Essay: Fractures in the elderly

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Background: Fractures in elderly are an important public health issue, especially as incidence increases with age, and the population of elderly people is growing. Elderly are more likely to have fractures due to many factors as frequent falls, impaired protective reflexes during falls, osteoporosis, many medical illnesses and drugs. Fracture incidence in institutionalized elderly people is generally higher than the general population. Function and quality of life may deteriorate drastically after a fracture. Detecting the most prevalent risk factors of fractures may help preventing further fractures and decrease their functional and economic burden.

Objective: to assess fracture risk among elderly living in geriatric homes.

Methods: Study design: a Cross sectional study. 100 elderly (≥ 60 years) subjects including both males and females living in four nursing homes in Cairo were recruited.

Fracture risk calculators to estimate the absolute risk of fractures were done for each participant including; Fracture Risk Assessment Tool (FRAX), which estimates the 10-year probability of hip fracture and major osteoporotic fracture (hip, clinical spine, proximal humerus, or forearm), Q fracture, which calculates the risk of developing any osteoporotic (i.e. hip, wrist, shoulder or spine) fracture or hip fracture alone by answering some simple questions and Garvan tool, developed by the Garvan Institute of Medical Research (one of Australia’s largest medical research institutions).

Results: According to presence of positive history of fractures our study concluded that the prevalence of fractures in the included nursing homes was 21%. The most prevalent risk factor of fractures in the current study is recurrent falls (49%) and the least prevalent risk factor is CKD (2 %). Other prevalent risk factors were Functional impairment in IADL (35%), prolonged Timed Up & Go Test (34%), functional impairment in ADL (32%), and depression by GDS (26%). There was a statistically significant difference between subjects with history of fractures and subjects without as regards history of recurrent falls in the last year, prolonged Timed Up & Go Test and functional impairment in ADL and IADL (P<0.05). However there was no statistically significant difference between both groups as regards diabetes mellitus, dementia, epilepsy, history of parent osteoporotic fracture, visual and hearing impairment, liver cirrhosis, cancer, COPD and Depression. Those who sustained fractures (Group I) had the higher mean of estimated 10 year fracture risk according to the three risk assessment tools (FRAX, Q fracture and Garvan) than those who didn’t sustain fractures (Group II) with high statistically significant difference between the two groups (P<0.001). According to the current study the cutoff of significant 10 year major osteoporotic fracture risk according to FRAX, Q fracture and Garvan is 7.1%; 17.5%and 19% respectively. And the cutoff of significant 10 year hip fracture risk according to FRAX, Q fracture and Garvan is 3%; 5.7% and 2 % respectively. Garvan tool has the highest sensitivity to calculate the estimated 10 year risk of hip and major osteoporotic fracture according to the current study with accuracy 85.2% and 93.9% respectively. FRAX tool has the highest specificity to calculate the estimated 10 year …

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