Fall-related Fractures Research Articles

Vestibular rehabilitation affects vestibular asymmetry among patients with fall-related wrist fractures—a randomized controlled trial

Background: Fall-related fractures are an increasing problem for society. Dizziness is identified as a risk factor for falls and vestibular asymmetry is often found among patients with fall-related fractures. An option to prevent fall-related fractures may be to identify patients with vestibular asymmetry and to improve their balance and asymmetry by exercise. Objective: To examine whether vestibular rehabilitation improves vestibular function, balance and self-rated health among patients with fall-related wrist fractures. Methods: Sixty-eight persons (65 women) with fall-related wrist fractures, mean age 72 years (54-89) participated in this randomized controlled trial. The following tests and measurements were performed: head shake test to evaluate vestibular asymmetry as primary outcome measure, five clinical balance measures, a force plate to measure postural sway, a tuning fork to measure vibration and the EQ5D questionnaire to measure self-rated health. The intervention comprised group-based vestibular rehabilitation sessions conducted twice a week for 9 weeks. Results: Nystagmus occurred in the head shake test in 65% (44 of 68) of the patients, indicating vestibular asymmetry. More patients in the intervention group (6 of 21) than in the control group (0 of 23) changed from having nystagmus in the head shake test at baseline (indicating vestibular asymmetry) to not having nystagmus at follow-up, and more patients in the control group (3 of 9) than in the intervention group (0 of 3) changed from not having nystagmus at baseline to have nystagmus at follow-up (p Conclusion: Group sessions with vestibular rehabilitation twice a week for 9 weeks affected the occurrence of vestibular asymmetry positively among patients having vestibular asymmetry. Patients with vestibular asymmetry had more balance deficits and increased postural sway than patients without vestibular asymmetry. Vestibular assessment is important, and, in patients with diagnosed vestibular asymmetry, vestibular rehabilitation may prove beneficial on balance and possibly reduce the risk of future falls.

Concomitant upper limb fractures and short-term functional recovery in hip fracture patients: does the site of upper limb injury matter?

The aim of this study was to evaluate functional recovery in a subgroup of hip fracture patients who sustained a simultaneous fracture at the upper limb, taking into account the site of upper limb injury. Of 760 patients admitted consecutively to the authors' rehabilitation hospital because of a fall-related hip fracture, 700 were retrospectively investigated. Functional outcome was assessed using Barthel Index scores. In 49 of the 700 patients, a single fall resulted in both a hip fracture and a fracture of either wrist (n = 34) or proximal humerus (n = 15). The patients with concomitant shoulder fractures had lower median Barthel Index scores after rehabilitation (70 vs. 90, P = 0.003), lower median Barthel Index effectiveness (57.1 vs. 76.9, P = 0.018), and prolonged median length of stay (42 vs. 36 days, P = 0.011) than did the patients with isolated hip fractures. Significant differences persisted after adjustment for six potential confounders. The adjusted odds ratio for achieving a Barthel Index score lower than 85 was 6.71 (95% confidence interval, 1.68-26.81; P = 0.007) for the patients with concomitant shoulder fractures. Conversely, no prognostic disadvantages were associated with concomitant wrist fractures. Data show a worse functional recovery and a prolonged length of stay in the subgroup of hip fracture patients who sustained a concomitant fracture at the proximal humerus, but not at the wrist.

The role of sarcopenia in the risk of osteoporotic hip fracture.

Several common age-related mechanisms and factors influence muscle and bone, affecting functionality of both tissues. Sarcopenia is closely linked with osteoporosis, and their combined effect may exacerbate negative health outcomes. Fall-related fractures are some of the most serious consequences of these two systemic pathologies, with hip fracture being a major complication affecting osteoporotic and sarcopenic elderly. This work aims to review the literature on the current state of knowledge about the relations between sarcopenia and osteoporosis and to present the association between sarcopenia and osteoporosis and the risk of hip fracture. A literature search was performed in PubMed and Scopus databases for articles with the predefined terms "sarcopenia," "muscular atrophy," "femoral fractures," "hip fractures," "osteoporosis," and "bone density." There is a growing and significant interest being directed to sarcopenia and associated risk for osteoporotic hip fracture, but there still is a notorious heterogeneity in the methodology and cohort size of the available studies. Collectively, most of the studies herein analyzed indicate that sarcopenia could be a predictor of risk for hip fracture. The simultaneous evaluation of sarcopenia and osteoporosis may be of importance in identifying those patients in higher risk of suffering an osteoporotic hip fracture and who could benefit from preventive or therapeutic interventions, or both.

The fall descriptions and health characteristics of older adults with hip fracture: a mixed methods study.

BackgroundIn light of the multifactorial etiology of fall-related hip fracture, knowledge of fall circumstances may be especially valuable when placed in the context of the health of the person who falls. We aimed to investigate the circumstances surrounding fall-related hip fractures and to describe fall circumstances in relation to participants’ health and functional characteristics.MethodsThe fall circumstances of 125 individuals (age ≥ 50 years) with hip fracture were investigated using semi-structured interviews. Data concerning participants’ health (comorbidities and medications) and function (self-reported performance of mobility, balance, personal activities of daily living and physical activity, previous falls and hand grip strength) were collected via medical records, questionnaires and dynamometry. Using a mixed methods design, both data sets were analysed separately and then merged in order to provide a comprehensive description of fall events and identify eventual patterns in the data.ResultsFall circumstances were described as i) Activity at the time of the fall: Positional change (n = 24, 19%); Standing (n = 16, 13%); Walking (n = 71, 57%); Balance challenging (n = 14, 11%) and ii) Nature of the fall: Environmental (n = 32, 26%); Physiological (n = 35, 28%); Activity-related indoor (n = 8, 6%) and outdoor (n = 8, 6%); Trips and slips on snow (n = 20, 16%) and in snow-free conditions (n = 12, 10%) and Unknown (n = 10, 8%). We observed the following patterns regarding fall circumstances and participants’ health: those who fell i) during positional change had the poorest functional status; ii) due to environmental reasons (indoors) had moderate physical function, but high levels of comorbidity and fall risk increasing medications; iii) in snow-free environments (outdoors) appeared to have a poorer health and functional status than other outdoor groups.ConclusionsOur findings indicate that patterns exist in relation to the falls circumstances and health characteristics of people with hip fracture which build upon that previously reported. These patterns, when verified, can provide useful information as to the ways in which fall prevention strategies can be tailored to individuals of varying levels of health and function who are at risk for falls and hip fracture.Electronic supplementary materialThe online version of this article (doi:10.1186/s12877-015-0036-x) contains supplementary material, which is available to authorized users.

Sulfonylurea use and risk of hip fractures among elderly men and women with type 2 diabetes.

Both increased age and type 2 diabetes mellitus are risk factors for developing bone fractures. While recent data in the elderly suggest a link between hypoglycemia and fall-related fractures, the association between sulfonylureas, commonly used hypoglycemic agents, and fracture risk has not been well investigated. We used patient data from a large commercial health insurer from 2002-2005. Individuals aged ≥65 years receiving oral sulfonylurea treatment (n=13,195) were matched 1:1 to non-users based on propensity for sulfonylurea use. Multivariable conditional logistic regression was used to estimate adjusted odds ratios (aOR) and 95% confidence intervals (CIs). During an average 4 years of follow-up, sulfonylurea users experienced 226 incident hip fractures (1.7%) and non-users experienced 157 (1.2%). Sulfonylurea use was associated with increased risk of developing hip fracture (aOR 1.46, 95% CI 1.17-1.82), and this association was apparent for men (120 cases; aOR 1.83, 95% CI 1.25-2.66) and women (263 cases; aOR 1.32, 95% CI 1.03-1.69). Patients with documented hypoglycemia in the follow-up period had increased odds of hip fracture relative to those without such diagnosis (aOR 2.42, 95% CI 1.35-4.34). Sulfonylureas are associated with increased risk of hip fracture in elderly men and women with type 2 diabetes.

Recovery of activities of daily living among older people one year after hip fracture.

This article aims to determine the functional recovery of older people, who were previously independent in activities of daily living (ADLs) and without cognitive impairment, in the year following a fall-related hip fracture. A cohort study was carried out among patients admitted to University General Hospital of Albacete (Spain). Consecutive sampling was performed. Variables included demographic, habitual residence, type of hip fracture, mental status (Short Portable Mental Status Questionnaire [SPMSQ] Pfeiffer), and independence in ADLs (according to the Barthel Index [BI]) prior to the fall and after the fracture. For 205 patients, 1 year after surgery, the mean BI score was 78.09 (SD = 25.13); (vs. 90.02 before the hip fracture), 59% showed urinary continence (vs. 79%), and 65% walked without assistance (vs. 82%). Regarding predictors of recovery, results indicate that patients who are older, who suffer complications after hospital discharge, or who reside in nursing homes experience poorer recovery in ADLs. Only 47.9% of the patients regained prior levels of autonomy 1 year after surgery.

Increased double support variability in elderly female fallers with vestibular asymmetry

There is a broad consensus on the coupling of deteriorating gait and vestibular asymmetry, which has proved predictive of falls in the elderly. To date, research on this coupling remains inconclusive and has not focused specifically on fallers. In the present study, differences in gait variability were examined in a population of elderly females with fall-related wrist fractures, divided into samples with positive (N=28, 73±9 years) and negative head-shaking tests (N=6, 67±9 years). Swing, stance, and double support time variability were measured in preferred speed walking using GAITRite® and statistically evaluated in multivariate analysis of covariance with age as covariate. Results showed overall greater gait variability for the positive nystagmus group (p=0.03) despite non-significant adjustment of the covariate (p=0.18). In post-hoc analysis, the effect on variability in double support time emerged as a significant and large contributor to this difference (p=0.009, ηp2=0.20). Conversely, the ability of swing and stance time variability to discriminate between groups was both non-significant and small (p=0.25, ηp2=0.04 and p=0.34, ηp2=0.03 respectively). We believe that the increased variability might stem from a strategic use of double support to re-stabilize from balance perturbations during gait. To some extent, these results diverge from previous findings and need to be reassessed in future studies.

Hip Fractures and Recovery Outcomes among Community-Dwelling Elderly

Copyright: © 2015 Frieson CW. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. As our population ages, many challenges will arise in meeting the older adult’s various health care needs. This generation of “baby boomers” is living longer than ever before and are faced with multiple chronic health conditions. Such conditions can pose a threat to their overall safety and quality of life and can increase their risk for falls. The average cost for hospitalized patients due to a fall injury is $35,000 and this cost increases with advancing age [1]. Chronic health conditions, such as arthritis, diabetes, stroke, hypertension, and osteoporosis are risk factors for falls. Other risk factors include multiple medication use and an unsafe home environment. Multiple risk factors can lead to serious fall-related fractures, such as hip fractures that result in hospitalization and an increase in health care costs. The recovery outcomes in the elderly after a hip fracture are unfavorable and can lead to an increase in readmission rates, nursing home placement, debilitated state, and even death.

グループホームの建物特性が骨折に及ぼす影響<br>その１ 転倒・転落骨折数の分析を通して

Data about the incidence of fractures in group homes for the elderly with dementia at 937 facilities was analysed on following aspects. 1) Per 100 residents per year, 60.0 residents had experienced a high fall, 9.7 had experienced a low-height fall, 4.3 had broken a bone during a high fall, and 0.3 had broken a bone during a low-height fall. 2) A meaningful decrease in fractures was found where average of residents' care level was ranked “over 3” in Japanese Long-term Care Insurance than ranked “over2 and under3”. 3) Comparing the rate of fracture, reinforced concrete structures with hard finished floor have a meaningfully greater rate of fall-related fractures than steel structures and reinforced concrete with shock absorbing materials under floor, and that steel reinforced concrete structures have a greater rate of fractures than do steel structures.

Vestibular Rehabilitation Affects Vestibular Asymmetry among Patients with Fall-Related Wrist Fractures - A Randomized Controlled Trial

Background: Fall-related fractures are an increasing problem for society. Dizziness is identified as a risk factor for falls and vestibular asymmetry is often found among patients with fall-related fractures. An option to prevent fall-related fractures may be to identify patients with vestibular asymmetry and to improve their balance and asymmetry by exercise. Objective: To examine whether vestibular rehabilitation improves vestibular function, balance and self-rated health among patients with fall-related wrist fractures. Methods: Sixty-eight persons (65 women) with fall-related wrist fractures, mean age 72 years (54-89) participated in this randomized controlled trial. The following tests and measurements were performed: head shake test to evaluate vestibular asymmetry as primary outcome measure, five clinical balance measures, a force plate to measure postural sway, a tuning fork to measure vibration and the EQ5D questionnaire to measure self-rated health. The intervention comprised group-based vestibular rehabilitation sessions conducted twice a week for 9 weeks. Results: Nystagmus occurred in the head shake test in 65% (44 of 68) of the patients, indicating vestibular asymmetry. More patients in the intervention group (6 of 21) than in the control group (0 of 23) changed from having nystagmus in the head shake test at baseline (indicating vestibular asymmetry) to not having nystagmus at follow-up, and more patients in the control group (3 of 9) than in the intervention group (0 of 3) changed from not having nystagmus at baseline to have nystagmus at follow-up (p < 0.00). No other changes occurred between the two groups between baseline and follow-up. At baseline, patients with vestibular asymmetry had more balance deficits and increased postural sway compared to patients without (p = 0.00-0.05). Conclusion: Group sessions with vestibular rehabilitation twice a week for 9 weeks affected the occurrence of vestibular asymmetry positively among patients having vestibular asymmetry. Patients with vestibular asymmetry had more balance deficits and increased postural sway than patients without vestibular asymmetry. Vestibular assessment is important, and, in patients with diagnosed vestibular asymmetry, vestibular rehabilitation may prove beneficial on balance and possibly reduce the risk of future falls.

Injury due to mechanical falls: future directions in gender-specific surveillance, screening, and interventions in emergency department patients.

The Centers for Disease Control and Prevention report that among older adults (≥65years), falls are the leading cause of injury-related death. Fall-related fractures among older women are more than twice as frequent as those for men. Gender-specific evidence-based fall prevention strategy and intervention studies show that improved patient-centered outcomes are elusive. There is a paucity of emergency medicine literature on the topic. As part of the 2014 Academic Emergency Medicine (AEM) consensus conference on "Gender-Specific Research in Emergency Care: Investigate, Understand, and Translate How Gender Affects Patient Outcomes," a breakout group convened to generate a research agenda on priority questions to be answered on this topic. The consensus-based priority research agenda is presented in this article.

P268: Feasibility of C-mill gait-adaptability training in older adults after fall-related hip fracture: user's perspective and training content

P268 Feasibility of C-mill gait-adaptability training in older adults after fall-related hip fracture: user’s perspective and training content M.W. van Ooijen, M. Roerdink, C. Timmermans, M. Trekop, S. Arendse, E. Nijenhuis, T.W.J. Janssen, P.J. Beek VU University Amsterdam, Amsterdam, The Netherlands; MOVE Research Institute Amsterdam, Faculty Human Movement Sciences, VU University, Amsterdam, The Netherlands; PW Janssen, Zorggroep Solis, Deventer, The Netherlands

Risk for femoral fractures in Parkinson's disease patients with and without severe functional impairment.

BackgroundImpaired balance is a major problem in patients with idiopathic Parkinson’s disease (PD) resulting in an increased risk of falls and fall-related fractures. Most studies which analyzed the risk of femoral fractures in patients with idiopathic PD were performed either in specialized centers or excluded very frail patients. The current study used a large population-based dataset in order to analyze the risk of femoral fractures in patients with idiopathic PD.MethodsData from more than 880.000 individuals aged 65 years or older and insured between 2004 and 2009 at a large German health insurance company were used for the analyses. Persons with idiopathic PD were identified by the dispensing of Parkinson-specific medication and by hospital diagnoses, if available. People without PD served as the reference group. Incident femoral fractures were obtained from hospital diagnoses. Analyses were stratified by gender and information on severe functional impairment (care need) as provided by reimbursement claims.ResultsCompared with the reference group, persons with idiopathic PD had a more than doubled risk to sustain a femoral fracture. The risk was higher in men (HR = 2.61; 95%-CI: 2.28–2.98) than in women (HR = 1.79; 95%-CI: 1.66–1.94). The increased risk was only observed in people without severe functional impairment. The sensitivity analysis using a refined definition of idiopathic PD patients yielded similar results.ConclusionThe findings confirm the increased risk of femoral fractures in patients with idiopathic PD. The relative risk is particularly high in male PD patients and in patients without severe functional impairment.

Health-related quality of life and functionality in elderly men and women before and after a fall-related wrist fracture

To evaluate health-related quality of life (HRQoL) and functionality among older men and women who suffered a wrist fracture because of a fall and to identify postfracture consequences. Observational, prospective cohort study of patients recruited in the emergency departments (ED) of six public hospitals of the Basque Health Service and one of the Catalan Health Service. Two groups of adults aged 65 or older were recruited: 960 with wrist fractures because of falls (fracture cohort) and 119 without fall-related wrist fractures in the previous year (non-fracture cohort). We collected sociodemographical and clinical data; general and specific HRQoL data measured by the 12-Item Short Form Health Survey (SF-12) and a short version of the Disabilities of the Arm, Shoulder, and Hand instrument (QuickDASH); and data about basic (BADL) and instrumental (IADL) activities of daily living, measured by the Barthel Index and the Lawton and Brody Index (LBI). Women with wrist fractures exhibited greater declines than men 6 months after the fall in all questionnaires except the LBI, and greater declines than those in the non-fracture cohort independent of gender. Patients aged 80 years and older presented with worse baseline scores in all the outcome measures and lost more HRQoL and functionality after wrist fractures. Women and older individuals experienced the greatest reductions in HRQoL and functionality after a fall-related wrist facture, suggesting that they might merit special attention in clinical care and public health policy. Specific prevention strategies may be needed to avoid or reduce the consequences of fall-related wrist fractures.

Association of polypharmacy with fall-related fractures in older Taiwanese people: age- and gender-specific analyses

ObjectiveTo elucidate the associations between polypharmacy and age- and gender-specific risks of admission for fall-related fractures.DesignNested case–control study.SettingThis analysis was randomly selected from all elderly beneficiaries in 2007–2008, and represents...

Changing epidemiology of adult fractures in Scotland

Fracture epidemiology in adults is changing but there is very little information about the rate of change or whether the change affects males and females equally. We have compared fracture incidence in two similar populations 50-60 years apart. A study of fractures in Dundee, Scotland and Oxford, England, in 1954-1958, was compared with a similar cohort of fractures in Edinburgh, Scotland, in 2010-2011. Fracture incidence in patients >35 years was recorded in both time periods. The incidence of fractures increased by 50% between the two time periods, although the increase in males was only 5% compared with 85% in females. The spectrum of fractures has changed considerably, and there has been an increase in the incidence of both fragility and non-fragility fractures. Analysis showed an increased incidence of fall-related fractures in all age groups in both males and females. There has been a substantial change in the incidence of fractures in the last 50-60 years. These have been caused by greater longevity and by considerable social and economic changes.

Visual Impairment and Hip Fractures: A Case-Control Study in Elderly Patients

Aims: To investigate the relationship between visual impairment and fall-related hip fracture and to determine the etiology of visual impairment in a population of elderly patients with hip fracture. Methods: A case-control study compared 96 patients diagnosed with hip fracture to a randomly selected control group of 103 patients without hip fracture. Inclusion criteria for the case group were as follows: patients aged 60 years and over with a hip fracture. Clinical assessment included visual acuity and ophthalmic examination. Results: Forty-three patients with hip fracture had a visual impairment compared to only 12 patients in the control group. Visual impairment was a significant risk factor for hip fracture (OR = 6.15; 95% CI 2.98-12.69). Twenty-seven hip fracture patients had an uncorrected refractive error compared to only 15 controls (OR = 2.78; 95% CI 0.92-8.35). There was no significant difference of dense cataract between both groups (OR = 2.28; 95% CI 0.75-6.93). Fourteen hip fracture patients had a macular degeneration compared to only 8 controls (OR = 5.63; 95% CI 1.57-20.18), and 10 patients had suspicion of glaucoma compared to only 5 controls (OR = 10.65; 95% CI 2.21-51.3). Conclusion: Visual impairment was significantly associated with an increased risk of hip fracture in elderly people. There are many etiologies that may contribute to hip fractures, most notably refractive error, cataract, macular degeneration and glaucoma.

Comment on Cassell and Clapperton: A decreasing trend in fall-related hip fracture incidence in Victoria, Australia

Comment on Cassell and Clapperton: A decreasing trend in fall-related hip fracture incidence in Victoria, Australia

Hypoglycemia in Diabetes Common Across Glycemic Control Levels

Hypoglycemia is common among patients being treated for type 2 diabetes, regardless of their level of glycemic control, according to findings from the Diabetes Study of Northern California (DISTANCE) survey. The findings challenge the conventional wisdom that hypoglycemia occurs only among those with the lowest hemoglobin A1c levels, reported Dr. Kasia J. Lipska of Yale University, New Haven, Conn., and colleagues. The study was published in Diabetes Care (2013;36:3535-42). Among 9,094 adults with diabetes who participated in the survey, 11% reported experiencing severe hypoglycemia in the past year, with nearly 1 in 4 (24%) reporting more than three events during that time period. In an unadjusted analysis, those with HbA at the highest and lowest levels were most likely to experience hypoglycemia, the investigators said. Compared with those with “good” HbA levels of 7.0%-7.9%; the relative risk of hypoglycemia was 1.25 in those with “near normal” levels of less than 6%, 1.01 in those with “very good” levels of 6.0%-6.9%, 0.99 in those with “suboptimal” levels of 8.0%-8.9%, and 1.16 among those with “very poor” levels of 9% or greater, they explained. However, the elevated relative risk was statistically significant only for those with HbA of 9% or greater, they noted, adding that while adjustment for demographic variables did not “alter the shape of the relationship,” and while the point estimates for hypoglycemia risk remained higher at the two extremes of glycemic control, the differences in risk between each HbA category and the reference group did not differ significantly in the fully adjusted model. Study participants were patients with type 2 diabetes aged 30-77 years, who were members of the Kaiser Permanente Northern California Diabetes Registry. The patients, who were using glucose-lowering therapy, were surveyed during 2005-2006 about episodes of severe hypoglycemia, such as episodes during which they passed out or required medical assistance. Patients most likely to report hypoglycemic episodes were women; those taking more than four medications for chronic conditions; those using either insulin or a secretagogue during the pre-observation period; and those with longer duration of disease, prior history of hypoglycemia, and multiple comorbidities, the investigators noted. After examining the prevalence of hypoglycemia across potential effect modifiers, however, they found no significant interaction. Prior studies have resulted in inconsistent findings about the relationship between glucose control and hypoglycemic events, but findings from the current study suggest that “hypoglycemia occurs across all levels of HbA, with higher risk associated with near-normal or very poor glycemic control,” the investigators said. The findings are important, they said, because several studies have shown that patients who experience severe hypoglycemia are at increased risk for a number of unfavorable health outcomes, including dementia, falls, fall-related fractures, cardiovascular events, poor health–related quality of life, and increased mortality. The researchers noted that in addition to efforts to limit adverse effects of overtreatment and to improve patient outcomes, efforts to consider the safety of the various glucose-lowering therapies in patients with higher HbA levels are needed. “Poorly controlled diabetes appears to be associated with both higher risk of diabetic complications and higher risk of treatment-related hypoglycemia. Therefore, quality improvement efforts must balance the need to improve glucose levels with safety of antihyperglycemic therapy in this group,” they said. Though limited by a number of factors, including self-reporting of hypoglycemia without laboratory confirmation and a wide age range of participants, which limits applicability to elderly patients with diabetes, the findings in this usual-care setting nonetheless underscore the importance of directing efforts to improve the safety of glucose-lowering therapies. Such efforts must be directed not only to patients achieving intensive glucose control, but also to those with poorly controlled disease, the investigators concluded, noting that “future analyses are needed to identify management strategies and treatment factors that may mitigate hypoglycemia risk.” The DISTANCE survey was funded by numerous grants, including grants to individual authors or their employers from the National Institute on Aging and the National Heart, Lung, and Blood Institute.

Vitamin D depletion in hip fracture women is associated with the occurrence of simultaneous upper limb fractures independently of bone mineral density

IntroductionSevere vitamin D deficiency is associated with the occurrence of simultaneous fractures at both hip and upper limb due to a single fall. We hypothesized that reduced bone mineral density (BMD) could explain the association. MethodsWe investigated 549 white women consecutively admitted to a rehabilitation hospital because of their first fall-related hip fracture. Thirty-three (6%) of the 549 women sustained a concomitant upper limb fracture of either distal radius (24 women) or proximal humerus (nine women). We assessed serum levels of 25-hydroxyvitamin D, hip BMD by dual-energy X-ray absorptiometry, and spine deformity index scores by lateral spine radiographs, 19.5±7.1 (mean±SD) days after fracture occurrence. ResultsSerum levels of 25-hydroxyvitamin D were significantly lower in the 33 women with concomitant fractures of both hip and upper limbs than in the remaining 516 (mean difference between groups 5.6ng/ml, 95% CI from 3.5 to 7.6, P<0.001). Conversely, no significant differences were found in hip BMD or spine deformity index scores between the two groups. After adjustment for eight potential confounders, the occurrence of simultaneous fractures due to a single fall was significantly associated with low levels of 25-hydroxyvitaimn D (P=0.001), but not with femoral BMD or spine deformity index scores. ConclusionThe association between severe vitamin D deficit and the occurrence of concomitant fractures at both hip and upper limbs due to a single fall is independent of femur BMD. Further investigations should focus on altered fall pattern or reaction to fall.