2014 World Congress on Osteoporosis, Osteoarthritis, and Musculoskeletal Diseases
April 2-5, 2014; Seville, Spain
Study Shows Correlation Between Low Body Mass Index and Death Among Nursing Home Residents
Although a body mass index (BMI) between 18.5 kg/m2 and 24.9 kg/m2 is considered to fall in the healthy range, this rule generally does not apply to elderly persons. In older adults, a higher BMI of between 25 kg/m2 and 27 kg/m2 is thought to be protective. A study presented during the World Congress on Osteoporosis, Osteoarthritis and Musculoskeletal Diseases by Fanny Buckinx and colleagues from the University of Liège, Liège, Belgium, provided additional evidence to support the potentially protective effect of a slightly higher BMI in the elderly, reporting a correlation between low BMI and death in a group of nursing home residents.
Buckinx and colleagues’ study included 100 nursing home residents who were followed prospectively for 2 years. At the beginning of the monitoring period, demographics characteristics were collected and the Tinetti test and a quantitative gait analysis using a triaxial accelerometer were performed. By the end of the study, there were 27 deaths. When comparing the demographics and test scores between those who were deceased and those who were still alive, Buckinx and colleagues found a significantly lower BMI among the deceased (23.3 ± 4.9 kg/m2 vs 26.5 ± 5.3 kg/m2; P=.007). In addition, the deceased had significantly higher dependence scores, significantly lower Tinetti scores, and a higher incidence of repeated falls; however, after adjusting for potential confounding variables, only BMI remained statistically significantly associated with the risk of death (odds ratio, 0.86; 95% confidence interval, 0.77-0.96; P=.04). There were no differences between the groups with regard to age, sex, number of medications used, and ambulatory support.
Based on their findings, Buckinx and colleagues conclude that a decreased BMI appears to be a predictor of the risk of death among elderly nursing home residents; however, they warn that “many confounding variables (strength, weakness, etc) were not evaluated in [their] study and therefore these results should be interpreted with caution.”—Christina T. Loguidice
Hip Fracture Risk Increases With Long-Term Vitamin D Insufficiency in Elderly Women
Vitamin D is crucial to bone health, as it promotes calcium absorption, helps maintain adequate serum calcium and phosphate concentrations, and facilitates bone growth and remodeling by osteoblasts and osteoclasts. Although previous studies have linked vitamin D deficiency and insufficiency with an increased risk of osteoporotic fractures in the elderly, the impact of long-term hypovitaminosis D in elderly women was unclear, as most previous studies relied on single vitamin D measures to derive their conclusions. During the World Congress on Osteoporosis, Osteoarthritis and Musculoskeletal Diseases, researchers from Sweden reported that low serum 25-hydroxyvitamin D [25(OH)D] levels sustained over 5 years was associated with an increased 10-year risk of hip fractures in elderly women.
The study, led by David Buchebner, PhD, included 987 Swedish women who were 75 years old at baseline and part of a prospective, population-based study that examined bone health, falling risk, and incidence of fractures. Participants’ vitamin D status was determined by measuring serum 25(OH)D levels at baseline and at 5 years. Levels greater than 75 nmol/L were considered high, 50 to 75 nmol/L were considered intermediate, and levels less than 50 nmol/L were considered low. Of the participants, 640 attended the 5-year follow-up and were included in the analysis. Women whose 25(OH)D levels fell in the same category at both samplings were considered to have consistently low, intermediate, or high levels of vitamin D. Fracture data for this population was gathered for 10 years, starting at baseline, using radiology screenings and the World Health Organization’s Fracture Risk Assessment Tool (FRAX).
The researchers found a significantly lower incidence of hip fractures over the 10 years in women who maintained 25(OH)D levels of 50 nmol/L or more at 5 years, with a 10-year hip facture incidence rate of 6.9%, 9.9%, and 20.6% for women with high, intermediate, and low levels of 25(OH)D, respectively (P=.005 and P=.031). The study found no association between 25(OH)D status and the incidence of shoulder, radius, and vertebral fractures. Of the hip fractures, 77% occurred between 5 and 10 years after baseline; however, the time to first fracture did not significantly differ between the three 25(OH)D groups when using single or serial measurements.—Christina T. Loguidice
Depression or Dementia Linked to Poor Functional Recovery After Fragility Hip Fracture
The connection between the mind and body has been explored for centuries, and an increasing number of studies are showing that an individual’s mental state can impact his or her health outcomes. During the World Congress on Osteoporosis, Osteoarthritis and Musculoskeletal Diseases, researchers from Italy and Canada presented the results of the C.O.D.E study, which examined the outcomes of osteoporotic fractures in elderly persons with depression, dementia, or cognitive impairment. The researchers reported that elderly persons affected by major depression or dementia experienced poor functional recovery after sustaining a fragility hip fracture and subsequently developed a high level of disability.
The study included 442 patients (106 men and 336 women) between 80 and 90 years of age who were hospitalized following their fracture. All patients underwent a variety of neuropsychological and physical functioning assessments during their hospital stay and at 3-, 6-, and 12-month follow-up. Assessments performed included the Mini Mental State Examination, Geriatric Depression Scale, Confusion Assessment Method, Mini International Neuropsychiatric Interview Plus, Barthel Index of Activities of Daily Living, Cumulated Ambulation Score, and Short Physical Performance Battery.
The researchers found that depressive symptoms and cognitive impairment increased suddenly after the hip fractures, whereas the incidence of cognitive impairment and the severity of cognitive symptoms decreased during the follow-up assessments; however, the incidence of depression and the severity of depressive symptoms increased during the follow-up examinations. An inverse association was found between the manifestation of depressive symptoms during patients’ hospital stay and early motor recovery in days 1 to 3 postoperatively. Major depression was associated with poor early motor recovery, poorer functional recovery, and a higher level of disability, whereas dementia was associated with the latter two.
Based on their findings, the researchers state that early interventions that focus on recovery motivation and early mobilization are essential for persons with depression and/or cognitive impairment who sustain a fracture. They also suggest “appropriate interventions on mood and cognitive symptoms may be useful to improve the process of functional recovery.”—Christina T. Loguidice
Two Studies Shed Light on Risk Factors for Falls Among Nursing Home Residents
Approximately 50% to 75% of US nursing home residents fall annually, with an estimated 20% of all fall-related deaths occurring in these individuals. Subsequently, fall prevention has become a major focus for quality improvement in US nursing homes; however, to more effectively prevent residents from falling, risk factors for falls need to be identified. During the World Congress on Osteoporosis, Osteoarthritis and Musculoskeletal Diseases, two European studies shed additional light on fall risk factors.
Tinetti Score and Step Frequency
The first study, which was presented by Fanny Buckinx and colleagues from the University of Liège, Liège, Belgium, included 100 residents who were monitored for 2 years for the occurrence of falls. During this period, a total of 440 falls were recorded, with 75 of the participants falling at least once (mean, 4.44 ± 6.79 falls per patient). Approximately 25% of participants fell during the first 2 months of the study, whereas 75% fell during the first year of monitoring.
To determine these residents’ fall risk factors, the researchers compared the baseline characteristics of the fallers with those of the nonfallers. Baseline characteristics assessed included general demographics (ie, sex, age, body mass index, number of medications, medical history, history of falls) and clinical characteristics (ie, Katz Index of Independence, Tinetti score, quantitative gait assessed using a triaxial accelerometer). The researchers found that the baseline characteristics were comparable between the two groups, with the exception of Tinetti scores (18.4 ± 4.45 points for fallers vs 20.6 ± 4.73 points among nonfallers; P=.04) and step frequency measured in dual-task conditions (0.77 ± 0.22 for fallers vs 0.66 ± 0.14 among nonfallers; P=.02).
Based on their findings, the researchers conclude that fallers have lower Tinetti scores and a greater step frequency measured in dual-task conditions compared with nonfallers, with the latter factor being particularly predictive of falls risk among elderly nursing home residents, as it remained the only predictor for falls when applying logistic regression.
Physical Activity, Handgrip Strength, and Fear of Falling
The second study, presented by Marija Tamulaitiene, MD, PhD, and colleagues from Vilnius University, Vilnius, Lithuania, specifically investigated the relationship between the risk of falling and physical activity, handgrip strength, and fear of falling among nursing home residents aged 65 years and older. The researchers assessed physical activity levels using the Rapid Assessment of Physical Activity (RAPA) questionnaire, measured handgrip strength using a handheld dynamometer, and determined fear and risk of falling using the Falls Efficacy Scale-International (FES-I) and the Morse Fall Scale (MFS), respectively. To effectively compare different levels of handgrip strength, participants were categorized as weak or strong for their sex based on where they fell with regard to the score cut point of the 50th percentile for their sex.
The study included 20 men and 37 women (mean age, 80.5 ± 6.8 years), all of whom were free of musculoskeletal or nervous system diseases or conditions that would restrict movements in the upper or lower extremities. The researchers found a positive correlation between age and fear of falling in women and a negative correlation between age and physical activity in men with weak handgrip strength. A negative strong correlation between physical activity and risk of falling was also observed in women with weak handgrip strength.—Christina T. Loguidice
