-up intervention study, population-based cohort, primary care

Background:

A multifactorial intervention program was tested to reduce hip fracture risk in a high-risk group of Swedish women.

Research questions:

Could reduced hip fracture incidence and mortality be observed during 20 years, after a fracture prevention program?

Method:

A total of 295 women, selected from a population-based cohort of 1248 women aged 70-100, were recruited for a controlled intervention study 2001 with follow up 2004. The 295 women had high hip fracture risk with at least two of the following risk factors: age ≥80 years, body weight ≤60 kg, prior fragility fracture, and fall previous year.
The intervention group of 103 women were offered exercise at home and in group, home hazard reduction and pharmacological treatment. A control group of 192 women were offered treatment as usual.
Risk factors including up-rise ability were assessed 2001 and 2004 and incident hip fractures were derived from radiology records 2002-2021. Survival analyses and standard statistics were performed.

Results:

Between 2001 and 2004, there was a decline in up-rise ability among controls compared to intervention group (136 to 117 out of 192 vs. 67 to 69 out of 103, p<0.001). By 2004, improved up-rise ability was more common in intervention group than in controls among those with impaired up-rise ability in 2001 (12 out of 36 vs. 5 out of 56, p<0.001). Up-rise ability at baseline was associated with a longer time to first hip fracture or death only for the intervention group (Kaplan-Meier, log rank 4.0, p<0.05; adjusted Cox regression analysis HR=0.4; CI 0.1-0.9, p<0.05).

Conclusions:

Self-reported up-rise ability decreased in controls compared to the intervention group, in a multifactorial intervention for 295 women at high hip fracture risk between 2001 and 2004. Only women in the intervention group with up-rise ability at baseline 2001 had a longer time to first hip fracture or death at follow-up 2021.

Points for discussion:

Is it new knowledge that self-reported impaired up-rise ability is associated with sarcopenia and frailty, that influences the risk of hip fracture and longevity?

Is prescribing osteoporosis treatment enough as fragility fracture prevention?

Should activities that strengthen muscles and/or improve the psychosocial network be "prescribed" in primary care?

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