Abstract
BackgroundSituational factors during a fall among three common types of fractures of the distal forearm, hip, and vertebrae among older women in Taiwan were investigated.MethodsIn 2016 ~ 2017, study participants were identified from those aged ≥65 years who visited emergency departments due to a fall in two university-affiliated hospitals in Taipei. In addition to individual characteristics, situational factors during the fall (location, activity, change of center of mass, fall mode, fall direction, initiating a protective response, and being hit) were collected. A sample of 203 distal-forearm fractures, 189 vertebral fractures, and 375 hip fractures was recruited, while 717 women with a soft-tissue injury were used as a control group. The identification of situational risk factors for each type of fracture was validated by using those who sustained one of the other two types of fracture as a control group.ResultsAfter adjusting for age and other individual characteristics, compared to soft-tissue injuries, distal-forearm fractures were significantly more likely to occur with slips (odds ratio [OR] = 11.0; 95% confidence interval [CI] = 4.76 ~ 25.4), trips (OR = 3.40; 95% CI = 1.42 ~ 8.17), step-downs (OR = 4.95; 95% CI = 2.15 ~ 11.4), and from sideways falls (OR = 1.73; 95% CI = 1.12 ~ 2.67) and significantly less likely to occur indoors (OR = 0.62; 95% CI = 0.42 ~ 0.90) or from backwards falls (OR = 0.62; 95% CI = 0.41 ~ 0.95). Hip fractures were significantly more likely to occur with step-downs (OR = 1.76; 95% CI = 1.13 ~ 2.75) and from backwards (OR = 3.16; 95% CI = 2.15 ~ 4.64) or sideways falls (OR = 5.56; 95% CI = 3.67 ~ 8.41) and significantly less likely when hitting an object (OR = 0.26; 95% CI = 0.13 ~ 0.52) or initiating a protective response (OR = 0.58; 95% CI = 0.36 ~ 0.93). Vertebral fractures were significantly more likely to occur with slips (OR = 2.42; 95% CI = 1.30 ~ 4.50), step-downs (OR = 2.53; 95% CI = 1.43 ~ 4.48), and backwards falls (OR = 2.15; 95% CI = 1.39 ~ 3.32). Similar results were found in the validation analyses.ConclusionsLarge variations in situational risk factors for the three types of fracture in older women existed. A combination of individual and situational risk factors may display a more-comprehensive risk profile for the three types of fracture, and an intervention that adds training programs on safe landing strategies and effective compensatory reactions may be valuable in preventing serious injuries due to a fall.
Highlights
Situational factors during a fall among three common types of fractures of the distal forearm, hip, and vertebrae among older women in Taiwan were investigated
Study participants During a 2-year period in 2016 ~ 2017, eligible women were identified from those aged ≥65 years who had immediately visited the emergency department (ED) due to a fall resulting in a distal-forearm fracture, hip fracture, vertebral fracture, or soft-tissue injury of two university-affiliated hospitals in Taipei, Taiwan and who could ambulate within their own households prior to the fall
Of 1888 eligible women during the study period, 1484 agreed to participate in the study, among whom 203 had sustained a distal forearm fracture, 189 had sustained a vertebral fracture, 375 had sustained a hip fracture, 717 had sustained a soft-tissue injury, and 404 declined to participate or had no relatives or caregivers around to serve as proxies
Summary
Situational factors during a fall among three common types of fractures of the distal forearm, hip, and vertebrae among older women in Taiwan were investigated. While distalforearm fractures occur most frequently as a result of a fall on an outstretched hand in healthy and active women with lower BMD [10], few studies have investigated the influence of situational exposures on the risk of other types of fracture, in which conflicting results exist as to whether a distal-forearm fracture is more likely to occur when falling backwards, sideways, or forwards [11,12,13]. Comparisons of the relative impacts of situational factors on various types of fractures can provide information to more comprehensively describe risk profiles for the three types of fracture and for developing more-precise prevention programs for older people with various risks of a certain type of fracture
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