Objective: Both falls and low bone density are important in the pathogenesis of osteoporotic fractures. Whilst bone density is routinely measured to assess fracture risk, little attention is given to the assessment of fall risk. In this study we have determined the prevalence and explored relationships between fall-related risk factors and osteoporosis in women referred to our open access bone densitometry service.
Design: Cross-sectional study.
Setting: Teaching hospital in south-west London, UK.
Subjects: Older women referred for open access bone densitometry.
Measurements: Bone densitometry by dual-energy X-ray absorptiometry and fall risk assessment (visual acuity, ability to do five stand-ups without arm use and ability to perform heel-toe walking).
Results: Data for 558 women seen over an 18 month period were examined. Their mean age was 74.8 years (range 65-93). Fall risk and femoral neck (FN) osteoporosis increased with age, with fall-related risk factors being more prevalent than FN osteoporosis at each tertile of age. Women with both FN osteoporosis and fall-related risk factors ranged from 7% in the youngest tertile to 22% in the oldest tertile. In women with FN osteoporosis, increased fall risk was found in 37% in the youngest tertile, increasing to 63% in the oldest tertile.
Conclusions: Fall-related risk factors are common in older women referred for open access bone densitometry. We recommend that both bone density and fall risk assessment, using simple screening tests for falls, are essential to determine fracture risk in older people referred for bone densitometry. Subsequent management to reduce fracture risk should be individualised for each patient.